Public Health Engagement Aff Notes

Their defense is descriptive, not prescriptive—today’s diseases are much faster, more lethal, and easier to spread due to dense populations, lack of attention, and mutation abilities

I am a microbiologist with over 25 years of experience in various areas of microbiology and human health research. I am currently the coordinator for two research centres at the University of Ottawa, the Emerging Pathogens Research Centre (EPRC) and the Centre for Research on Environmental Microbiology (CREM). I’m also known as the “Germ Guy” and a promoter of global health and hygiene. At Ottawa, our work focuses on the nature of pathogens both in the environment and in the host, their evolution, their spread and how best to prevent and control them. With respect to pandemics, we have published peer-reviewed articles on the evolution of SARS (the pandemic that never was) and the infamous H5N1, more specifically, why it may never end up causing a pandemic. I’ve also co-authored a chapter on the environmental survival of SARS and how to effectively control its spread. How likely are we to see a major pandemic in the near future? By its definition, a pandemic is major however in the context here, I believe that the world is becoming increasingly more likely to see a major event. It’s a process that is highly predictable. It starts with migration of agriculture and urban environments into more rural and remote areas, increasing the likelihood that a potential pandemic strain of a pathogen will come into contact with humans increases. Then, thanks to the rise in densification of both animal and human populations, these pathogens can spread in a localized environment and evolve to cause greater problems. Finally, with travel from the localized area, the pathogen can then move worldwide. This fact is particularly important when one thinks that almost 100 years ago, when we had the 1918 pandemic, it could take months to circumnavigate the globe. Today, it can be accomplished in a day. Moreover, with more individuals traveling than ever before (some 1.4 billion air travelers per year), the opportunity for a pandemic strain to spread is greater than it has ever been.

What are the biggest threats that you see on the horizon? The majority of pandemics have been due to the evolution of an animal pathogen to a human pathogen. So, the real threat that faces humanity is the continued sharing of spaces between animals who carry these viruses, such as chickens and pigs, and humans. In the case of several near-pandemic pathogens, like H5N1 influenza and the H1N1 pandemic, cases were almost always associated with close contact with a carrier animal. Then, through a process of evolution, the pathogen can ‘adapt’ to the human host and then be able to spread without the need of an animal. The H5N1 has yet to accomplish this adaptation whereas the H1N1 successfully made the transition and led to the pandemic. If a major pandemic does hit what will it look like? I guess if one looks back over the last decade, there are two possible streams for a pandemic. The first, represented by H1N1, may lead to a high number of infections with a slightly higher or equal rate of mortalities. Normally, influenza has a mortality rate of about 0.1% . The mortality from the H1N1 pandemic virus was similar, if not lower. By the time the pandemic was over, there was some impact on the global scale but for the most part, the world was able to move forward. The second, represented by SARS, would be much worse. With a mortality upwards of 15-20%, the virus would not only spread like wildfire, but also kills in high numbers. In affected regions, which included Toronto here in Canada, hospital intensive care units would be filled to capacity and many of them would be essentially locked down. Away from the health impact, travel to these cities would plummet and economies would suffer for years afterwards. As a result of a rapid global effort, SARS was effectively stopped before it could go global, however, the impact could be extrapolated to give an idea of what might happen in the event of a pandemic following this path.

Can you give us some realistic contagion timelines? To be honest, no. While it’s easy for Hollywood to come up with potential timelines for a pandemic, the reality is that several factors have to be taken into consideration before making a guess as to the speed that a pandemic might travel. These factors include: The ability of the strain to infect, How lethal the strain is to humans, The ability of the strain to spread, How easy it is to kill the strain, The likelihood that people will listen to warnings and advisories in order to prevent a pandemic from taking hold. For example, almost everyone believes that Ebola virus would make a great pandemic. It infects rapidly and it quite lethal. However, it’s fairly easy to kill and it’s not easy to pick up the virus unless you are relatively close to an infected individual. Also, because it’s so lethal, when infection is found, people tend to ‘run for the hills’ and would easily take to any recommendations to prevent spread. So, in that sense, it’s not a particularly good candidate for a pandemic and it’s timeline would be rather short. As we saw with the H1N1 pandemic, the virus infected with relative ease although it wasn’t quite lethal. It spread between humans effectively although it was simple to kill. The real reason the pandemic took hold was that people simply didn’t listen to the warnings and advisories and acted as if nothing was wrong. It wasn’t until a few key deaths occurred in October of 2009 that suddenly the world took notice. By that point, the virus had spread worldwide and simply had to peter out, which took at least another 10 months. So, I guess the simplest way to estimate a timeline is a comparison between the lethality of the virus and the ability of humans to react to the news of the virus. I’m sure that there’s a ‘happy medium’ that could lead to the worst case scenario, significant lethality and a lack of attention leading to a sustained timeline, but I haven’t seen anything that could qualify…yet.

