The Impact of Globalization on Infectious Disease Emergence and Control Exploring the Consequences and Opportunities: Workshop Summary (2006) / Chapter Skim
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3 The Global Application of Knowledge, Tools, and Technology: Opportunities and Obstacles
3 The Global Application of Knowledge, Tools, and Technology: Opportunities and Obstacles
Pages 80-124
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From page 80... ...
One of the most enthusiastically discussed opportunities made available by our increasingly interconnected world is the type of transnational public health research, training, and education program exemplified by the Peru-based Gorgas Course in Clinical Tropical Medicine. This program not 80
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The trend toward a bidirectional, more egalitarian approach that benefits the developing-country partner as much as its northern collaborator reflects a growing awareness that a sustainable global public health capacity can be achieved only with the full and equal participation of the developing world. Thus, not only are the Gorgas Course and other, similar programs becoming more popular, both politically and among students, but their nature is also changing in significant and telling ways.
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From page 82... ...
One-third of all new infectious diseases identified over the past 25 years were discovered in Latin America. The Gorgas Course in Clinical Tropical Medicine and other international training programs offered by the Instituto de Medicina Tropical "Alexander von Humboldt" (IMT)
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From page 83... ...
Developed-world partners are adopting new approaches in their interactions with the developing world and realizing that respecting the decisions made by their developing-country partners is critical to the long-term sustainability of these partnerships. For example, IMT, on the campus of the Universidad Peruana Cayetano Heredia in Lima, where the Gorgas Course in Clinical Tropical Medicine is held, maintains a strong collaboration with the Belgian-run Institute of Tropical Medicine in Antwerp.
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From page 84... ...
. In addition to respecting the decisions made by participants from the developing world, the adequate transfer of economic support is vital to the continued success of these types of programs.
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Head of Slovak mission Latvia (Riga) Head, Infectious Diseases Epidemiology Unit Peru (Iquitos)
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This situation must be changed. The Changing Nature of Fogarty International Center's Transnational Training Partnerships The 35-year-old FIC has a specific mandate to promote and support international scientific research and training in the global health sciences and reduce global health disparities.
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From page 87... ...
The emphasis is on the integration of therapy and care with prevention efforts. In addition to FIC's training grants programs, NIH oversees several other, similar international efforts, including the Prevention Trials Network, the Vaccine Trials Network, the Comprehensive International Program of Research on AIDS, Popular Opinion Leaders, International Cen
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From page 88... ...
The program provides five years of support at $50,000 a year to scientists who reenter their home country after receiving training in the United States. Also relevant is the International Training and Research Program in Emerging Infectious Diseases, a traditional program carried out at university sites conducting research overseas.
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From page 89... ...
Such a registry could be used in bioterrorism prevention and control, for example, to differentiate between bioterrorist and natural outbreaks. • Russian experts could also aid in the development of a register of infectious disease carriers for use in preventing the dissemination of infectious diseases beyond national borders as a result of migration.
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From page 90... ...
Not only there is a need for more training in tropical infectious diseases among health care providers in the United States and other countries in the developed world, but there is also a strong student demand for such training. By going abroad, students learn about and encounter diseases and conditions, such as measles, that do not occur regularly or at all in the United States.
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From page 91... ...
As noted earlier, some physicians practicing today have never seen a case of measles, and some veterinarians practicing today have never encountered foot-and-mouth disease. Although training in tropical infectious diseases should constitute a significant component of the public health education of medical and veterinary school students, it is important to keep in mind that not all infectious disease problems emerge in the developing world.
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From page 92... ...
Another participant suggested that perhaps medical and veterinary school curricula could be modified to incorporate public health training programs -- both general programs and those focused on tropical infectious diseases -- without necessarily increasing contact time. However, the cost of doing so could be prohibitive.
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REGIONAL EFFORTS TO TAKE ADVANTAGE OF GLOBAL OPPORTUNITIES3 Three regional or organizational efforts have been undertaken to take advantage of some of the newly available global tools and opportunities: (1) PAHO's efforts to prevent the spread of infectious diseases in the Americas; (2)
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From page 94... ...
