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Epidemics in a Globalized World: Multidisciplinary Perspectives

UCSIA organized a workshop on epidemics in a globalized world from a multidisciplinary perspective on March 23rd-24th 2017. It addressed the topic of combatting epidemics as a case in point to engage in the wider debate of health security versus right to basic health within a global context. At the opening lecture on March 22nd international experts, Rebecca Martin, Director of the Center for Global Health Centers for Disease Control and Prevention, Atlanta and Heidi Larson, Associate Professor at the London School of Health and Tropical Medicine & Fellow at the Chatham House Centre on Global Health Security, introduced the audience into the subject matter.

Professor Martin opened the session by indicating how globalisation renders disease only a plane ride away, increases urbanisation and amassment of poor people in the periphery, with limited access to health care. 60 million (of which 15 million in Africa) are globally and regionally displaced people forming pockets of disease.

It is no coincidence that the three countries where polio is still endemic (Nigeria, Afghanistan and Pakistan) are areas of insecurity and violence. A combination of decades of civil unrest, a weak public health infrastructure and fragmented border control has played a role in the Ebola crisis in Guinea, Liberia and Sierra Leone (2014-2016).

Throughout the 21st century pandemics are estimated to have cost 6 trillion dollars with an annual expected loss of 60 billion dollars from potential pandemics, while the annual cost per person for protection against current global threats amounts to a mere 0.65 dollar.

Epidemics are the world’s problem and the international community is also responsible when national capacities fall short. Global action must work through national systems. To counter epidemics of this scale (detect the emerging threat, act promptly and prevent spreading where possible), requires a strong domestic public health structure. The World Health Organisation, through its International Health Regulations, hoped to meet the target of developing core capacities by 2012, but only 33% of the envisaged countries did and the deadline was extended. The WHO’s Global Health Security Agenda (GHSA) of 2014, to which 50 countries have committed to assist 76 countries, is a good road map to improve global response to disease outbreaks.

Professor Larson focused, in her talk, on the role of local communities. Public health solutions rely on trust. The decline of deference for medical expertise and vaccination campaigns forms a danger to public health. Fear and emotion are neglected dimensions of health. It demands an understanding of social psychology and socio-political context for which other experts, such as sociologists and anthropologists are needed.

Rumours have health impacts (cf. boycott of polio vaccination in northern Nigeria in 2003-4 out of fear of presumed effect of sterilization, Catholic bishops’ protest against vaccination in Kenya in 2014 out of dissatisfaction that they were not appealed to for support). Rumours are also an indicator of emerging disease (they emerge when there is a lack of information). They need to be taken into account when rolling out health interventions.

We need to accept the public as a legitimate partner and develop tools to measure vaccine confidence. That is why the London School of Hygiene and Tropical Medicine has developed the Vaccine Confidence Project to monitor public confidence in immunisation programmes by building an information surveillance system for early detection of public concerns around vaccines; by determining the risk level of public concerns in terms of their potential to disrupt vaccine programmes; and to provide analysis and guidance for early response and engagement with the public to ensure sustained confidence in vaccines and immunisation.

The reflection was further developed in the ensuing two-day workshop where senior and junior scholars from various disciplines such as medicine and epidemiology, communication and media, law and governance, ecology and economy, migration research, …. discussed, on the basis of their research, the critical factors for a future global strategy and the implications for further academic investigation.