Public Health Engagement Aff Notes

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Plan Solves

Disease research and control is important to prevent pandemics

McCarthy '15 (Matt McCarthy, assistant professor of medicine at Cornell and a staff physician at Weill Cornell Medical Center, "The Next Ebolas: Three factors predict whether a new virus will cause a human pandemic.", Slate, January 9,, CL)

Peter Daszak has spent the past three decades attempting to predict global pandemics. He leads a group of international investigators who try to anticipate when and where outbreaks will happen and how far they will travel. “Pandemic prediction is a bit like earthquake prediction,” Daszak recently told me from his office in Manhattan. “There are lots of tremors, and occasionally you get a big one. Ebola was the big one.” The Ebola outbreak caught us all off guard. As an infectious-disease physician who practices in Manhattan, I readily answered basic questions about the virus, but I got uncomfortable as soon as things got nuanced. Could it go airborne? I didn’t think so, but I wasn’t sure. And that’s because I wasn’t prepared for it. None of us was. Any new health threat comes with uncertainties, which can be twisted into the suggestion that experts don’t really know what they’re doing. In the worst cases, this leads to panic or suspicion of medical advice. Part of preventing that scenario has to do with better communication and public relations. But a much larger part involves knowledge. Infectious-disease discovery must become a public health priority. We need to know what diseases are out there and which ones are coming for us; we need to be prepared. Scientists estimate that between 1940 and 2004, 335 new infectious diseases appeared in humans. This number includes pathogens that likely entered our species for the first time, such as HIV, and newly evolved strains of familiar organisms, such as multidrug-resistant tuberculosis. The majority of these diseases—about 60 percentwere caused by zoonotic pathogens, meaning they were transmitted to humans from animals. And of those, about 70 percent were from animals that typically live in the wild. (Two of the last global pandemics—SARS and Ebola—were caused by viruses that appear to live in bats.) Interestingly, the percentage of human diseases coming from wild animals seems to be rising—and quickly. But why? And more importantly, what can we do about it?

Daszak is trying to give us answers. As president of the EcoHealth Alliance, he leads a team that has analyzed hundreds of new infectious agents, trying to determine the factors that allow a disease to make the leap from animal to human. His group does this by traveling to biodiversity hot spots—Bangladesh, Malaysia, Brazil—to sample wildlife known to harbor unstudied viruses. When team members discover one, they enlist mathematicians to run computer models to predict the likelihood of human transmission. This type of investigation, referred to as mathematical epidemiology, has long been the basis for our understanding of how most pathogens emerge, evolve, and spread. But the nature of outbreak prediction is becoming more sophisticated, as Daszak and others have increasingly incorporated insights from behavioral economics to improve the quality of outbreak prediction and prevention. Economic behavior plays a vital role in disease transmission. Trade affects the number of humans exposed to a pathogen, which means it’s possible to model a potential outbreak as a function of commerce. This approach, referred to as economic epidemiology, has recently opened up a new set of prediction tools and prevention strategies. “We’ll tell a local government that there’s a market selling bats and we found a lethal virus in those bats,” Daszak told me. “You can shut down that market. There’s a rat breeder I know in Guilin, China, who sells them for food. We test his rats to make sure they’re safe to eat.” Daszak’s team has identified three factors that help a virus take hold in people: human population density, wildlife diversity, and changes in land use. “The worst thing you can have,” he told me, “is a place where you have rapidly growing human population—West Africa, China, or India—in a place with a lot of wildlife diversity, like near a rain forest. It creates a pathway for a virus to go directly from animal to humans.” There are believed to be about 320,000 viruses in the world that infect mammals (some estimates push that number even higher), and it’s been projected that it could cost about $6 billion to discover and characterize them. “In the next 20 years, we’ll find all of them,” Daszak said. “Then we’ll figure out which ones are the most likely to emerge as a global pandemic.” Given viruses’ high mutation rates and abilities to colonize new hosts, the next pandemic will likely be caused by a virus. Recently, two candidates have emerged: Nipah virus and Rift Valley fever. Nipah was identified in 1999 after a cluster of Malaysian pig farmers developed encephalitis. (The virus is named after a village where an infected patient lived.) Farmers were developing a sudden onset of fever, headache, vomiting, and diffuse muscle aches; 60 percent were in a coma within one week of becoming infected and more than 70 percent died. Infection occurred through direct contact with respiratory secretions and urine from infected pigs. More troublingly, there was also evidence that Nipah may have been transmitted from person to person—a Malaysian nurse who cared for infected patients was found to have the hallmark blood and brain abnormalities of the disease, despite the fact that she had no exposure to infected animals. The disease has spread from Malaysia since then. “Every year, we see an outbreak of Nipah virus in Bangladesh,” Daszak said. “[Outbreaks are] small right now, but they’re extremely lethal. More lethal than Ebola, but less transmittable. But viruses evolve … they’re supreme evolutionary machines.”