PAHO is currently assisting Central American countries with the development of INFOCAM, an electronic system that will allow routine sharing of surveillance information. Also being used are e-mail, electronic chat rooms, and the Program for Monitoring Infectious Diseases (ProMED)
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• Nine countries in the Amazon basin have held regional meetings to address malaria-related issues. • Three subregional laboratory surveillance networks have been established in the Americas: one in the Amazon basin, one in the southern cone, and one in Central America.
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• Finally, to improve public health, it has become necessary to work outside regular health channels and target everyone at the community level, from vendors to street children and favelas.
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VECTOR plays a leading role in Russia's participation in various international cooperative efforts to prevent and control the emergence and reemergence of infectious diseases, and serves as an excellent example of the type of international collaboration made possible in a borderless world. VECTOR is located in Koltsovo, in the Novosibirsk region, the geographic center of the Russian Federation.
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From page 98... ...
The center is involved in multiple public health research and disease prevention endeavors encompassing a wide range of infectious agents, including a collection of about 120 smallpox virus strains that SCR VB Vector scientists are studying in close cooperation with the United States and WHO. Moreover, the center is the only civilian institution in Russia where researchers work with Ebola and Marburg viruses.
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From page 99... ...
• VECTOR has been collaborating closely with several international and foreign agencies, including WHO, CDC, and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID)
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From page 100... ...
• Continued laboratory and diagnostic support for the identification and localization of infectious disease outbreaks. • Continued development of a new generation of techniques for the diagnosis, prevention, and treatment of infectious diseases in both humans and animals, which could also be used in the event of a bioterrorist attack.
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From page 101... ...
A participant noted that the Cooperative Threat Reduction program, the scientific cooperation between former Soviet scientists and their western counterparts that was established for the purpose of fighting infectious disease and sharing knowledge, is in considerable jeopardy at the moment. The Bush Administration can no longer certify that Russia is committed to honoring and abiding by the terms of the Biological Weapons Convention and, as a result, will no longer request money for new projects or additional spending on ongoing cooperation projects on which approximately $350 4See also Appendix D
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A Public Health "Bank" Because limited global public health resources must be used in a costeffective and conservative manner, the only way the public health sector will be able to respond effectively to the increasing globalization of infectious disease is by pooling the resources of all participants. If this cannot be accomplished, individual countries, especially those in the developing world, will never be able to afford everything they need to manage increasingly globalized infectious diseases, nor will public health as an institution be able to protect its credibility.
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From page 103... ...
One participant suggested that a bank of this sort might be a useful construct for establishing bidirectional training programs in infectious disease control. DRUG AND VACCINE ACCESS AND DELIVERY IN THE DEVELOPING WORLD5 Vaccines and antiretroviral agents have enormous proven public health benefits and could potentially save millions of lives in the developing world.
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-- suggests potential areas of improvement for the global public health system. Before 1974 and the eradication of smallpox, routine vaccination for childhood diseases was implemented in less than 5 percent of the global birth cohort and in very few developing countries.
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* Used in ~ 50% of global birth cohort FIGURE 3-2 Number of vaccines used routinely in developing and developed countries.
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Without credible demands that are backed financially, serious problems will be encountered. For example, even though whole-cell pertussis vaccines are still being promoted in much of the developing world, soon no company may be manufacturing them.
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The new influx of global funds directed toward international public health is a step in the right direction (see Chapter 4)
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From page 108... ...
Access to and Delivery of Antiretroviral Agents in the Developing World Antiretroviral therapy is currently the only tool available for mitigating the economic and social destabilization due to HIV/AIDS in sub-Saharan Africa, a situation that may spread to India and other parts of the world. This is the case despite the tremendous resources that have been expended on development of an HIV vaccine.
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From page 109... ...
First, disparities in access to health care have made it more difficult to implement antiretroviral therapy effectively in the African American community, where a significant number of individuals are experiencing treatment failure as a result of drug resistance. Second, increased morbidity and mortality have occurred secondary to druginduced toxicities.
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From page 110... ...
