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Workshop Overview
Pages 1-40

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From page 1...
... . The profound consequences of human-mediated biological intro ductions include emerging infectious diseases: those caused by pathogens that have increased in incidence, geographic or host range; or that have altered capa bilities for pathogenesis; or that have newly evolved; or that have been discovered or newly recognized (Anderson et al., 2004; Daszak et al., 2000; IOM, 1992)
From page 2...
... . International endeavors to contain infectious diseases commenced more than 150 years ago and are today embodied in the International Health Regulations (IHR)
From page 3...
... Through invited presentations and discussions, participants explored a variety of interrelated topics associated with global infectious disease emergence, detection, and surveillance including the historical role of human migration and mobility in pathogen and vector movements; the complex interrelationship of travel, trade, tourism, and infectious disease emergence; national and international biosecurity policies; and obstacles and opportunities for detecting and containing globalized pathogens, thereby reducing the potential burden of emerging infectious diseases. Organization of the Workshop Summary This workshop summary was prepared for the Forum membership in the name of the rapporteurs and includes a collection of individually authored papers and commentary.
From page 4...
... Such introductions, abetted by additional genetic, biological, social, and political fac tors associated with infectious disease emergence (see Box WO-1) , have given rise to epidemics throughout recorded history (IOM, 2003; Morens et al., 2008)
From page 5...
... The second wave included eastern Europeans (which encom passes many different ethnic groups including Russian and Polish Jews, people from the Balkans, and southern Italians) , and in much smaller numbers Chinese, Korean, and Japanese, as well as Mexicans from the south.
From page 6...
... In 30 years, there will be twice as many Africans as Europeans." These differences are likely to produce a world of regions that differ greatly from each other, he continued, with "fundamental differences separating the rich countries from the poor countries." Population Mobility and Public Health While migration issues have become increasingly salient in politics and diplomacy, Miller observed that relatively little attention has been paid to the relationship between migration and health.6 Yet as speaker Brian Gushulak, of the Canadian Immigration Department Health Branch, explained, this link is becom ing increasingly crucial, as the widening economic gap separating countries and regions both contributes to, and results from, health disparities. "It is possible to look at migration and population mobility as a metaphor for the evolution of public health and public health security," Gushulak remarked, as he traced the history of public health through the various means advanced against introduced diseases (see Gushulak and MacPherson in Chapter 1)
From page 7...
... Travel, Conflict, Trade, and Disease In discussions that focused on the rapid acceleration and expansion of international travel and trade as a catalyst of pathogen movements, workshop participants considered various ways in which the movement of people and goods influences the transmission dynamics of infectious diseases, and how these influ ences might be better understood in order to reduce the global burden of emerging infectious disease. Workshop presentations examined the role of the traveler as a sentinel -- as well as a vector -- for disease; the role of armed conflict in increas ing infectious disease risks; the complex and multifaceted relationship between trade and disease; and the numerous and diverse risks associated with a globalized food supply.
From page 8...
... Tertiary St. Lucia tertiary health care availability depends on humanitarian and secondary health care is rudimentary.
From page 9...
... . This upheaval occurs against a backdrop of microbial evolution, remarked Mary Wilson of Harvard University, whose presentation explored the influence of human travel on the geography of infectious diseases, as well as the role of the traveler as a disease sentinel (see Wilson in Chapter 2)
From page 10...
... 0 FIGURE WO-3 World waterways network. SOURCE: Figure derived from the Ship Traffic, Energy, and Environment Model (STEEM)
From page 11...
... . Travelers as Sentinels Travelers represent an important sentinel population for disease emergence, according to Wilson, who added that several surveillance networks have been developed to monitor infectious diseases in travelers.
From page 12...
... Maps are derived for EID events caused by (a) zoonotic pathogens from wildlife, (b)
From page 13...
... . Certain categories of infectious diseases tend to increase during war, accord ing to speaker Barry Levy of Tufts University, including diarrheal diseases, acute respiratory infections, and tuberculosis (see Levy in Chapter 2)
From page 14...
... , speaker Ann Marie Kimball, of the University of Washington, concluded that "market forces in the globalized world are misaligned for microbial safety." Using examples of diseases including avian influenza, the use of antibiotics in farm animals, and the growing practice of xenotransplantation,9 she demonstrated the profound influence of trade on infectious disease emergence, and vice versa (see Kimball and Hodges in Chapter 2)
From page 15...
... agreed with the importance of such research, in which he participates, but warned  that controlling H5N1 in backyard flocks is extraordinarily difficult.  Trade in beef and prion diseases The emergence of two prion diseases, bovine  spongiform  encephalopathy  (BSE)   and  new-variant  Creutzfeldt-Jakob  disease  (NvCJD)
From page 16...
... Trade in risky therapies Market forces favoring medical tourism12 and xenotransplantation are also raising the risks for disease emergence, according to Wilson and Kimball. Kimball noted that organ transplantation is becoming increasingly common, and the pig has become a popular, relatively low-cost source for islet cells (to reverse type 1 diabetes that cannot be managed with insulin therapy)
From page 17...
... In so doing, Kimball says, APEC hopes to apply lessons learned from SARS to the threat of avian influenza. Mobile Animals and Disease As discussed in the previous section and in a previous workshop summary report of the IOM's Forum on Microbial Threats -- Addressing Foodborne Threats to Health (IOM, 2006)
From page 18...
