Background

The COVID-19 pandemic has highlighted the world-changing impact of infectious diseases to all 7.8 billion people. Our distant ancestors were aware of the enormous impact of epidemic fevers on their lives and the havoc that they wrought, as we continue to do today. However, before urbanisation, endemic infectious diseases would probably have had greater impact on people’s daily lives. Endemic infectious diseases, with the exception of those such as TB, HIV, malaria and dengue that have grabbed public, research and policy attention, have tended to be relatively neglected. Epidemics of Chikungunya, Ebola and Zika have hit the media spotlight in the last decade, but were often perceived as regional tropical issues. Endemic diseases may become epidemic and epidemic diseases endemic. We need to know what infectious diseases are where in order to inform prevention and public engagement programmes and treatment guidelines, both for specific pathogens and for syndromic empirical treatment, and to prioritise interventions and funding. Without such public health intelligence, we will wait for the next disaster blindfolded. The large scale implementation of affordable and accurate malaria rapid diagnostic tests (RDTs), usable by health workers with minimal training in rural malarious areas has demonstrated that malaria, although remaining a focally important cause of fever in many areas, has been overestimated as a cause. There have been decreases in malaria incidence in most endemic regions. Hence, there is a great need to understand the epidemiology of fevers other than malaria to inform many policy and implementation decisions.