The Impact of Globalization on Infectious Disease Emergence and Control Exploring the Consequences and Opportunities: Workshop Summary (2006) / Chapter Skim
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1 A World in Motion: The Global Movement of People, Products, Pathogens, and Power
1 A World in Motion: The Global Movement of People, Products, Pathogens, and Power
Pages 21-48
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. Migrant populations are among the most vulnerable to emerging and reemerging infectious diseases and have been implicated as a key causal factor in the global spread of such diseases, most notably multidrug-resistant tuberculosis (TB)
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That mosquitoes can cross the ocean by riding in airplane wheel wells is a commonly cited example of this phenomenon and is one of several hypotheses proposed to explain the introduction of West Nile virus into New York City in 1999, the first known incidence of this disease in North America. Beyond such transport of disease vectors, controversial evidence suggests that global warming, much of which is generated by human activities, has caused or is causing changes in vector distributions worldwide and affecting the incidence rates of various tropical infectious diseases, such as malaria and dengue.
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One participant noted that people on the move not only transmit infectious diseases, but also spread antimicrobial-resistant genetic material. A traveler's immunological system may afford protection from certain strains but not others.
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Between July 1998 and June 1999, the three New York City area airports experienced nearly five million international arrivals. The most rapid increases in international air travel, however, have been in Africa and the Middle East, places where many new infectious diseases are emerging.
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Migration and Migrant Health A 1998 National Geographic article describes human migration as "the dynamic undertow of population change; everyone's solution, everyone's conflict" (Parfit and Kasmauski, 1998, p.
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Susceptibility to infection usually increases during transit and while living in the destination country, particularly if individuals are separated from their families, partners, or the social and cultural norms to which they are accustomed and that guide behavior in a stable community. Recent trends in TB, particularly the incidence of multidrug-resistant TB, demonstrate the critical relationship between emerging infectious diseases and population mobility.
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• On the basis of preliminary data from a 2000 International Organization for Migration health assessment of more than 76,000 migrants and refugees, the TB incidence rate among migrant populations is generally five to six times higher than the average rates among the populations of the countries of destination (i.e., the United States, Canada, and Australia) ; these findings are consistent with reports from the host countries.
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GLOBAL DEMOGRAPHIC TRENDS2 Changing world demographics, especially the rapidly increasing size of the world's population, play a key role in the impact of globalization on the emergence and spread of infectious diseases. In fact, as one participant emphasized, the dynamic interplay between poverty and global population growth is the single most important factor responsible for many infectious disease problems.
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, other important global demographic trends that will likely have a direct impact on infectious disease threats include increasing urbanization in poor countries, the growth of the developed world's aging population (see below) , the demographic consequences of the HIV/AIDS pandemic, and the growing proportion of youth in poor countries.
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The increasing urbanization in poor countries has significant implications for the transmission and spread of infectious disease. • About two-thirds of all fatal infectious diseases are spread person to person; greater population density increases transmission by bringing people into closer contact with each other.
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Once they have been infected with another serotype, however, they are at risk for a more severe form of the disease; infection with one serotype offers no protection against another. One of the more severe forms of the disease, dengue hemorrhagic fever, or dengue shock
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The Caribbean is experiencing an epidemic of DEN-3, a dengue virus serotype that has not been present in the area for the past 30 years and that was recently reintroduced from Asia. Because the Caribbean has experienced epidemics involving other serotypes, the likelihood that dengue hemorrhagic fever will appear in the region over the next few years is even greater than it would otherwise be.
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. THE MOVEMENT OF VECTORS3 Increased vector movement may be just as important as increased human movement in contributing to the global spread of infectious diseases.
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or via commodities that are being transported. It has been demonstrated experimentally that a number of different disease vectors can survive in the wheel wells of jet aircraft at high altitudes for long intercontinental flights.
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In a single year (i.e., August 1998 to July 1999) , there were more than 2.8 million international animal importations into New York City; most of these were amphibians (61 percent)
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, was already ubiquitous in the New York metropolitan area; the marshy habitat where the disease emerged was an ideal mosquito breeding ground; the location of emergence was near a major international airport; and international travelers are constantly arriving in Queens, which houses perhaps one of the most ethnically diverse populations in the world. Although the virus was almost certainly introduced via a transportation vehicle, it is unclear whether it was introduced via a vector mosquito or some other means.
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would appear to provide a natural opportunity for investigating the effects of increased temperature and rainfall fluctuations on the incidence of vectorborne diseases. Because the phenomenon lasts only one to two years, however, it is difficult to extrapolate ENSO findings to global warming.
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To meet these expectations, the food industry must import items from many different parts of the world. A globalized food supply raises questions about food safety and opens the door for potential bioterrorist attacks.
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No one country or community has the capability to test for all possible hazardous agents in its imported food products, which makes local control very important. Each year, a growing number of different foods are imported into countries throughout the world.
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As this example demonstrates, local conditions, local controls, and import controls all play significant roles in the prevention and control of outbreaks of foodborne disease. Local conditions set the stage for a pathogen to enter the food supply.
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While having received scant attention in the public health literature, the global flow of capital and the international unification of markets have been emphasized by social scientists and in the more economically oriented globalization literature. Their importance is reflected in the fact that the "development of global financial markets" is Soros's (2002)
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The most direct consequence of the international movement of capital for emerging infectious diseases is the financing of environmental projects in a country with external funds. These projects, frequently planned by a coalition of local and international environmental planners, usually have either intended or unintended environmental effects and alter human– environment relations in ways that have significant implications for host– pathogen interactions and potential human exposure to vectorborne or waterborne diseases.
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Land Modification Projects Land modification and clearance projects that involve capital flow can also have significant consequences for the emergence and transmission of infectious diseases through their alteration of local human–environment relations. For example, the clearance of land in Malaysia for the construction of rubber plantations, economic development, and the promotion of an export economy have resulted in notable increases in the rates of malaria transmission among plantation laborers.
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Ultimately, these underlying social factors -- including poverty, population growth, and the massive displacement of people -- must be addressed to ensure a sustainable global capacity to prevent and control the emergence and spread of infectious diseases. THE GEOGRAPHIC EVOLUTION OF HIV/AIDS8 Not only does the global spread of HIV/AIDS serve as a paradigm for the effect of globalization on emerging infectious diseases, but HIV/AIDS has also emerged as an overriding concern because it makes people more susceptible to other infectious diseases, particularly TB.
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In other parts of the world, India has the greatest potential for a widespread increase in the number of people with HIV/AIDS, given that 70 to 80 percent of the population lives in poor rural areas where the education rates are low and the public health infrastructure is weak. HIV/AIDS is already costing India substantially in terms of lost productivity and treatment costs.
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Presentation at the Institute of Medicine Workshop on the Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities, Washington, D.C. Insti tute of Medicine Forum on Emerging Infections.
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. Global Migration and Infectious Diseases.
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Presenta tion at the Institute of Medicine Workshop on the Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities, Wash ington, D.C. Institute of Medicine Forum on Emerging Infections.
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