Public Health Engagement Aff Notes



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Quarantine Fails

Quarantine fails—increases the likelihood of spreading disease


Hull '14 (Harry F. Hull, trained in epidemiology at the U.S. Centers for Disease Control and Prevention and an adjunct professor of pediatric infectious diseases and infectious disease epidemiology at the School of Public Health., "Why quarantines won’t stop Ebola from spreading in the U.S.", The Washington Post, October 3, https://www.washingtonpost.com/posteverything/wp/2014/10/03/why-quarantines-wont-stop-ebola-from-spreading-in-the-u-s/, CL)

The United States’ first Ebola patient was identified this week in Texas. He probably won’t be the last. Ebola is contagious and highly lethal. With no demonstrably effective vaccine available, isolation and quarantine are invaluable tools. Is it enough to stop Ebola here? Although used interchangeably, isolation differs from quarantine in a couple of key ways. Isolation refers to placing an ill and contagious person in a controlled environment to prevent transmission. Quarantine, on the other hand, means restricting the movements and contacts of healthy people exposed or potentially exposed who may become contagious. Isolation is commonly used in hospitals for many diseases. Quarantine is rarely employed because it may unnecessarily restrict liberty and may spread disease to quarantined persons who were not actually exposed. Calls for quarantine to control AIDS in the 1980s were counterproductive. Quarantine of passengers arriving from Ireland in the 1800s on typhus ships condemned many to death. Quarantining crowded slums in Liberia may have increased the spread of Ebola as people fled. Mass quarantine efforts in the United States would likely be similarly ineffective as people seek to escape perceived death traps. Closing borders to healthy travelers from Africa would be ineffective. People would simply lie, forge documents or carry more than one passport. An inability to return if exposed would deter skilled health workers from supporting control efforts in Africa. Except for extremely high risk or uncooperative persons, quarantine has been replaced by identification and monitoring of at-risk people.


Quarantines are too outdated to work today


Werner '14 (Erica Werner, Associated Press, "Do quarantines actually work? Experts question effectiveness", PBSNews, October 30, www.pbs.org/newshour/rundown/quarantines-rarely-used-effectiveness-questioned/, CL)

Large-scale quarantines were used frequently during disease outbreaks in the 19th and early 20th centuries, including the influenza pandemic in 1918. Experts say it’s not clear such quarantines were very effective. In some cases, entire populations were isolated, such as a quarantine of Chinatown in San Francisco in 1900 in response to the bubonic plague. The quarantine order was struck down by a court after an outcry by residents. Such large-scale quarantines have largely fallen into disuse with the rise of modern medicine, vaccines and antibiotics. More recently, the spread of tuberculosis led authorities to quarantine individuals to make sure they were taking their medicine and following other protocols. More than 100 TB patients were detained in New York City between 1993 and 1995. What about elsewhere? The SARS epidemic led to large-scale quarantines in Asia and Canada in 2003, including around 30,000 people quarantined in Toronto, mostly at home. There’s disagreement about whether the quarantine in Toronto was effective. Some believe it did limit the spread of the outbreak, while others say it was ineffective and inefficient and noncompliance was a problem. What are experts’ concerns about quarantine for Ebola? Experts note that unlike SARS and the flu, Ebola is not easily spread to others by coughing or sneezing. Instead it requires direct contact with a sick person’s bodily fluids while they are showing symptoms of the disease. So they question the need to quarantine people who are not showing symptoms. Health officials also agree that the best way to protect the U.S. from the disease is to end the outbreak in West Africa. Doctors, nurses and other health workers are badly needed there, and experts worry that imposing quarantines here at home could discourage those volunteers. “Being overboard, being draconian is not necessarily the best way to keep us safe,” said Wendy Parmet, a health policy expert at Northeastern University School of Law.