... . They are also sources and sinks for introducing novel diseases into naïve ecosystems -- or changing ecosystems in ways that alter transmission dynamics of existing infectious diseases.
From page 19...
... To date, the CDC's regulatory actions to address disease threats from imported animals "have been very reactive .
From page 20...
... ) , which he predicted would herald "a major tragedy in European agriculture." Invasive Species Introduced animals, plants, and microbes can disrupt ecosystems in ways that increase the potential for infectious disease outbreaks.
From page 21...
... bJoint pain. FIGURE WO-7 Approximate global distribution of chikungunya virus, 2008.
From page 22...
... In general, Dobson said, invasive host species have a major advantage over native ones because the invaders have escaped their parasites (Torchin et al., 2003)
From page 23...
... An important way to build resilience against zoonoses and non-host-specific infectious diseases, according to Dobson, is to make diverse and abundant host species available to pathogens. For example, Dobson said, if he found himself in one of the several locations in India where 99 percent of mosquito bites occur in cattle, he "would much rather go buy a cow than have a malaria vaccine." Some participants questioned the general applicability of Dobson's influenza model, based on their own research findings.
From page 24...
... The original IHR, established in 1969, were preceded by a long history of multinational public health measures designed to control the spread of infectious diseases across national borders (see also Gushulak and MacPherson in Chapter 1)
From page 25...
... Member nations are required to assess their disease surveillance capacity and develop national action plans by 2009. By 2012, member states must meet stan dards for national surveillance and response systems, as well as for designated airports, ports, and ground crossings (extensions may be obtained, however)
From page 26...
... However, Fidler observed, "the mere existence of radical changes in the IHR 2005 does not guarantee that the IHR 2005 will radically change global health." He noted that global crises -- including energy, food, climate change, and most recently, the precipitous downturn of worldwide financial markets -- have overshadowed the threat of infectious diseases, causing the effort to implement the IHR 2005 to lose momentum. The emergence of the swine-origin influenza A (H1N1)
From page 27...
... When polio eradication is achieved, the IHR 2005 could be used to ensure the simultaneous, global cessation of oral polio vaccinations, so that no country is put at risk, Heymann said. However, when this measure was recently proposed to the World Health Assembly, it was not accepted, nor was a proposal to address the destruction or consolidation in secure laboratories of wild polioviruses under the IHR.
From page 28...
... or the WTO compounds the problem of disproportionate and asymmetrical travel and trade restrictions and creates disincentives to report outbreaks and deal with them in a transparent and decisive manner." Intent Versus Reality The intent of the IHR 2005 -- to raise the importance of global health as a foreign policy issue and to transform global health governance -- contrasts starkly with the reality of multiple barriers to its implementation, several workshop participants observed. They noted that the virus-sharing controversy highlighted several important inequities in public health capacity that exist between developed and developing countries that are not adequately addressed by the IHR 2005.
From page 29...
... Economic harm to tourism or export industries could result from public health measures such as travel advisories, quarantine, seizure of hazard ous products, or culling of infected livestock -- or simply from unjustified public fears. Mounting an emergency response will challenge the health budget of many developing countries, yet the IHR include no provision for financial support or compensation." Global Disease Surveillance and Response: Challenges and Opportunities The IHR 2005, a landmark in the development of a global governance mechanism to respond to global health threats, demonstrate both the promise and the peril of global health governance and, more specifically, of global infec tious disease surveillance.
From page 30...
... "Business, trade, and tourism stakeholders, and those who support them, such as the insurance industry, have a strong vested interest in working with public health authorities to promote global health security," according to Bell (2008)
From page 31...
... One World, One Health®20 Recognizing the importance of zoonoses as emerging diseases and the economic impact of animal diseases, several workshop participants advocated expanding the purview of surveillance under IHR 2005 by linking its human infectious disease networks with those focused on animal diseases. A similar argument was made to integrate infectious and foodborne disease surveillance by speaker David Nabarro of the United Nations (UN)
From page 32...
... . He described that organization's efforts to address animal disease to ensure animal health worldwide, food safety and safeguard global trade, which parallel those of the WHO.
From page 33...
... . Cosivi described the development of the "One World, One Health®" strategy as a paradigm shift in public health, from the "response and rehabilitation mode" characterized by initial attempts to address avian influenza, to prevention and preparedness for all emerging infectious diseases.
From page 34...
... Engaging all stakeholders Nabarro, whose remarks focused on the issue of conducting effective global disease surveillance and response in an atmosphere of increasing suspicion toward the value of globalized initiatives, recalled that, for a time, the threat of pandemic avian influenza generated "unity of purpose and synergy of action." Although occasional discord arose, coordination between donors, foundations, national governments, regional bodies, and international nongovernmental groups was strong. "What was the incentive that brought so many disparate groups to work together as if in a strong magnetic field, and not to lose their separateness?
From page 35...
... "If you compel, then people start to hide, they fail to explain, they don't involve themselves. So it is absolutely essential to build the necessary trust so that the work can progress." Moreover, he said, mistrust among stakeholders in a common enterprise, such as global disease surveillance and response, must be anticipated, insured against, and addressed as soon as it arises.
From page 36...
... 2000. Emerging infectious diseases of wildlife -- threats to biodiversity and human health.
From page 37...
... 2008. Global trends in emerging infectious diseases.
From page 38...
... Emerging Infectious Diseases 6(2)
From page 39...
... 2009a. Global Early Warning System for Major Animal Diseases, Including Zoonoses (GLEWS)


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