The negative repercussions of the premature introduction of antiretrovirals must be kept in mind when these drugs are made available in resource-limited areas. In addition to drug resistance, other constraints on the use of combination antiretroviral therapy in resource-limited areas of the world include toxicity and side effects, drug–drug interactions, issues of adherence to and the complexities of the regimens, a lack of long-term efficacy in real-life settings, a loss of HIV-specific immunity, and cost.
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From page 111... ...
Cost reduction efforts by the pharmaceutical industry and potential contributions from the Global Fund also enhance the feasibility of introducing the widespread use of antiretroviral therapy into Africa. Although the development of an African solution involving the use of antiretroviral agents must proceed aggressively, the effort must also be undertaken with great caution.
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From page 112... ...
is perhaps the most critical element of any antiretroviral treatment strategy, at least initially. The mutation thresholds for individuals with viral loads greater than 50 copies of RNA per milliliter of blood plasma are much higher than those for individuals with viral loads below 50 copies per milliliter, and pilot studies have shown that DOTS can achieve 100 percent suppression rates.
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From page 113... ...
Antiretroviral Therapy as a Global Public Good Some of the issues addressed during the discussion of antiretroviral therapy in Africa raised questions about drug development and drug delivery in general. Given the complexities and implications of the economics of the pharmaceutical and vaccine industries, it was suggested that an in-depth discussion of this important topic be reserved for a separate workshop or other venue involving economists, among others.
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From page 114... ...
Thus it is crucial that the first steps taken be the right ones. OPPORTUNITIES FOR AND OBSTACLES TO GLOBAL SURVEILLANCE7 Effective in-country surveillance systems are one of the many reasons smallpox was and remains eradicated.8 As noted throughout this report, however, emerging infectious diseases are no longer geographically contained; therefore, effective in-country surveillance systems alone cannot prevent and control their global spread.
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From page 115... ...
Eventually, the outbreak would be controlled with minimal international spread and disruption of trade. However, there are several impediments to the establishment of such a global surveillance and response system.
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From page 116... ...
Signs indicating that people should treat their food and water to prevent cholera were posted throughout Peru and the rest of Latin America. Despite these measures, several of Peru's neighbors, including Bolivia, Ecuador, Chile, and Argentina, imposed trade restrictions (although the epidemic spread to Ecuador and Chile anyway)
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From page 117... ...
To encourage the rapid and accurate reporting of outbreaks and to strengthen global surveillance and response capacities, three main challenges must be met: • The economic and political costs of outbreak reporting must be minimized: -- Governments and trade associations must be better educated. -- WTO and WHO need to be proactive in preventing inappropri ate economic responses.
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From page 118... ...
Quality assurance tests could be used to monitor the data as necessary. In fact, global surveillance efforts would benefit from tighter links to all components of the clinical arena, including health care providers and physicians.
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From page 119... ...
The region has very limited human resources devoted to the reporting of infectious diseases, and the statistics produced are notoriously unreliable. In most countries in the region, only a single person is responsible for reporting all infectious diseases, including HIV/AIDS.
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From page 120... ...
(GOARN and the Global Atlas of Infectious Diseases are discussed below.) Because the Internet and other communications technologies can be used to raise general awareness of the fundamental problems of global health, a participant suggested that they could also be used as leverage to ensure that those who can alleviate problems remain accountable -- for example, governments that fail to provide resources for the Global Fund.
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From page 121... ...
of the information gathered by the network is transmitted to WHO from the Global Public Health Intelligence Network in cooperation with Health Canada. This real-time early-warning system scans more than a million Internet websites daily for news and other reports of infectious disease events.
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From page 122... ...
WHO is currently developing a secure website for the network at which network members will be able to find timely information about ongoing responses. Global Atlas of Infectious Diseases The Global Atlas of Infectious Diseases is intended to be a web-based information and interactive mapping system that will support the global surveillance of infectious diseases.
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From page 123... ...
. The Global Application of Tools, Technology, and Knowledge to Counter the Consequences of Infectious Diseases: A Discussion of Priorities and Options.
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From page 124... ...
. The Global Application of Tools, Technology, and Knowledge to Counter the Consequences of Infectious Diseases: A Discussion of Priorities and Op tions.
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