Even if they work, overuse risks disaster and more suffering—doesn’t assume mass spread


Hill-Cawthorne '14 (Grant hill-Cawthorne, lecturer in Communicable Disease Epidemiology at the University of Sydney, "Quarantine works against Ebola but over-use risks disaster", The Conversation, October 1, theconversation.com/quarantine-works-against-ebola-but-over-use-risks-disaster-32112, CL)

While quarantine is an important weapon in our arsenal against Ebola, indiscriminate isolation is counterproductive. The World Health Organisation has warned that closing country borders and banning the movement of people is detrimental to the affected countries, pushing them closer to an impending humanitarian catastrophe. Stopping international flights to the affected countries, for instance, has led to a shortage of essential medical supplies. Still, this didn’t stop Sierra Leone from imposing a stay-at-home curfew for all of its 6.2 million citizens for three days from September 19 to 21. Results from this unprecedented lockdown are unverified, with reports of between 130 and 350 new suspect cases being identified and 265 corpses found. But in a country where the majority of people live from hand to mouth with no reserves of food, the true hardship of the measure is difficult to quantify. In addition to the three-day lockdown, two eastern districts have been in indefinite quarantine since the beginning of August. On September 26, Sierra Leone’s president, Ernest Bai Koroma, announced that the two northern districts of Port Loko and Bombali, together with the southern district of Moyamba, will also be sealed off. This means more than a third of the country’s population will be unable to move at will. Sierra Leone’s excessive quarantine measures are having a significant impact on the movement of food and other resources around the country, as well as on mining operations in Port Loko that are critical for the economy. The country had one of Africa’s fastest-growing economies before the outbreak, with the IMF predicting growth of 14%. The World Bank estimates the outbreak will cost 3.3% of its GDP this year, with an additional loss of 1.2% to 8.9% next year. Rice and maize harvests are due to take place between October and December. There’s a significant risk that the ongoing quarantines will have a significant impact on food production. Quarantine is an excellent measure for containing infectious disease outbreaks but its indiscriminate and widespread use will compound this epidemic with another humanitarian disaster.

U.S.-China Framework

U.S. Chinese public health collaboration spans research, fighting disease, sharing info, and tobacco control


Brown et al. 13 (Matthew Brown, Bryan A. Liang, Braden Hale, and Thomas Novotny, Senior Advisor at Office of Global Affairs, US Department of Health and Human Services - ‎US Department of Health and Human Services, “China's Role in Global Health Diplomacy: Designing Expanded U.S. Partnership for Health System Strengthening in Africa”, Global Health Governance, Volume 6, No. 2, CL)

To understand where opportunities to capitalize on existing U.S.-China collaborations to work in Africa, it is useful to describe the organization of the Chinese health system as well as how U.S. and Chinese public health agencies work together, sharing nearly two decades of various collaborations in public health. China has a single party political system, governed by the Communist Party of China. While this is in stark contrast to the United States and many other countries that maintain a multiparty system of democracy, this centralized system has unique characteristics that need to inform any foreign collaboration. China has 34 province-level administrative units, similar to U.S. states, including four municipalities, 22 provinces, five autonomous regions, two special districts, and Taiwan, a province handled by a separate Taiwan Affairs Office within the State Council.61 One critical characteristic of China’s intricate bureaucratic structure is a consistent separation of political authority from implementation functions. The Chinese Ministry of Health (MOH) preserves this same separation within the Chinese public health system.62 The highest level of administrative authority is the Chinese State Council. The State Council supervises the MOH, which consists of approximately 100 technical leaders who set policy and which serve as the main authority for the national public health system.63 Additionally, the MOH supervises the multiple technical implementing agencies including provincial health bureaus. The provincial health bureaus supervise the prefectures health units. This pattern continues down the administrative chain to counties, townships, and village health centers (Figure 2).64 One technical implementing agency overseen by the MOH is the Chinese Centers for Disease Control (China CDC), which has also served successfully as the Principal recipient of over U.S.$825 million for the Global Fund to Fight Tuberculosis, Malaria, and HIV/AIDS.65 With authority and purview over the public health component of the Chinese health system, China CDC is the lead technical implementing agency for disease control and prevention at the national level. China CDC has its own counterpart CDC entities at the provincial, prefecture and county levels (Figure 3). This network of authority, supervision, and implementation, yields a health system of more than 2,200 provincial and county CDCs.66

COLLABORATIONS BETWEEN U.S. AND CHINESE PUBLIC HEALTH AGENCIES

Due to these characteristics and differences in governmental structure, U.S. governmental counterparts do not align perfectly with Chinese governmental units. Unless the Chinese implementing institution has the appropriate delegated authority from their supervising institution, that institution or agency may find it difficult to engage with a foreign institution on a global health project. This can create significant barriers to collaboration.67 Despite these barriers, bridging the U.S. and Chinese health agencies are multiple Memoranda of Understandings (MOUs) between the Chinese MOH, the China CDC, and the U.S. Department of Health and Human Services (HHS), CDC, and the National Institutes of Health (NIH), dating from 1979. These address HIV/AIDS, influenza, emergency preparedness, health communications, emerging and reemerging infectious diseases, and most recently, chronic and non-communicable diseases and tobacco control.68 U.S.-Chinese partnerships in public health illustrate how arrangements in other countries where these nations share similar health development agendas.