The other candidate for a pandemic among humans, Rift Valley fever, was identified in 1931 during an epidemic among sheep on a farm in the Rift Valley of Kenya. Transmission to humans occurs via bites from infected mosquitoes or through close contact with infected mammals. Symptoms are similar to those of Ebola, including the acute onset of fever and headache, and hemorrhage from the gastrointestinal tract. The largest human outbreak of Rift Valley fever occurred during the rainy season in Kenya in 1997–1998, when nearly 90,000 people were infected and 478 died. Although not as lethal as Ebola or Nipah, it still worries epidemiologists. “Rift Valley fever is transmitted by mosquitoes,” Daszak said, “which means it can get on a plane—there’s an average of 1.2 mosquitoes on every flight—and that means it could spread quickly.” The Ebola epidemic in West Africa isn’t over, but as it recedes from the headlines, it’s time to consider what’s coming for us next. Pandemic prediction isn’t cheap, but waiting for an outbreak to happen can be even more costly. Economic losses due to SARS were estimated to be anywhere from $15 billion to more than $50 billion; the cost of the Ebola outbreak will almost certainly exceed that figure. By contrast, Daszak estimates that it would cost a total of $6.3 billion to discover all of the viruses that infect mammals—a fraction of the cost required to respond to a global pandemic like Ebola or SARS—and that information will ultimately lead to better disease monitoring, treatment, and preventative measures at the cusp of the next outbreak. It’s a massive endeavor, but a necessary one. Once we know what’s out there, we’ll be able to figure out what’s coming for us.

New collaborative regulations are necessary to effectively prevent the international spread of diseases

Fidler '03 (David P. Fidler, professor of Law and Ira C. Batman Faculty Fellow at Indiana University School of Law, Bloomington, "SARS and International Law", The American Society of International Law, April 5, Volume 8, Issue 7,, CL)

WHO's International Health Regulations: The SARS outbreak implicates the International Health Regulations (IHR). The IHR were promulgated by WHO under Article 21 of its Constitution in 1951 and, according to WHO, constitute the "only international health agreement on communicable diseases that is binding on [WHO] Member States." [6] The purpose of the IHR "is to ensure the maximum security against the international spread of diseases with a minimum interference with world traffic." [7] To achieve maximum security against the international spread of diseases, the IHR establish a global surveillance system for diseases subject to the IHR, [8] require certain types of health-related capabilities at ports and airports, [9] and set out disease specific provisions for the covered diseases. [10] To achieve minimum interference with world trade and travel, the IHR, among other things, set out the most restrictive health measures that a WHO member state may take to protect its territory against the diseases subject to the IHR. [11] WHO officials and public health experts acknowledge that the IHR have historically failed to ensure the maximum security against the international spread of diseases with minimum interference with world traffic. [12] One of the leading reasons for the failure of the IHR is that the Regulations only apply to a small number of diseases. Since the eradication of smallpox at the end of the 1970s, the IHR have applied to only three infectious diseases-cholera, plague, and yellow fever. [13] The IHR do not apply to new infectious diseases that have emerged, such as HIV/AIDS, or are now emerging, such as SARS. WHO member states have no international legal obligation under the IHR to report SARS cases to WHO or to refrain from certain trade and travel restricting measures aimed at stopping the spread of SARS. Thus, the only international agreement on infectious diseases binding on WHO member states has been irrelevant to the SARS outbreak. In the mid-1990s, WHO began the process of revising the IHR to address, among other things, the narrow disease-specific scope of the Regulations. WHO's objective is to make the IHR more relevant for the infectious disease threats faced by its member states in the 21st [14] Although the final structure and substance of the revised IHR have not been determined, [15] the SARS epidemic may encourage WHO member states to accept a more robust international legal framework for global infectious disease control than has existed historically. century.

