Global Public Health And Pandemics
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  • 1. Terms To Know… Endemic   Present in a community at all times but in relatively low frequency; typically restricted to a locality or region Epidemic   A sudden, severe outbreak within a region or group; as with AIDS in Africa and in intravenous drug users Pandemic   Occurs when an epidemic becomes widespread and affects a whole region, a continent or the entire world
  • 2. 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
  • 3. 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 quarter  A pandemic that lasted a year would produce economic losses of $800 billion
  • 4. 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 development  Foster health security  Strengthen health security  Harness research, information and evidence  Enhance partnerships  Improve performance
  • 5. 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 means  Ensure healthy environments where we live, work and play  Safeguard lives and respond to health threats  Improving global health through technology, international coalitions and basic behavior changes
  • 6. GAVI Global Alliance for Vaccines and Immunization  (GAVI):  Save children’s lives and protect people’s health by providing access to immunizations in poor countries  Includes IFFIm to issue bonds in order to provide cash resources  The Bill & Melinda Gates Foundation to accelerate the use of existing vaccines and promote research to develop new vaccines  WHO  The Word Bank to provide development assistance UNICEF to promote children’s survival and the use  of vaccines
  • 7. Vaccines and Other Preventative Measures Vaccines are a method of providing active  artificially acquired immunity that prove to be effective in preventing illness  Problem: difficult to transport to warmer climates, must be refrigerated Spray-drying   Method used to pasteurize milk  Chemicals used to protect from drying due to excessive heat are lethal to bacteria  Powder is fast, cheap and easy to make  Can be stored at room temperature  10x more potent than a vaccine  Can transport to warm, tropical climates allowing for easier distribution
  • 8. 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
  • 9. Looking Back… Asian Flu of 1957   H2N2 outbreak that affected 40-50% of people of which 25-30% experienced clinical disease  Death rate was estimated 1 in every 4,000 people  At least 1 million are estimated to have died Hong Kong Flu of 1968   H3N2 outbreak comparable in size to the Asian flu  Death toll ranges from 1-3 million  WHO estimates that a pandemic comparable to this could result in 7.4 million deaths
  • 10. Avian Influenza “Bird flu”   Subtype of Influenza A virusH5N1  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
  • 11. 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
  • 12. Map courtesy of Pandemicflu.gov
  • 13. 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  strain  More research necessary, may be effective in children but not adults  April 8th, 2009-oseltamivir being used to treat 2 year old boy in Egypt  April 17th, 2009-oseltamivir being used to treat infected woman in Egypt
  • 14. 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?
  • 15. Prevention of Avian Influenza Vaccine Production/antiviral stockpiling  Change in the traditional raising and marketing  of poultry in the developing world  Place more distance between birds and people Compensation programs for farmers   Prevent 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)
  • 16. 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 infection  Strengthen the early warning system ○ Emergence of a Pandemic Virus  Contain or delay spread at the source ○ Pandemic Declared and Spreading Internationally  Reduce morbidity, mortality and social disruption  Conduct research to guide response measures
  • 17. Is the International Community Adequately Prepared to Address Global Health Pandemics? NO: H.T. Goranson   Underinvestment = shortage in health workers  Present methods of detection are not sensitive enough  Key is to harness existing infrastructure ○ More likely to be reported at a city hospital ○ Promote regional public health
  • 18. 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?
  • 19. Sources The Great Pandemic : : The United States in 1918-1919 : . 19 Apr. 2009  <http://1918.pandemicflu.gov/the_pandemic/03.htm>. quot;CDC - About CDC Fact Sheet.quot; Centers for Disease Control and Prevention. 19 Apr.  2009 <http://www.cdc.gov/about/resources/facts.htm>. quot;Endemic definition - Medical Dictionary definitions of popular medical terms easily  defined on MedTerms.quot; 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.  quot;WHO | Avian influenza (quot; bird fluquot;).quot; 19 Apr. 2009  <http://www.who.int/mediacentre/factsheets/avian_influenza/en/>.