AT: Ebola Didn’t Spread

Ebola got out of control very quickly—7 reasons


Belluz '14 (Julia Belluz, senior health correspondent, "Seven reasons why this Ebola epidemic spun out of control", Vox, September 4, www.vox.com/2014/9/4/6103039/Seven-reasons-why-this-ebola-virus-outbreak-epidemic-out-of-control, CL)

If you'd asked public-health experts a year ago whether an Ebola outbreak could turn into an epidemic spread across borders, they probably would have confidently told you that there was no way: the virus isn't transmitted very easily, and people usually get so sick and die so quickly, it has little opportunity to infect a new host. Then came 2014, the year that is rewriting the Ebola rulebook. More people have died from the virus in the last nine months than the total number of deaths since the first recorded outbreak in 1976. The virus has also popped up in enough countries — first Guinea, then Liberia, Sierra Leone, Nigeria, and now Senegal — that the cases add up to the world's first Ebola epidemic. How did Ebola spiral so badly out of control? There are a few obvious features that have made this outbreak different and more violent: the virus hit unprepared countries in West Africa that had no previous experience with Ebola, and it quickly moved to densely populated urban hot spots (as opposed to isolated, rural areas where the virus typically popped up in Central and East Africa). But there are other more subtle factors that are helping Ebola survive today for the first ever Ebola epidemic. They hold lessons for public health responses of the future on how to better contain such a deadly disease.

1) Public-health campaigns started too late and didn't reach enough people: In Uganda, as soon as an Ebola case is identified, public health officials overwhelm all streams of media with messages about how to stay safe. People won't leave their houses out of fear of infection, and they immediately report suspected cases to surveillance officials. It's one of the reasons Uganda has successfully stamped out four Ebola outbreaks, even ones that have turned up in urban areas. Dr. Anthony Mbonye, Uganda's director of health services, said this aggressive public-health awareness campaigning didn't start soon enough in the current West African outbreak. "They responded too slowly to make the community aware of the disease," he told Vox. Ishmeal Alfred Charles, who has been working on the Ebola front-line in Freetown, Sierra Leone, said there was little awareness about Ebola until late July, about four months after the first suspected cases emerged in the country. "It only got serious when we lost Dr. Sheik Umar Khan," he said of the prominent local Ebola physician whose July 29 death made international headlines. "That's when the political wheels (started turning) and the government started putting resources together to help." Charles also noticed that, in the initial periods of the outbreak, most of the public-health messaging about Ebola was concentrated on mainstream media, including TV and radio, so it was mainly reaching the middle- and upper-classes of the country. "Not a lot of people have access. We're talking about people who are living in very poor communities so they basically have little or no Internet or TV or to radio." For this reason, by the summer, Charles — who works as a program manager with the Catholic aid agency Caritas — took to the streets to spread the word. "We get people out into small communities to talk to people (about Ebola)," he said. "We gave megaphones to our community volunteers and told them to go public places, to markets, to houses." Of course, the message came too late and Ebola has now reached almost every district in Sierra Leone.

2) The countries affected by Ebola have some of the world's lowest literacy rates: Health campaigning and raising health literacy is not easy in places where people can't read. As you can see in the map below, the countries that are now most affected by Ebola — Guinea, Liberia, and Sierra Leone, circled in green — are also the ones with the lowest literacy rates in the world.

3) There's a strong Ebola rumor mill: The low levels of literacy, poor access to health information, and delayed public-health campaigning only fueled the Ebola rumor mill. There's no proven treatment for Ebola but lies about supposed cures have spread fast. One persistent myth has been that hot water and salt can stop Ebola. Others suggest faith healing or hot chocolate, coffee and raw onions will stamp out the virus. Homeopathy has also emerged as a supposed Ebola crusher. In the US, the the FDA has warned consumers to watch out for Ebola quackery, while African public health officials are getting creative to debunk the lies. The electro-beat song 'Ebola in Town' was created to set the record straight about how to avoid the illness. "Ebola, Ebola in town. Don't touch your friend! No kissing, no eating something. It's dangerous!" In Lagos, Nigeria, the local government resorted to hiring a "rumor manager" to help wage a war on the misinformation that is swirling about. "The rumors themselves can actually cause a lot of damage," Lagos state Commissioner for Health Jide Idris told reporters. And he has reason to be worried. If this disease starts to take off in Lagos - Africa's largest city, population 22 million - some say this could "instantly transform this situation into a worldwide crisis."

