Monday, 27 April 2009

Disease in a connected world

The threat of the spread of swine flu is understandably grabbing news headlines just now. Building on previous threats (bird flu and SARS) which have arisen in recent years, the media can be guilty of sometimes inflating the threat to apocalyptic proportions. The fact that people have already died in Mexico from the strain, and the fact that it has already popped up in so many different countries across the world heightens this situation.

Regardless of whether this particular strain of influenza turns out to present a large scale threat to the world or not, the situation highlights the threat that disease poses to us in the interconnected world we live in. The outbreak of flu in 1918 led to a pandemic which killed more than double the number that had been killed in the First World War. This was before the explosion in globalisation which has led to interconnectedness on a scale previously inconceivable.

At the risk of sounding alarmist, imagine the deadly possibilities of an outbreak of flu (or another disease) of the severity of 1918. The swine flu currently being observed seems to have an incubation period 0f 24-48 hours - other diseases can be even longer. This is more than enough time, particularly in the case of a disease with aerosol transmission, for an infected person to have travelled by plane from the country of infection to any where else on the globe, potentially infecting others on the plane with them so that by the time they land, possibly in a major population hub such as New York or London, there are already a number of infections.

Disease has always possessed the means to spread globally - the Black Death was an example of using rodents as a vector - and travel methods are often key to this spread. However, the nature of the world today makes this even easier. Indeed this is why health departments around the world are open about the fact that infections are inevitable - it is not a matter of stopping the spread but rather minimising its impact and health implications.

The monitoring of infectious disease is a key area where more work is required in order to ensure that information is shared to reduce the impact. One of the key issues with the spread of SARS was that there was a delay in alerting the world to its existence, by which it had moved outwith China's borders. It is very difficult to bring together different nations, particularly those whose political contexts make them wary of or hostile to other nations, however it is crucial in this context in order to allow for co-ordinated responses led by the WHO.

Disease is an issue which does not respect national sovereignty, and therefore a globalised response is essential in order to meet the challenges of global infection. Once this particular outbreak is responded to (going on the hopeful basis that its impact can be restricted - certainly the fact that it can be treated by certain drugs gives hope) it is important that the WHO is given more support in developing methods of reporting across the world. As we link up ever more closely we open doors to infectious diseases to spread across the world - it is vital that we respond to this challenge before we are met with a pandemic which could indeed be of apocalyptic size.

For more reading on this matter I would strongly recommend Promed Mail and the Coming Plague by Laurie Garrett. Promed in particular is an absolutely vital resource bringing together front line practitioners from across the globe, and has been at the forefront of responding to emerging situations in the manner that I have suggested we need more of above.

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