One of the issues discussed during this year's Aid & Trade Event (Geneva, 29-30 January 2008) was the link between globalization, humanitarian crises and diseases. Tara S. Kerpelman of ICVolunteers.org filed the following conference-report.
"Globalization and increased travel between countries has changed the whole nature of 'world health'," states Katie Adie from the BBC (www.bbc.co.uk). What were once obscure diseases are now carried and spread to countries closer to us because international travel has become simple and commonplace. To ensure our health security, it is crucial to promote partnerships between private and public sectors, to increase the research and development of neglected diseases, and to attack the spread of viruses at their source. It is more important now than ever to address the containment of pandemics, because soon they might affect us all.
Climate change and globalization, both of which are prominent issues, encourage the movement of pathogens. Diseases which were endemic can now easily become pandemic. For example, due to the changing ecosystems, vector-borne diseases such as the Bluetongue Virus and West Nile Fever have spread enormously. Also, the propagation of Foot and Mouth Disease has been linked to the intensification of commercial movement. According to Dr. David Heymann, Assistant Director-General for Health Security and Environment, and Representative of the Director-General for Polio Eradication at the World Health Organization (WHO) (www.who.int), most of the emerging infectious diseases are not new: they began by affecting animals, but as time has passed, the diseases breached the species barrier.
The animal disease which is most widespread now in humans is Influenza, better known as the flu. The first great flu pandemic was in 1918 in Spain when 40 million people died from the H1N1 strain of the virus. In 1957 the h3N2 strain hit and later the h4N2 was seen destroying lives as well. What is commonly known as bird flu is in fact a highly pathogenic strain of avian influenza called the H5N1 virus type. In the past 4 years, there have been 351 recorded cases of H5N1, of which 219 were fatal. This high proportion is suggestive that we are in the precursor stage of a pandemic.
The varying strains of this virus are thought to originate from the original avian flu virus. According to the Adaptive Mutation Hypothesis, avian flu entered a non-human mammal, mutated to adapt itself so that it could spread from mammal to mammal and then managed to propagate itself to humans as well. The genetic material of the virus would have re-assorted and combined into a single cell, creating a new pandemic virus. The WHO has 115 influenza centers around the world. They are important in the research and prevention of the flu because they study the virus' mutations, which is necessary for the development of new vaccines as every strain requires a different one.
But vaccines are not enough. The flu pandemic must be prevented from its source. We must contain the virus in the avian species to stop its periodic infection of humans. If a pandemic broke out, there would be insufficient stock of the available antiviral drugs and there would be limited access to the medications and vaccines in developing countries. Phil Harris, Information Officer at the Emergency Centre for Transboundary Animal Diseases (ECTAD) of the Food and Agriculture Organization of the United Nations (FAO) (www.fao.org) says that if a disease is not contained "it will become impossible to contain its pandemic". 'Biosecurity' (the protection of people and animals from pathogens through the exclusion or containment of disease) is what Harris believes is the key.
During the life cycle of poultry farming, there is a high potential for disease contamination. There are three major risk sectors: village/backyard, commercial farms/production plants and live bird markets. To improve biosecurity in the first sector, we need to raise awareness and open up lines of communication concerning the problem of disease-spreading. In the second sector, better efforts need to be made to improve the segregation of different animal species. The third sector carries the highest risk of disease-spread because many markets are small, crowded and rarely hygienic. They are a "major vector of disease transmission". Care should be taken to disinfect the markets and the equipment there. Unfortunately many farmers keep their livestock in crates made of wood, because it is cheap, and these are impossible to disinfect since that material is very absorbent.
Phil Harris proposes that farmers "keep it clean" and do not transport the disease. To facilitate this, the authorities need to communicate with the farmers and provide them with incentives to report and contain disease when found. Half the problem is socio-economic: people do not report disease because they lose income when an outbreak causes them to shut down their farms. Therefore, the "key to sustainable control is to implement the highest levels of biosecurity which in turn is a step towards protecting the livelihoods of people".
The challenges we face alert us to the fact that we must continue to find partnerships for the prevention and control of epidemics and pandemics. The treatment of diseases and the development of preventative measures should be researched and developed, but in order to do so, Sadia Kaenzig, Senior Communication Officer at Drugs for Neglected Diseases Initiative (DNDi) (www.dndi.org), says that we need "more political commitment, more work from governments, from the public sector and the pharmaceutical industry. Through collaboration, we will be able to research, develop and provide medications to prevent, treat and manage neglected diseases" before they spread and cause a pandemic.
But these groups have "more incentive to put efforts into global diseases instead of neglected ones and most are given none or little attention". Perhaps this is because of the unprecedented rate in lifespan increase in developed countries where medicines are available and accessible, and where little-known diseases are rare.
"Disease doesn't know national boundaries," reminds Harris, "we're looking for international cooperation among the governments of the countries involved. In some cases we have to convince the authorities of the countries involved that cooperation is essential". Without international collaboration to prevent and treat these neglected diseases, some of them with severe effects like Chagas, Visceral Leishmaniasis, malaria and Human African Trypanosomiasis (HAT) could be spread to other parts of the world. There are drugs available for the treatment of HAT but they are highly toxic, often causing death, and they are not affordable in rural areas. The drugs for Visceral Leishmaniasis are not affordable either and, furthermore, their administration is complicated and not adapted to the field. Sadly, there is currently no treatment for chronic Chagas.
Because of globalization, the spread of such diseases is an imminent possibility. Therefore, it is crucial to bring together experts from different sectors to foster research and development for the prevention and treatment of the diseases. DNDi's primary mission is to deliver six to eight new treatments for NTD by 2014. Their secondary objectives are to use and strengthen existing capacities in disease-endemic countries to raise awareness of the diseases, and to advocate for increased public responsibility. But they cannot do it alone. Because of globalization, the international community must make it their responsibility to collaborate with other governments and organizations effectively to prevent, treat and maybe even eradicate diseases in order to contain pandemics.
Speakers: Dr David L. Heymann, Assistant Director General for Health Security and Environment and Representative of the Director General for Polio Eradication at the World Health Organization, Phil Harris, Information Officer at the Emergency Centre for Transboundary Animal Diseases and Public Information Officer for the Crisis Management Centre, Sadia Kaenzig Senior Communication Officer at Drugs for Neglected Diseases Initiative
Moderator: Katie Adie
Reporter: Tara S. Kerpelman, ICVolunteers.org