4) Sierra Leone, Liberia, and Guinea are some of the poorest countries in Africa with fragile health systems: Before the Ebola outbreak, the three countries hardest hit this year had very weak health systems and little money to spend on health care. Less than $100 is invested per person per year on health in most of West Africa and these countries record some of the worst maternal and child mortality rates on the planet. So resources were already extremely constrained when Ebola hit. Daniel Bausch, associate professor at the Tulane University School of Public Health and Tropical Medicine, who is working with the WHO and MSF on the outbreak put it this way: "If you're in a hospital in Sierra Leone or Guinea, it might not be unusual to say, 'I need gloves to examine this patient,' and have someone tell you, 'We don't have gloves in the hospital today,' or 'We're out of clean needles,' - all the sorts of things you need to protect against Ebola." In these situations, local health-care workers — the ones most impacted by the disease — start to get scared and walk off the job. And the situation worsens. In Liberia, nurses have gone on strike because of Ebola. When Bausch was in Sierra Leone in July, he and other doctors were left scrambling during a nurse strike, too. "There were 55 people in the Ebola ward," he said, "and myself and one other doctor." He'd walk into the hospital in the morning and find patients on the floor in pools of vomit, blood, and stool. They had fallen out of their beds during the night, and they were delirious. "What should happen is that a nursing staff or sanitation officer would come and decontaminate the area," he said. "But when you don't have that support, obviously it gets more dangerous." So the disease spread.

5) These countries have spotty disease surveillance networks: These countries also had spotty disease surveillance networks. "We're dealing with countries with very poor health systems to start with," said Estrella Lasry, the tropical medicines adviser for MSF. "That goes from setting up surveillance systems through setting up networks of community health workers." By contrast, places that have been able to fight off the virus in the past — like Uganda — have robust disease surveillance systems, said Lasry. That means that suspect cases can be tested and reported on quickly, and that information can spread through the surveillance network in the country as fast as possible so that prevention measures and public-health campaigns are implemented right away. While there's no way to completely prevent another outbreak from happening, she said, "We can prevent spread by putting the appropriate measures in place so we can identify Ebola and stopping transmission as quickly as possible."

6) The international community responded painfully slowly: "Ebola is a very preventable disease," said Lawrence Gostin, a health law professor at Georgetown University. "We've had over 20 previous outbreaks and we managed to contain all of them." But this time, the international response just wasn't there. "There was no mobilization," Gostin said. "The World Health Organization didn't call a public health emergency until August — five months after the first international spread." Part of the reason for the slow response can be attributed to cuts at the WHO that have left the agency understaffed and under-resourced. But Gostin said this epidemic has also revealed how poorly designed and unready our global systems seem to be for epidemics. In an article published today in the Lancet, he offered this wake-up call for future outbreaks: "How could this Ebola outbreak have been averted and what could states and the international community do to prevent the next epidemic? The answer is not untested drugs, mass quarantines, or even humanitarian relief. If the real reasons the outbreak turned into a tragedy of these proportions are human resource shortages and fragile health systems, the solution is to fix these inherent structural deficiencies."

7) The countries most affected — and our world — is increasingly interconnected: The most worrying vector of spread in any epidemic or pandemic is the traveler. And in this outbreak, the three worst-hit countries shared very porous borders, where the disease could easily hop across in people moving around for work or to go to the market. But Dr. Bausch said this West African outbreak should also serve as a reminder that we live in an increasingly interconnected planet. "Even from the most remote areas of our world, people are getting more and more connected," he said, "sometimes nationally, sometimes internationally." This is the new normal, he said, and it should rewrite how public health officials think about Ebola going forward. "The various different features of this outbreak —where we have an outbreak cutting across international boundaries, involving urban areas — we can think of this as the new norm and we have to be concerned this can happen every time because of the connectivity of places."

