GLOBAL PUBLIC HEALTH AND PANDEMICS

Terms To Know… Endemic

Present in a community at all times but in relatively low frequency; typically restricted to a locality or region

EpidemicA sudden, severe outbreak within a region or group;

as with AIDS in Africa and in intravenous drug users

PandemicOccurs when an epidemic becomes widespread

and affects a whole region, a continent or the entire world

Global Health

One billion people are without healthcare systems world-wide

In a recent year, 10 million people died from infectious diseases and 10 million children under the age of 5 suffer from disease and malnutrition

Approximately 40 million people are living with HIV

Each year HIV, tuberculosis and malaria claim 6 million lives

According to WHO, 175 million-360 million people could contract avian influenza if a pandemic occurred

Global Health

2003 H5N1 outbreak cost Southeast Asia more than $10 billion and depressed its GDP by 1.5%

Vietnam and Thailand each lost 15-20% of poultry stocks

2003-SARS outbreak caused 2% decrease in South Asia’s GDP in a single quarterA pandemic that lasted a year would produce

economic losses of $800 billion

World Health Organization

Authority within the United Nations that directs and coordinates global health founded April 7, 1948

Monitors and assesses trends in health

Agenda:Promote developmentFoster health securityStrengthen health securityHarness research, information and evidenceEnhance partnershipsImprove performance

Center for Disease Control

Part of the US Department of Health and Human Services founded in 1946

Ensure health protection through promotion, prevention and preparedness

Goals:Reduce health risks at all stages of life through the most

efficient and effective meansEnsure healthy environments where we live, work and

playSafeguard lives and respond to health threatsImproving global health through technology, international

coalitions and basic behavior changes

GAVI Global Alliance for Vaccines and Immunization

(GAVI):Save children’s lives and protect people’s health by

providing access to immunizations in poor countriesIncludes IFFIm to issue bonds in order to provide cash

resourcesThe Bill & Melinda Gates Foundation to accelerate the

use of existing vaccines and promote research to develop new vaccines

WHOThe Word Bank to provide development assistanceUNICEF to promote children’s survival and the use of

vaccines

Vaccines and Other Preventative Measures

Vaccines are a method of providing active artificially acquired immunity that prove to be effective in preventing illnessProblem: difficult to transport to warmer climates, must be

refrigerated

Spray-dryingMethod used to pasteurize milkChemicals used to protect from drying due to excessive

heat are lethal to bacteriaPowder is fast, cheap and easy to makeCan be stored at room temperature10x more potent than a vaccineCan transport to warm, tropical climates allowing for easier

distribution

Looking Back… “The Great Pandemic” of 1918-1919

Influenza outbreak (H1N1) stretched

from Kansas to Europe

Doctors confused with common cold and bacterial infection

More virulent form developed, became harder to diagnose

Treatments: home remedies, bans on public gatherings and spitting, gauze masks

Ineffective

Resulted in approximately 30-50 million deaths

WHO estimates that if an Avian Influenza pandemic were as lethal as this, the death tolls would be well over 7.4 million

Looking Back… Asian Flu of 1957

H2N2 outbreak that affected 40-50%

of people of which 25-30%

experienced clinical diseaseDeath rate was estimated 1 in every 4,000 peopleAt least 1 million are estimated to have died

Hong Kong Flu of 1968H3N2 outbreak comparable in size to the Asian fluDeath toll ranges from 1-3 millionWHO estimates that a pandemic comparable to this

could result in 7.4 million deaths

Avian Influenza

“Bird flu” Subtype of Influenza A

virusH5N1 Spreads in birds through

contact with contaminated saliva, nasal secretions, feces, dirt or food/water supply

More than 150 million birds have died from H5N1

Symptoms in birds: “Low Pathogenic

Form”ruffled feathers, drop in egg production

“Highly Pathogenic Form”affect internal organs, death rate of 90-100% within 48 hours

Avian Influenza

Does not spread easily among humans

Humans contract after contact with infected birds

1997-virus first isolated from human host in Hong Kong

As of April 17, 2009 there have been 418 total confirmed cases and 257 deaths (~60% death rate)

Symptoms in humans:range from typical flu symptoms to pneumonia, eye infections,

acute respiratory distress and other life threatening complications

Map courtesy of Pandemicflu.gov

Treatment for Avian Influenza?

No definite cure or prevention

Resistant to two common antiviral medications used to treat influenza: amantidine and rimantidine

Use oseltamivir and zanamivir against H5N1 strainMore research necessary, may be effective in children

but not adultsApril 8th, 2009-oseltamivir being used to treat 2 year old

boy in EgyptApril 17th, 2009-oseltamivir being used to treat infected

woman in Egypt

Availability of Treatment

Less than 10 countries have domestic vaccine companies working on a pandemic vaccine

Would require rich, developed countries to provide vaccines to poor, developing countries Is this a good idea?

Prevention of Avian Influenza

Vaccine Production/antiviral stockpiling

Change in the traditional raising and marketing of poultry in the developing worldPlace more distance between birds and people

Compensation programs for farmersPrevent farmers from concealing outbreaks in flocks

“The control is at the level of the animal. The window of opportunity for doing that is still open. The virus has not yet reassorted or mutated”-Samuel Jutzi (FAO official)

Is the International Community Adequately Prepared to Address Global Health Pandemics? YES: WHO

1/5 of the world’s countries have pandemic preparedness plans

Objectives:○ Pre-pandemic Phase

Reduce opportunities for human infectionStrengthen the early warning system

○ Emergence of a Pandemic VirusContain or delay spread at the source

○ Pandemic Declared and Spreading InternationallyReduce morbidity, mortality and social disruptionConduct research to guide response measures

Is the International Community Adequately Prepared to Address Global Health Pandemics?

NO: H.T. GoransonUnderinvestment = shortage in health

workersPresent methods of detection are not

sensitive enoughKey is to harness existing infrastructure

○ More likely to be reported at a city hospital○ Promote regional public health

Questions to Debate Should vaccines be required?

Are programs such as WHO and CDC useful? How could they be better?

Should treatments such as Oseltamivir be used if they do not provide a cure?

Should we focus more on developing a vaccine or cure, or on improving environments where people have close contact with birds?

Do we have the resources to control the spread of avian influenza?

Sources The Great Pandemic : : The United States in 1918-1919 : . 19 Apr. 2009

<http://1918.pandemicflu.gov/the_pandemic/03.htm>.

"CDC - About CDC Fact Sheet." Centers for Disease Control and Prevention. 19 Apr. 2009 <http://www.cdc.gov/about/resources/facts.htm>.

"Endemic definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms." 19 Apr. 2009 <http://www.medterms.com/script/main/art.asp?articlekey=3234>.

GAVI - The Global Alliance for Vaccines and Immunization. 19 Apr. 2009 <http://www.gavialliance.org/>.

Global Issues 08/09. 24th ed. New York: McGraw-Hill, 2009.

Taking Sides: Clashign Views on Global Issues. 5th ed. New York: McGraw-Hill, 2009.

"WHO | Avian influenza (" bird flu")." 19 Apr. 2009 <http://www.who.int/mediacentre/factsheets/avian_influenza/en/>.