Slide1: Globalization, Infectious Diseases and the Public's Health
John Eyles PhD FRSC
McMaster Institute of Environment and Health Outline of Talk: Outline of Talk What is Globalization?
What are its Impacts?
Globalization and Infectious Disease
Examples of the Diffusion of Disease
Impacts on the Public’s Health
What is Globalization: What is Globalization Globalization is the flow across national boundaries of goods and services, capital, people, technology, ideas, and culture.
Flow of People, Goods, Ideas
Flow of Insects, Disease Vectors, Viruses
Economic, Political, Cultural, Social & Health Impacts Consequences of Globalization: Consequences of Globalization Economic: Global economic integration can be a powerful force for increasing incomes and hence improving health and other aspects of welfare.
Political: The emergence of transnational systems and institutions, many more powerful than nation states, are a powerful influences of countries social and economic conditions
Consequences of Globalization: Consequences of Globalization Health: The globalization of the food supply also carries a risk. Case in point: a recent outbreak of gastrointestinal illness that ultimately was traced to a meat packing plant in Aylmer Ontario.
Cultural: Homogenizing effect of cultures by corporate hegemonies
Benefits of Embracing Globalization: Benefits of Embracing Globalization Global Population Explosion: Global Population Explosion Global Air Travel (People): 1950-1998: Global Air Travel (People): 1950-1998 Global Air Travel (Freight): 1950-1998: Global Air Travel (Freight): 1950-1998 Media Giants: Size and Breadth: Media Giants: Size and Breadth Slide12: Economic Globalization: The Auto Trade Biological Invasion of the Zebra Mussel: Biological Invasion of the Zebra Mussel Invasive species is an unintended consequence of globalization, which facilitates the movement of species across all geographical and physical boundaries with the vastly increased movement of people and materials. Zebra Mussels in 1990: Zebra Mussels in 1990 Slide15: Zebra Mussels in 2003 Economic Trade and Health: Economic Trade and Health Globalization of trade favors the globalization of serious epidemics such as foot-and-mouth disease (FMD). FMD is highly contagious and can spread extremely rapidly in livestock through movement of infected animals and animal products, contaminated objects (i.e. trucks) and even wind currents. Many infectious animal diseases, most importantly FMD, thrive through trade in livestock or livestock products, whether legal or illegal. Diseases Without Borders: “No country can consider itself safe from the risk of the disease due to increased international trade, tourism, the movement of animals, animal products, and foodstuff.” UNFAO, 2001 Diseases Without Borders International Trade in Major Animal Commodities: International Trade in Major Animal Commodities World Foot and Mouth Outbreaks: World Foot and Mouth Outbreaks Model Linking Globalization and Health: Model Linking Globalization and Health Lyme Disease: Lyme Disease Lyme disease due to the infectious agent, spirochete Borrelia burgdorferi, illustrates how changes in the ecology, including reforestation and increasing deer populations, and suburban migration of the population, can result in the emergence of a new microbial threat. Lyme Disease: Risk Map: Lyme Disease: Risk Map Lyme Disease: Vector Dispersion: Lyme Disease: Vector Dispersion Slide24: The Spread of Cholera: British Isles 1831-2 The Speed of an Epidemic: The Speed of an Epidemic Slide27: The Spread of Smallpox The Big Four Pandemics: The Big Four Pandemics Leading Causes of Death in 2002: Leading Causes of Death in 2002 WHO, 2002 Global Impact of Infectious Disease: Global Impact of Infectious Disease The Global Impact of HIV/AIDS: The Global Impact of HIV/AIDS Hepatitis B: Hepatitis B Definition: Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. It is preventable with access to vaccine.
Link to Globalization: Hepatitis B is an example of how globalization enables global solutions to national problems through access to vaccines that are supplied to developing countries by global immunization initiatives and alliances.
The Global Picture of Hepatitis B: The Global Picture of Hepatitis B 2000 million with current or past infection 350 million chronic carriers ~1 million deaths/year Hepatitis B Hotspots: Hepatitis B Hotspots West Nile Virus: West Nile Virus What is it?: It is contracted by mosquitoes when they bite infected birds. The virus is spread to humans through bites from infected mosquitoes. Symptoms of WNv can vary from mild illness such as "West Nile Fever", to serious neurological illness such as encephalitis (inflammation of the brain).
Impact: Trans-species transaction
Animal Insect Human
Unknown Diffusion Mechanism WNv in 1999: Initial Outbreak: WNv in 1999: Initial Outbreak WNv in 2003: Established Presence: WNv in 2003: Established Presence Incidence Patterns of WNv: Incidence Patterns of WNv Human Test Results: 2003 Surveillance: Human Test Results: 2003 Surveillance Slide42: Major Tropical Vector-Borne Diseases and Likelihood of Change with Climate Change SARS: SARS What is it? Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus. SARS was first reported in Asia in February 2003. In general, SARS begins with a high fever. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.
How is it Spread? The main way that SARS seems to spread is by close person-to-person contact, most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes.
The Global March of SARS: The Global March of SARS SARS Impact in Ontario: SARS Impact in Ontario Tracking Down the Animal Hosts of SARS: Tracking Down the Animal Hosts of SARS The first animals found with SARS-associated coronavirus were civet cats which are sold in exotic animal markets in Guangdong Province in China, where the SARS outbreak emerged.
Since the civet cat research, the SARS-associated coronavirus has been found in snakes, bats, and perhaps most importantly, wild pigs. Finding the virus in pigs is most disturbing because 30% of the original cases in Guangdong Province were in foodhandlers. Cost of SARS in Canada: Cost of SARS in Canada Healthcare System: As of June 27, 2003 SARS has cost the Ontario health-care system $945 million due to specialized protection facilities and supplies.
It has been estimated that the net cost of the outbreak to the national economy will reach between $1.5 billion and $2.1 billion. Slide48: Factors in Infectious Disease Emergence Slide49: Factors in Infectious Disease Emergence The Future?: The Future? “Of the some 5000 species of viruses known to exist in the world, we’ve characterized less than four percent of them. We’ve only characterized 2000 bacterial species…of an estimated 300,000 to one million thought to exist. Less than one percent of all ocean bacteria have been characterized.”
quoted in ‘The Coming Plague’ Slide51: “Canada's ability to contain an outbreak is only as strong as the weakest jurisdiction in the chain of P/T public health systems.”
“F/P/T collaboration has been inadequate in the realm of disease surveillance and outbreak management. Had the SARS outbreak mushroomed into a truly national epidemic, our lack of preparedness could have been disastrous.”
Health Canada's presence on the ground in Toronto was largely ``invisible.'' And it echoes the persistent criticism of front-line doctors who argued they were fighting a war without a general, because the Ontario government refused to appoint a single ``SARS Czar'' to run the show.
from ‘Learning From SARS’ Slide52: “…smallpox is a devastating biological weapon in an unimmunized human population. If you look at real world data from a 1972 outbreak in Yugoslavia, you find that the multiplier of the virus was ten: the first infected people gave it to ten more people, on average. Basically, if you don’t catch the first guy with smallpox before he kisses his wife, it goes out of control. We could be dealing with hundreds of thousands of deaths. It will absolutely shut down international trade, and it will make 9/11 look like a cakewalk. Smallpox can bring the world to its knees.”
Expert, NIH consulatation
‘The Demon in the Freezer’