Globalisation and Emerging Infectious Diseases (Draft 2)

“Today, diseases as common as the cold and as rare as Ebola are circling the globe with near telephonic speed, making long-distance connections and intercontinental infections almost as if by satellite. You needn’t even bother to reach out and touch someone. If you live, if you’re homoeothermic biomass, you will be reached and touched” (Angier, 2001).

Introduction:

In his TED talk, Goldin (2009) mentions that globalisation has caused the world to become more complex and functionally integrated. This means that local events may have global consequences. Globalisation, the increase of “flows and influences of capital and goods, information and ideas, and people and forces, as well as environmentally and biologically relevant substances” across multi-continental distances, has facilitated the spread of emerging infectious diseases around the world (Keohane & Nye, 2000). Using the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 as a case study, this essay seeks to discuss that contemporary globalisation has resulted in greater human mobility which contributes to the spread of the virus to 37 countries within weeks. This essay will also evaluate the measures taken to tackle this global health threat.

Human mobility:

Armelagos and Harper (2010) assert that we are witnessing a re-emergence of infectious diseases due to anthropogenic factors. As a result of globalisation and technological advances, more people are becoming mobile with the ability to travel more frequently as well as visit areas that used to be remote and inaccessible (Wilson, 2007). According to the World Tourism Organization (2014), more than a billion tourists travelled outside their countries in 2013. This is notwithstanding the undocumented travellers, internal migrants and the millions more who crossed national borders for other reasons.

With a highly efficient transportation system, it is now possible to reach most places in the world within two days which corresponds with the incubation period of most infectious diseases (Wilson, 2007). Incubation period is defined as the “time between catching an infection and symptoms appearing” (NHS, 2014). Furthermore, travel often involves multiple shared spaces such as airplanes and hotels, where people from different origins congregate together before moving to different destinations. These networks of global travel become conduits for pathogen transmissions, allowing infectious diseases to spread quickly and extensively.

The rapid dispersal of SARS in 2003 is an apposite example of how the world’s interconnectedness has facilitated the spread of the virus. SARS first appeared in Guangdong province of China on November 2002 and was subsequently reported outside of the country on March 2003. The outbreak was traced back to a Chinese doctor who had been treating patients with ‘atypical pneumonia’ in Guangdong and stayed on the ninth floor of Hong Kong’s Metropole Hotel. Other international guests who stayed on the same floor soon became infected with the virus. These guests who felt well at the beginning travelled out of Hong Kong, bringing the virus into Canada, Vietnam and Singapore. In the next few months, SARS spread to other countries in the Asia-Pacific region, Europe, North and South America. By the time the outbreak was contained, there were a total of 8,437 known cases with 813 fatalities (Mwambi & Zuma, 2007).

Responding to SARS:

In response to the outbreak, the World Health Organization (WHO) (2003b) issued an international health warning on SARS and travel advisories to regions affected by the virus on March 2003. The agency also recommended screening of air passengers departing from certain affected areas in an attempt to prevent travel-related spread of SARS (World Health Organization, 2003c).

The SARS outbreak highlighted limitations the WHO encountered in identifying and controlling its spread. Based on international health regulations in 2003, countries were only required to notify the agency of yellow fever, cholera and plague outbreaks (Federation of American Scientists, 2003). It then had the authority to intervene and restrict trans-boundary movements. With other diseases however, the WHO can only take on an advisory role which means that the organisation has a limited ability to respond to SARS. The global health threat was exacerbated when the Chinese government failed to report promptly and openly about SARS (Huang, 2004). Moreover, not everyone is willing to cooperate with WHO’s guidelines. For instance, despite being suspected of having SARS, a man still managed to board his plane (Federation of American Scientists, 2003). While some view freedom of movement as a human right, others question the ethics in issuing SARS related travel advisories or compulsory quarantines (Paquin, 2007; Teo, Yeoh & Ong, 2005).

