Globalization and Disease

Illustration by Mimi Shang

Illustration by Mimi Shang

In 2006, the United Nations reported a growing total of 232 million migrants in the world, who represent roughly 3 percent of the global human population. Population migration is a global affair due to its implications in the realm of public health. Throughout history migration and immigration have played major roles in the spread of infectious diseases at the regional, national and global scale.

Many anthropologists and historians argue that smallpox played a mammoth role in shaping the world as it decimated entire communities globally for over 3000 years until its cure was developed by Edward Jenner in 1796. A lack of effective prevention measures and treatments caused smallpox to be a class-blind disease that affected people of all socioeconomic statuses. Smallpox is perhaps most famously known for wiping out the Incas and the Aztecs when it was introduced to the Americas by Spanish Conquistadors.

Fortunately, the smallpox vaccine proved to be extremely effective and the disease was declared eradicated by the World Health Organization (WHO) in 1980. In the modern world, screening procedures for immigrant health is far more rigorous than it was in the 15th century but how would a disease like smallpox affect humans if it was accidentally reintroduced to a migrant population?

We live in a world that is more connected than ever before. People can travel around the world in under 48 hours for a few thousand dollars, and goods are shipped around the world nonstop. For a disease causing microbe the modern day is the best possible scenario to facilitate increased reproductions rates. A microbe can move around the globe in a manner that would have taken months or even years several decades ago. In addition there are millions of potential hosts conveniently packed in dense metropolises scattered throughout the seven continents. A contagion need only infect a few city dwellers in order to potentially grow at exponential rates. If a disease had this kind of mobility in the old world humans wouldn’t have stood a chance. We live under the constant fear of lethal diseases that may one day gain the ability to sweep across countries and wipe out millions of humans. But now we are armed with powerful medical technologies that are incredibly effective at combating these threats. We can only hope that we are able to advance our scientific knowledge and our ability to react and prevent these contagions at a faster rate than they find new means of infecting us.

The Ebola virus disease epidemic may have demonstrated to us that the World Health Organization is incapable of controlling disease outbreaks in less developed regions. Because Ebola has a fairly long incubation period, numerous cases went unreported and the disease reached the critical mass which was needed for large scale dissemination. The situation quickly spiraled out of control in Guinea, Liberia, Sierra Leone and other parts of West Africa. Ebola also threatened parts of Europe and the Americas when cases were reported in France, Spain, Brazil and the United States. Smallpox was endemic in India for at least 2000 years, whereas Ebola was spread across continents in the span of a few months.

When asked about the cause for the rapid spread of the Ebola virus Dr. Peter Benson, Associate Professor of Sociocultural Anthropology at Washington University in St. Louis, said, “I don’t think the WHO and the International community did enough. If the responses had been quicker and more robust they would have limited the outbreak.”  Professor Benson does not agree with assumptions that the outbreak would have occurred regardless of intervention, and thinks that a swifter intervention would have been successful in mitigating the spread. He also stated that another cause for the bad outcome was a lack of public health infrastructure in some countries in the form of infectious disease surveillance and effective treatments.

There is a stark contrast between how Ebola was handled when it was ravaging West African Countries and when handful of cases presented in the United States. Different organizations like the WHO and the CDC have protocols in place to enable them to respond to disease outbreaks around the world. But in the face of a global threat there is a question of where priorities lie and where resources should be distributed. When Ebola was discovered in Dallas there was a coordinated response from numerous medical professionals to ensure that the situation did not escalate. Over a hundred people who may have had contact with the infected man were closely monitored to make certain that the virus was contained, even so two nurses were declared Ebola positive and spent time in quarantine. This Ebola incident gained a lot of publicity and many people questioned the effectiveness of protocols meant to regulate such occurrences. If the same level of vast public health infrastructure and mobilization of health care resources that was seen for one case in the U.S could be mirrored in West African countries this health crisis could have turned out very differently.

Often members of developed countries can be insulated from the realities of the rest of the world. As a result the important goal of making exceptional health care equally available to people all around the world becomes a lower priority. What we often forget is that the fight isn’t “X” Disease against Sierra Leone, India, or Brazil, but “X” Disease against Humankind. It should now be apparent to us that a disease thousands of miles away can effortlessly find its way into our own country. The solution is not to bar ourselves from the rest of the world, but instead we must work to improve global medical infrastructure. The WHO’s response to cases of Avian Flu among Asian poultry farmers is an example of how international health measures can potentially prevent epidemics. Avian Flu, specifically the deadly H5N1 strain, is a disease that mainly affected bird populations, but people that had regular contact with bird populations were at a high risk of contracting the disease. A majority of the world didn’t need to fear this disease, but yet there were major efforts supported by many countries around the world to contain the endemic through means such as culling. If this flu variant was to gain the ability to transmit between humans through interactions with human flu variants it would be a deadly killer. Such an ability would turn the Avian Flu into a major global concern very quickly.

The International Society of Travel Medicine maintains a global surveillance network known as GeoSentinel in partnership with the CDC. This program collects data from travel/tropical medicine clinics in order to identify “geographic and temporal trends in morbidity among travelers, immigrants and refugees”. The efficient dissemination of information is crucial in order for proper medical assistance to be provided in areas where it is most needed. Reliable information gives international medical professionals the ability to provide quicker responses in a manner comparable to places like the United States. Dr. Benson said, “Whenever we see a massive humanitarian disaster. Health crisis. Outbreak. I think it is fair to say there is a failure on the part of the international community.” Developing countries cannot be expected to implement world class medical technologies on their own. Developed countries have a responsibility to do everything in their power to prevent disasters before they have the opportunity to arise so that human travel can remain safe and the global community can continue to be strengthened.

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