AT: No Incentive

The benefits of controlling infectious disease outbreak are both internal and external to a country

Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of Conflict", published June 2011, CL)

Why Cooperation: Securing Common Interests in a Transnational Public Good

Absent the prospect for meaningful new gains, states and their private and public collaborators have limited motivation to overcome the challenges to cooperation. States participate in transnational initiatives to obtain interests they could not otherwise secure, and it is the overlapping of interests among states and nonstate actors that can be seen as the central or necessary condition for transnational cooperative efforts.' A transnational initiative must have the potential to create a collaborative advantage, that is, some significant welfare enhancing benefit that could not be achieved without the collaboration. Furthermore, the value created must flow to all core members. Preventing and controlling infectious disease outbreak and the health benefits related to doing so are a shared interest in a public good best se cured regionally or transnationally. In general, securing public goods is difficult and capturing the benefits of transnational public goods even more problematic. Public goods are those that yield benefits that are non-rival in consumption (can be enjoyed simultaneously by all in a specific community) and non-excludable (from which no one in the community can be kept from consuming).3 At a local level, for example, a public good could be the enjoyment of a city park, or at a national level, the sense of security from foreign invasion provided to all citizens by the existence of a national army or militia. The paradox of public goods, of course, is that they tend to be underprovided. Because they are non-excludable, a price cannot be enforced and thus no private incentive exists to produce them.4 The paradox can be overcome at the local and national level to the extent that the government can enforce production, such as by taxing citizens for the provision of a city park or by conscripting soldiers for an army: For global and regional transnational public goods, however, the problem is more difficult because (as realists rightly underscore) no global or regional government finances and enforces public goods production. Absent a formal government with such powers, the multilateral actors involved in providing a regional or global public good must rely on recognizing their enlightened self-interest. Enlightened self-interest is composed of self-interest, shared interest, and altruism (other-interest) that together enhance one's well-being.' As all theoretical perspectives can agree, recognizing and acting collectively on one's enlightened self-interest is rare in international relations; it does not happen just because one believes it should happen from an ethical or logical standpoint. Cooperation is particularly vexatious when it touches on the security of the state and the states in question, as here, have little or no history of cooperation. Why are MBDS, MECIDS, and, for a time, EAIDSNet, exceptional in their ability to overcome the barriers to the production of a sensitive trans-national public good, especially when the organizations' membership in-dudes countries without a strong history of cooperation? I suggest three reasons. First, it is in the clear self-interest of each member to control trans-boundary communicable diseases. As noted in chapter 1, it is increasingly the responsibility of states to provide for the health of their populations. Second, infectious disease control is a public good that is, preventing or treating an infectious disease not only benefits the patient, but also benefits others by reducing their risk of infection. Likewise, the control of a communicable disease in a given country reduces the likelihood of an outbreak in an adjacent country if the two countries share common food, air, and water or other vectors of interdependence. If each country receives substantial consumption externalities from another's control of infectious disease, then both are more likely to appreciate and act on their shared interest in disease control. Furthermore, because of their physical interdependence, the mutual benefit arising from infectious disease control is readily apparent and the consequences of failing to cooperate are equally clear to all. In this sense, vulnerability to infectious disease outbreak and spread is a classic and compelling superordinate problem because infectious disease affects each member, is shared by all, and cannot be resolved without joint action. As one author suggests, "the vicious threat posed by diseases and pathogenic microbes . . . is predicated on . . . the mutuality of vulnerability."' Because of their proximity, network participants are keenly and directly aware of their mutual vulnerability and that national efforts alone will not protect their populations. Third, their shared vulnerability both underscores the benefits of securing mutual interests and infuses an element of altruism into state calculations. Public health officials, by virtue of their training and current responsibilities, are particularly sensitive to the indivisible nature of their shared vulnerability. MBDS actors, for example, expressed empathetic understanding of the problem their cohorts in other member states faced and showed no interest in blaming each other for past outbreaks. They stressed that the dangers in this area of public health are serious, and, as scientists, recognized that infectious disease could arise in any part of the region at any time.’ Taken together, states can more readily appreciate and act on their en-lightened self-interest in providing a regional public good when interdependence (both positive and negative) is acute and where positive externalities exist. Recent pandemic scares such as SARS and avian flu added a sense of urgency to national efforts. With regard to infectious disease control, the six countries of the MBDS system, the three political entities of MECIDS, and the three founding countries of the EAIDSNet each faced a problem with a clear and compelling win-win-win-win solution, not just win-win: by cooperating on infectious disease control, I benefit, you benefit, I benefit by you benefiting, and vice versa. As one MECIDS principal explained, in infectious disease protection, "You are only as strong as your neighbor."' Also, each actor can take credit for any successful results from cooperation because this benefit is also nonrival and nonexclusive. This latter feature helps to ensure political support from participating countries' health ministers.

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