Since 2003, the WHO (2003a) has taken a stronger role in coordinating and leading the fight against any infectious disease that threatens global health. This can be seen in 2013, when a new SARS-like virus was promptly reported to the WHO which later issued an international alert (Sutton, 2013). I believe that with global cooperation and mobilisation, global health security can be enhanced when “global solidarity is placed above national sovereignty” (Heymann, 2006). As individuals, we can all play a part by being responsible global citizens who prioritise societal rights over individual liberties in the event of an outbreak.

Conclusion:
Diseases transcend boundaries. As the world becomes more complex coupled with the unprecedented volume, reach and speed of human mobility, the risk of emerging infectious diseases transmitting around the world is set to rise. However, the very interconnectedness that allows pathogens to spread globally offers mechanisms to address global health threats. With the WHO spearheading medical responses around the world, countries’ governments have to do their part by making disease surveillance and response a priority.

References:

Angier, N. (2001, May 6). Case study: globalization; location: everywhere; Together, in Sickness and in Health. The New York Times. Retrieved from http://www.nytimes.com/2001/05/06/magazine/1-case-study-globalization-location-everywhere-together-sickness-health.html

Armelagos, G. J., & Harper, K. N. (2010). Emerging Infectious Diseases, Urbanization, and Globalization in the Time of Global Warming. In W. C. Cockerham (Ed.), The new Blackwell companion to medical sociology (pp. 289 – 311). Oxford, UK: Wiley-Blackwell.

Federation of American Scientists. (2003). SARS: Down But Still a Threat. Retrieved from https://www.fas.org/irp/nic/sars.html

Goldin, I. (2009). Navigating our global future. Retrieved from http://www.ted.com/talks/ian_goldin_navigating_our_global_future

Heymann, D. L. (2006). SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity. Annals of the Academy of Medicine, 35(5), 350-353.

Huang, Y. (2004). The SARS epidemic and its aftermath in China: a political perspective. In S. Knobler, A. Mahmoud, S. Lemon, A. Mack, L. Sivitz and K. Oberholtzer (Eds.), Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary (pp. 116-136). Washington, DC: National Academic Press.

Keohane, R. O., & Nye, J. S. (2000). Globalization: What's New? What's Not? (And So What?). Foreign Policy, Spring(118), 104 – 119.

Mwambi, H. G., & Zuma, K. (2007). Mapping and Modeling Disease Risk Among Mobile Populations. In Y. Apostolopoulos & S. Sönmez (Eds.), Population Mobility and Infectious Disease (pp. 245 - 266). New York, NY: Springer.

NHS. (2014). What are the incubation periods for infections? Retrieved from http://www.nhs.uk/chq/Pages/1064.aspx?CategoryID=200&SubCategoryID=2001

Paquin, L. J. (2007). Was WHO SARS-related travel advisory for Toronto ethical? Canadian Journal of Public Health, 98(3), 209.

Sutton, R. (2013, August 26). What ever happened to SARS?  Retrieved from http://www.sbs.com.au/news/article/2013/03/09/what-ever-happened-sars

Teo, P., Yeoh, B. S. A., & Ong, S. N. (2005). SARS in Singapore: surveillance strategies in a globalising city. Health Policy, 72(3), 279-291.

Wilson, M. E. (2007). Population Mobility and the Geography of Microbial Threats. In Y. Apostolopoulos & S. Sönmez (Eds.), Population Mobility and Infectious Disease (pp. 21-39). New York, NY: Springer.

World Health Organization. (2003a). Chapter 5: SARS: lessons from a new disease. Retrieved from http://www.who.int/whr/2003/chapter5/en/index5.html

World Health Organization. (2003b, April 23). WHO extends its SARS-related travel advice to Beijing and Shanxi province in China and to Toronto, Canada. Retrieved from http://www.who.int/mediacentre/news/notes/2003/np7/en/

World Health Organization. (2003c, March 27). Update 11 - WHO recommends new measures to prevent travel-related spread of SARS. Retrieved from http://www.who.int/csr/sars/archive/2003_03_27/en/

World Tourism Organization. (2014, January 20). International tourism exceeds expectations with arrivals up by 52 million in 2013. Retrieved from http://media.unwto.org/press-release/2014-01-20/international-tourism-exceeds-expectations-arrivals-52-million-2013