AT: Nanotech

Nanotech may sound good but fail to manifest in real life


Koshy and Sethi '13 (Jacob P. Koshy is a deputy science editor at The Hindu and business editor at The Huffington Post and Neha Sethi is the principal correspondent for the Economic Times News Network in Noida, India and previously been a reporter and editor for the Hindustan Times, "Nanotech research speeds up, but applications fail to materialize", Live Mint, April 22, www.livemint.com/Specials/j8UZSy0iiA8kRpgtjwxioM/Research-speeds-up-but-applications-fail-to-materialize.html, CL)

Slightly more than a decade after India officially embarked on a concerted Rs.1,000 crore effort to accelerate nanoscience and build an industrial base reliant on nanotechnology applications, it has doubled its share of research publications in the sector in that period. On the other hand, it has barely made a dent in being able to translate this research into usable products, says a just published report on nanotechnology in India. “There is a long way for promising research leading to applications and only a few organizations have been able to translate some of their research to applications,” according to the study, Knowledge Creation and Innovation in Nanotechnology, prepared by the National Institute of Science Technology and Development Studies (NISTADS). More worryingly, key elements that are necessary to accelerate industrial applications, such as specifying manufacturing standards and a clear policy on addressing the potential health risks posed by nanotechnology, are only “at preliminary stages” and lag behind those of China and South Korea even though these countries began concentrating resources on nanotechnolgy around the same time as India. Nanotechnology is the science of creating and manipulating particles that are a thousand times thinner than human hair. At those dimensions, many common materials behave unexpectedly. Highly water absorbent materials become water repellent. Gold for example melts at much lower temperatures and silicon absorbs a higher amount of solar energy, leading to more efficient solar cells. Sujit Bhattacharya, a professor at NISTADS and key author of the report, said that while several government departments and top-flight research institutions were investing in nanotechnology, the surprise was that consumer goods companies—even in India—were incorporating nanotechnolgy in their products. Thus companies such as Arvind Mills Ltd offer a range of fabrics that use nanomaterials, and Tata Chemical’s Tata Swach and Hindustan Unilever’s Pureit water filters have employed indigenously developed nanotechnology applications to make water filters.



At the other end, according to the report, the bulk of forthcoming products that employ nanotechnology applications were from the pharmaceutical sectors—Shasun Pharmaceuticals and Dabur Pharma Ltd have nano-particle based drugs for cancer in development. Early entrepreneurs in India’s nanotechnology scene maintain that it made sense for them to offer low-cost materials using nanotechnology and then move up to more complex products. Arup Chatterjee, chief executive officer (CEO) of Kolkata-based I-CAnNano, which makes nanoparticle-based cleaning agents, was among a group of early adopters that used nanomaterials to develop a new class of adhesives which could be used in a wide range of articles from windshields to paint. “It was a big leap as nanocomposites (a mixture of nanomaterials) are sensitive to temperature during manufacture,” Chatterjee said in an earlier interview to Mint. “Making nanoparticles is only the beginning. Handling and using them practically is substantially difficult.” His company has now forged tie-ups with academia to develop more complex materials and products, he said. A hurdle in the way of India’s nanotechnology industry was a general aversion to risk and the unwillingness to explore beyond low-hanging fruit, said Rudra Pratap, chairperson of the Indian Institute of Science (IISc) Centre for Nanoscience and Engineering. Most investors in nanotechnology based products looked for “quick returns”, and were unwilling to stay the long haul for investing in genuinely inventive products, said Pratap, who’s led his own nanotechnology start-up. “Things like nanomaterials and paints are the easy bits and they are all done,” said Pratap. “To get beyond that you have to commit funds at an early stage for a long time.” His company, i2n Technologies, makes scanning tunnelling microscopes that are frequently used in research labs to take atom-level snapshots of surfaces. Though his entry-level products cost two-thirds of what similar devices are priced at, Pratap said that he typically runs into demands such as “give me references from three customers who’ve used your product”. “Such obstacles reflect a lack of an entrepreneurial mindset. More than money or institutional support, it’s this mindset that must change to foster acceptance for nanotechnology products,” he added. Then there’s the problem with the health aspects of nanotechnology. A recent US study published in Proceedings of the National Academy of Sciences indicated that nanomaterials potentially posed unknown health hazards. Given their small size, they could easily be absorbed via the skin or orally and lodge themselves within several organs and pose a variety of risks. These risks were relevant to India too, according to Alok Adholeya, director of the biotechnology and bioresources division at The Energy Resources Institute. “One is occupational hazard— we have to in-build policies to ensure that (nano) science is done in a safe manner, which is not there as of now and the second is future risk,” said Adholeya. “Even though currently India doesn’t use much of nano for consumer materials, things may change.” Adholeya, who’s in the process of preparing a study to ascertain the risks associated with nanotechnology with the Department of Biotechnology, added that currently, the use of nanoparticles in the agricultural sector was predominantly in the form of nano-fungicides and nano-fertilizers but other sectors getting involved would “rise in the future”.