Public Health Measures to Stop the Spread of SARS and Infringements on Civil and Political Rights: A number of countries affected by the SARS epidemics have resorted to voluntary and compulsory isolation and quarantine measures as part of the effort to stop the spread of SARS. According to the CDC, isolation and quarantine "are common practices in public health and both aim to control exposure to infected or potentially infected individuals. . . . The two strategies differ in that isolation applies to people who are known to have an illness and quarantine applies to those who have been exposed to an illness but who may or may not become infected." [16] Isolation and quarantine infringe, however, on civil and political rights recognized in international law, such as freedom of movement and the right to liberty. International law on human rights has long recognized that governments may infringe on civil and political rights for public health purposes. [17] The use of isolation and quarantine by governments to stop the spread of SARS is not, therefore, illegal per se under international human rights law. Governments must, however, fulfill certain conditions before interference with a civil or political right on public health grounds survives scrutiny under international law. Public health measures that infringe on civil and political rights must (1) be prescribed by law; (2) be applied in a non-discriminatory manner; (3) relate to a compelling public interest in the form of a significant infectious disease risk to the public's health; and (4) be necessary to achieve the protection of the public, meaning that the measure must be (a) based on scientific and public health information and principles; (b) proportional in its impact on individual rights to the infectious disease threat posed; and (c) the least restrictive measure possible to achieve protection against the infectious disease risk. [18] Most national governments have enacted public health statutes that authorize isolation and quarantine as measures to control infectious diseases, even if many of these statutes are quite old and have not been widely used in recent decades. Because public health experts believe SARS is contagious and can be transmitted through the air from person to person, isolation and quarantine measures appear to (i) relate to a significant infectious disease threat; (ii) be based on the best available scientific and public health information; and (iii) be proportional in impact on individual rights to the serious public health threat SARS and its unchecked spread poses. Further, the lack of effective diagnostic technologies, treatment options for infected persons, or vaccine for prevention purposes suggests that isolation and quarantine measures may be the least restrictive measures currently possible to achieve protection against the spread of SARS. Not all isolation and quarantine measures enacted, or that could be enacted, to deal with SARS are necessarily permissible under international human rights law. The main point is that responses to SARS should be reviewed under international human rights law, especially the obligation not to discriminate on any grounds in the application of SARS control measures.

Public health systems have a direct correlation with health outcomes

Woolf and Aron '13 (Steven H. Woolf and Laudon Aron, Editors on the Committee on Population for the National Research Council and U.S. Institute of Medicine, "U.S. Health in International Perspective: Shorter Lives, Poorer Health", National Research Council and Institute of Medicine,, CL)

As other chapters in this report emphasize, population health is shaped by factors other than health care, but it is clear that health systems—both those responsible for public health services and medical care—are instrumental in both the prevention of disease and in optimizing outcomes when illness occurs. The importance of population-based services is marked by the signature accomplishments of public health, such as the control of vaccine-preventable diseases, lead abatement, tobacco control, motor vehicle occupant restraints, and water fluoridation to prevent dental caries (Centers for Disease Control and Prevention, 1999, 2011b). Public health efforts are credited with much of the gains in life expectancy that high-income countries experienced in the 20th century (Cutler and Miller, 2005; Foege, 2004). The effectiveness of a core set of clinical preventive services (e.g., cancer screening tests) is well documented in randomized controlled trials (U.S. Preventive Services Task Force, 2012), as are a host of effective medical treatments for acute and chronic illness care (Cochrane Library, 2012). For example, gains in cardiovascular health have occurred with the adoption of evidence-based interventions including antiplatelet therapy, beta-blockers, and reperfusion therapy (Khush et al., 2005; Kociol et al., 2012). Although some authors have questioned the impact of medical care on health (McKeown, 1976; McKinlay and McKinlay, 1977), others estimate that between 10-15 percent (McGinnis et al., 2002) to 50 percent (Bunker, 2001; Cutler et al., 2006b) of U.S. deaths that would otherwise have occurred are averted by medical care. Across various countries, medical care is credited with 23-47 percent3 of the decline in coronary artery disease mortality that occurred between 1970 and 2000 (Bots and Grobbee, 1996; Capewell et al., 1999, 2000; Ford and Capewell, 2011; Ford et al., 2007; Goldman and Cook, 1984; Hunink et al., 1997; Laatikainen et al., 2005; Unal et al., 2005; Young et al., 2010). Barriers to health care also influence health outcomes. Inadequate health insurance coverage is associated with inferior health care and health status and with premature death (Freeman et al., 2008; Hadley, 2003; Institute of Medicine, 2003b, 2009a; Wilper et al., 2009). Conversely, universal coverage has been associated with improved health, both in U.S. states (Courtemanche and Zapata, 2012) and in other countries (Hanratty, 1996). Two other barriers, inadequate numbers of physicians and a weak primary care system, are associated with higher all-cause mortality, all-cause premature mortality, and cause-specific premature mortality (Chang et al., 2011; Macinko et al., 2003, 2007; Or et al., 2005; Phillips and Bazemore, 2010; Starfield, 1996; Starfield et al., 2005).

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