The Next Pandemic: A Nation at Work (Part 2 of 3)

Editor’s Note: This article is the second of a three-part series on the components involved in the creation and prevention of infectious disease outbreaks. Check out the first part “It Only Takes One” if you haven’t yet. The third (and final!) article will be coming in a month–stay tuned!

A NATION is the center of organization for the individuals in it–the individual people, vectors, diseases… sound familiar? In our last discussion on the web of components that create an epidemic or pandemic, we learned how an individual disease (like Ebola) can be carried by a vector (such as a mosquito) to a human, who can then transmit the disease to even more people until there is a disease outbreak. We might expect frequent epidemics from such a seemingly simple process–until we look at the bigger picture surrounding it. National governments can influence the spread of infectious disease outbreaks, such as the 2014 Ebola epidemic, through their infrastructure design, public health investments, and response time to epidemics.

Infrastructure design involves the basic processes that keep a nation running, such as water supply and sanitation, and can have a big impact on a nation’s outbreak risk. Erin Mordecai, a disease ecology professor at Stanford University, argues that “urban areas that don’t have good infrastructure, like piped water and sanitation… create a huge amount of risk for disease transmission” because these conditions create optimal habitats for disease vectors.[1] Infectious disease then becomes a “poor problem” in a way because it takes money to build reliable and robust infrastructure. This is why there are more epidemics and disease control problems in impoverished countries, best exemplified by the Ebola epidemic in West Africa.[2]

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Global Poverty Levels” by Durcan is licensed under CC BY-SA 3.0

 

Kathleen Alexander, a professor at UC Davis, underscores that “poverty and poor health infrastructure, among other social conditions in the outbreak region, likely contributed to the unprecedented expanse, duration, and size of the Ebola epidemic in West Africa.”[3] She and Dr. David Relman, a past member of multiple U.S. infectious disease advisory boards, strongly believe that better infrastructure goes hand in hand with strong national public health systems.

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Dr. David Relman [4]

Public health systems, such as the Centers for Disease Control (CDC) in the United States, are responsible for preventing, detecting, and responding to health threats through scientific investigations and medical care provision. Good public health systems that can adequately fulfill these responsibilities also require consistent investment. Dr. Relman explains that “what tends to happen is good investments in public health are made [and] it looks like everything is great and people say we don’t have a problem and back off until they have a problem again.”[4] This occurs because it’s hard to measure prevention and predict what would have happened if those investments hadn’t been made.

Usually, nations address the threat of infectious disease and potential pandemics when faced with an actual outbreak instead of maintaining consistent funding.[5] This lack of continuous investment is a dangerous cycle, however, and results in a large loss of human life and monetary capital. The Ebola epidemic, for example, came at a huge cost to the already impoverished West Africa region. Response and recovery efforts amounted to $318 million in Sierra Leone and $385 million in Liberia, with neighboring countries facing similar expenses. Even the few cases that reached the U.S. were a similarly large expense.[4] These costs make it even harder for impoverished countries to invest in good public health and infrastructure that would prevent these outbreaks. However, if nations were able to continuously invest in public health, they could implement effective surveillance for disease threats before an outbreak occurs.

Surveillance is a key component of anticipating epidemics and comes in a variety of forms. One such surveillance method involves locating disease “hot spots”, areas where diseases emerge the most frequently, such as Central Africa and Southeast Asia where Ebola is believed to have originated.[3] The focus of surveillance is to answer the questions of where and when diseases emerge and transmit.[1] Currently, researchers are looking for these answers in the field.

“There are a number of scientists and public health people interested in surveying nature more proactively,” notes Relman. They “go out and find the places in nature where we already know infectious disease agents have arisen” in order to take samples and examine what kinds of microbial species and pathogens happen to be there.[4]

The goal of surveillance is to be proactive and detect an infectious disease in its natural habitat before it can infect a large number of people. There is a pattern to vector and pathogen spread when diseases emerge, and scientists and public health experts use this to get ahead of the next pandemic.[6] However, surveillance is futile if the findings aren’t reported early on. Early reporting can minimize the negative consequences of an epidemic and is even more crucial in the case of a pandemic. This was the most common complaint by the global health and medical community regarding the management of the Ebola epidemic. Researchers generally agree that knowledge production and exchange by public health systems lagged. This allowed the deadly pathogen to spread further than it would have if information on the epidemic had been gathered and shared in a more timely manner.[7]

The national government’s responsibility to provide adequate infrastructure, invest in public health, and  respond quickly to epidemics is no easy task. These responsibilities are not limited to national governments, but rather require global support. Pandemics affect communities all over the world and therefore call for a global effort. To find out how the world comes together to fight infectious disease, be sure to watch out for the next, and final, installment in this series, “The Next Pandemic.” Don’t miss it!

References:

  1. Mordecai, E., Assistant Professor (2017, November 3). Disease Ecology [Personal interview].
  2. Garchitorena, A., et al. “Disease Ecology, Health and the Environment: A Framework to Account for Ecological and Socio-Economic Drivers in the Control of Neglected Tropical Diseases.” Philosophical Transactions of the Royal Society B: Biological Sciences, vol. 372, no. 1722, 2017.
  3. Alexander, Kathleen et al. “What Factors Might Have Led to the Emergence of Ebola in West Africa?” PLoS Neglected Tropical Disease, vol. 9. 2015.
  4. Relman, David. Researcher at Stanford University. (2017, November 8). [Personal interview].
  5. Commission, GHRF. “The Neglected Dimension of Global Security: A Framework to Counter  Infectious Disease Crises.” 2016. http://nam.edu/GHRFreport.
  6. Morse, Stephen S. “Emerging Infections: Condemned to Repeat?” A Tribute to the Life and Scientific Legacies of Joshua Lederberg, 2009.
  7. Moon, Suerie, et al. “Will Ebola Change the Game? Ten Essential Reforms before the next Pandemic. the Report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola.” The Lancet, vol. 386, no. 10009, Elsevier Ltd, 2015, pp. 2204–21.
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