AT: Trust Alt Cause

Increasing trust now—recent rural health care financing proves; concerns are resolved by the plan


Hu et al. '16 (Rong Hu, Chunli Shen, Heng-fu Zou, East China Normal University, "Health Care System Reform in China: Issues, Challenges and Options", down.aefweb.net/WorkingPapers/w517.pdf, July 16, date is date accessed, CL)

The financing mechanisms in community should follow at least three principles: equity, openness, and be in accordance with economic status (Liu 2006). The rural people should enjoy the equal right in term of health care as the urban people and the government needs to pave the road. In terms of insurance spending, the administration should attempt to make the whole process open and accessible to all the insured people and actively accept the supervision from them. This activity will enhance people’s trust in the new CHCS and attract more people to participate in its system.

Inevitably, there have been a lot of various difficulties in financing rural health care. Income instability of peasants, the lack of suited legislation and high administration cost are barriers on financing schemes (MOH 2004). The current policy in the poor region is to insure as many people as possible with basic medical care. However, patients with a severe illness face the risk of bankruptcy. Besides, the competition between public and private medical institutions has negative impact on the peasants’ enthusiasm in participating in the insurance system. In the framework of the new policy, the peasants generally need to pay the cash first and then apply for reimbursement. The prices of drug and health service in public hospitals are higher than that of private clinics in most cases. As a result, people prefer go to private sector, which is included in the new CHCS. Financing methods should be more flexible in order to attract more people to join the cooperative medical system. Considering that peasants have less cash, the local governments in some areas (Henan province) have ever tried to replace the cash premium with farm products. (Liu 2006) It has been demonstrated that the peasant welcomes this policy, and the administration cost is lower. However, it takes a long time to sell the products and get cash for the new CHCS funding. Meanwhile, many other factors such as product price, would influence the operation of the system. The “compulsory participation”, where the governments pay the premium for the farmers using the tax money, was was adopted in some places so as to improve the coverage of the cooperative medical scheme. However the peasants indirectly bear the burden because the local government usually has to exert more tax on them. In many cases, the peasants’ resist to insurance medical system did not result from the financing mechanisms themselves, but something else, e.g. low quality of health care service in town hospitals. The simultaneous improvement of health care service in rural areas can encourage the peasants’ participation in the new CHCS.

The majority of the Chinese have more trust in the central government, who would do the plan—a better economy would also increase trust


Huang '14 (Hsin-hao Huang, Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan, Republic of China., "Explaining Hierarchical Government Trust in China:The Perspectives of Institutional Shaping and Perceived Performance", Taiwanese Journal of Political Science, March Volume (Vo. 59), politics.ntu.edu.tw/psr/?post_type=english&p=3115, CL)

“Hierarchical government trust” indicates that political trust varies according to the level of government. Many scholars have argued that within Chinese society, trust in the central government is higher than trust in local governments. However, the literature is primarily focused on specific groups, and still needs to be verified with more representative surveys. Using comprehensive survey data from the 2012 World Values Survey in China, this article demonstrates that Chinese citizens have varying levels of political trust according to the level of government. The results show that approximately 75 percent of respondents had higher trust in the central government than in local governments, demonstrating that “hierarchical government trust” is prevalent in Chinese society. Second, this article uses the perspectives of institutional shaping and perceived performance as a starting point to explain hierarchical trust in government in China. Through empirical analysis, this article identifies the petitioning system and political mobilization as two contextual factors shaping institutions. Perceived performance (central and local government performance and assessment of family economic condition) has a mediating effect on the higher trust in central government. Finally, the article argues that hierarchical government trust is a more suitable approach for understanding the nature of public opinion in China, and identifying its political implications.


AT: Warming Alt Cause

Warming doesn’t cause disease


Moore '16 (Thomas Gale Moore, Senior Fellow at the Hoover Institution at Stanford University, "Why Global Warming Doesn't Cause Disease", web.stanford.edu/~moore/WarmingandDisease.html, July 15, date is date accessed, CL)

Threats of global warming are bringing on a plague. Some will tell you it's a plague spread by the mosquitoes that thrive in a hotter climate. But we know differently. In fact, infestation we speak of is a plague of misinformation, infecting the public consciousness and blurring the issue of the effects of climate change on human health in a swarm of anxiety and confusion. This plague feasts not on blood but on fear: Officials at the very highest levels of government are doing all they can to scare us, even though some of us know better, and they probably know better themselves. Both the President and the Vice President continue to emphasize the health hazards of climate change. In setting his goals for Kyoto, President Clinton asserted that "temperatures will rise and will disrupt the climate Disease-bearing insects are moving to areas that used to be too cold for them." In his sermon to the congregation of environmental ministers praying together in Kyoto, Vice President Gore spoke of "disease and pests spreading to new areas." (Like Washington, D.C.?)

Oh, the tangled Website they weave...In keeping with these high-tech times, the White House's home page also trumpets this theme: Americans better watch out-global warming will make them sick. Going to extremes, the President's Website extrapolates CO2 concentrations to a quadrupled level of 1100 ppm-a scary prophecy-which they claim would boost the average July heat index (combination of humidity and temperature) for Washington, D.C., to 110 degrees! (Some of us have difficulty suppressing the thought that such a climate might provide a great boon: The federal government would shut down during the hot summer months, as it used to do before air-conditioning. Ah, the beauty of human adaptation to climate.) In truth, promoting such a scenario on the official White House Website constitutes terror-hawking. No one-on either side of this issue-is predicting such a high concentration of greenhouse gases for any time during the next century, or even during the first part of the hundred years to follow. Forecasts for the late 21st century can only come under the heading of "science fiction." And those for the 22nd century are "pulp fiction." No one knows which types of energy humans will be using, or what technology will be available to them. Remember, in the late 19th century, waistcoated forward-thinkers predicted America's major cities would be knee-deep in horse manure by 1920 unless we "did something" like institute a big horse tax. We cannot predict the climate's future. What we can predict, however, is that people will be richer, have more and better technology, and will be living longer. They will be better equipped to deal with any climate change than are people today. Moreover, the warmer climate predicted for the next century is unlikely to bring a rise in heat-related deaths. As a recent article in Science magazine points out, "People adapt. One doesn't see large numbers of cases of heat stroke in New Orleans or Phoenix, even though they are much warmer than Chicago." Even so, the Presidential Website goes on to warn that "Diseases that thrive in warmer climates, such as malaria, dengue and yellow fevers, encephalitis, and cholera are likely to spread."

Unfounded, exaggerated, misleading: Even if the White House ignores WCR's frequent, informative messages on global warming and health, these officials should pay attention to the experts on disease. Both the scientific community and the medical establishment say the frightful forecasts are unfounded, exaggerated, or misleading. Further, and more important for policy-makers to note, these rumors of an upsurge in disease and early mortality stemming from climate change do not require action to reduce greenhouse gas emissions. As Science reports: "Predictions that global warming will spark epidemics have little basis, say infectious-disease specialists, who argue that public health measures will inevitably outweigh effects of climate." The article adds: "Many of the researchers behind the dire predictions concede that the scenarios are speculative." The director of the division of vector-borne infectious diseases at the Centers for Disease Control and Prevention (CDC), Duane Gubler, calls those prophecies "'gloom and doom' based on 'soft data.'" Others attribute them to "simplistic thinking." These experts agree that "breakdowns in public health rather than climate shifts are to blame for the recent disease outbreaks." Even El Nino, our most recent climate scapegoat, cannot take the blame for recent epidemics. The claim that dengue fever epidemics in Latin America in1994 and 1995 were due in part to El Nino is simply wrong. Science quotes dengue experts at the Pan American Health Organization: "The epidemics resulted from the breakdown of eradication programs aimed at Aedes aegypti in the 1970s and the subsequent return of the mosquito. Once the mosquito was back the

AT: Won’t Spread

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


Richardson ’16 (Robert Richardson, founder and editor of OFFGRID Survival, "PANDEMICS – How likely are we to see a Major Pandemic?", Offgrid Survival, July 6, offgridsurvival.com/globalpandemic/, *date is date accessed, no date available, CL)

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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