Global mobility part 2

Identify a disease outbreak at a global scale, such as H1N1 or SARs, including its rate of spread and patterns of outbreak
distribution
Case study of the role that one NGO has played in dealing with a disease outbreak within one country at national and
local level.

1) Describe the distribution of H1N1 globally ( what doe this classify the disease as? Epidemic or pandemic? )

H1N1 is a pandemic that is affecting countries globally, the countries with the largest no of cumulative cases (501 or more ) are the Australia, China, N
& S America.

Focused on ACs– Spreading through highly populated areas with high levels of global mobility ( lots of flows of people) – cities more than rural areas
( more interconnected)
 First emerged in Mexico – neighbourhood effect

LIDCs in Africa (central in particular) and central Asia have very low cases – not very interconnected.

2) Suggest 3 disadvantages of this data presentation technique

Perhaps not as accurate as there could be some cases that are not reported to WHO
Doesn’t give the exact value of the no of cases or deaths per country – no absolute figures. Also figures are cumulative and not per capita.
Ranges in the key are quite large – big differences so 2 countries could have the same colour but have different levels of the disease. 1010 and more
could be massive ?! don’t know the full scale
2009 data – could be out of date – could still be spreading so this may not be the full picture.
Doesn’t state whether the countries that are blank mean that there is no cases or that data hasn’t been collected from there yet – incomplete
Choropleth map at national scale – cant see differences within the countries eg USA/China/Canada – not showing regional variations.

Quick task – textbook p.354

A: where did H1N1 start?
In April,2009, H1N1 was identified in Veracruz state in Mexico.

B: when was it declared a) global health issue and b) pandemic?

WHO declared H1N1 a international public health emergency in April, and then in June it was declared a pandemic has it had spread to 74 countries.

C: how many waves of the disease in the UK? ( and why do you think? )
There were 2 peaks ; in July and October. Seasonal affects due to winter.
 D: Death toll globally and other useful stats?
Official figures quote 18,000 deaths but based on lab-conformed deaths. Total mortality estimates by the end of 2010, - 151,700 to 575,400. And WHO
suggests an average of 284,500 deaths.
½ of all deaths were reported in Africa and Southeast Asia where the number of cases ranged from 43 million to 89 million.

Video notes

Originated in Mexico – and it affected its neighbouring countries – N.America and S.America. It affected HIC, due to
the fact that they are more interconnected through travel and trade.

The last few countries affected were Greenland and North West Africa.

A lot of cases and deaths in S.America generally due to closer proximity to outbreak ( neighbourhood effect )

Spread fast ( due ot air travel – see in ACs worst hit in terms of incidence rates ) WHO classified as pandemic fairly
quickly

Pandemic status is based on geographical distribution NOT severity of disease.

Rates lower in SE Asia – Western/central Africa – less globally mobile areas – less vulnerable to a disease spreading –
Central Asia.

Discussion points:
• How does H1N1 link to increasing global mobility? Which places are most at risk of disease diffusion due to increased mobility ?

Increased global mobility = increased spread of H1N1 ( Globalisation )

More at risk = ACs as they are more interconnected and neighbouring countries ( neighbourhood effect )
Cities / urban areas – bigger pop density and more flows of people
 • How important is the WHO in cases such as this? Which places get most benefit due to increased mobility ?
Not incredibly important. Their role is to raise awareness ( could be done anyway ?) Didn’t enforce a travel ban – so they didn’t actually do much.
As cases were mainly in ACs and the WHO mostly supports LICs they didn’t have a big role to play.
Records incidence and mortality rates.

• Offer arguments for a travel ban associated with communicable diseases like H1N1 ( influenza )

Travel ban would reduce infections / spread – reduce the flows of people – stop international spreads ( contain it within fewer countries ) therefore it ca be
tackled on a national level rather than international ( and evidence suggests that national scale eradication is the most effective )( China did impose a travel
ban in this instance)

• Why do you think the WHO did not advocate for a travel ban?
It will slows economic activity / trade / growth.
Could be difficult if LIDCs need aid – slows this down
Stops tourism ( key source of income)
May mean that countries are not co-operating as closely
Social impacts – isolated / challenges associated with this
Extension activity – how could COVID be used as another c/s to illustrate this point - spend 15 minutes doing
some research on which countries have been most significantly affected and where the disease spread to first (and
where it took a long time to spread to?!)

USA

Italy – elderly pop – ho9t early less time

African countries

The H1N1 Virus: Varied Local

Responses to a Global Spread
Pandemics are global but political calculation to confront them
is decidedly local
Tuesday, September 1, 2009

Draconian safeguards: Chinese health officials inspect an arriving

foreign aircraft; tough measures are popular with citizens
 NEW YORK: Apart from killing at least 2,185 people worldwide, the H1N1 virus – popularly known as the Swine Flu – has sown great confusion
and more than normal uncertainty about the future. Despite declaring that the flu has become a pandemic – meaning a global threat – the World
Health Organization has advised against travel restrictions. More bizarrely, China which once earned the WHO’s opprobrium for its secretive and
lackadaisical approach during the SARS crisis, is now ignoring the world body’s advice to set up stringent travel barriers. Is China right and what
can be done to prevent further havoc by the virus are the questions that occupy health officials and the public world over. An answer to the last
question may not be known until autumn comes to the Northern hemisphere. At this point, the Chinese approach seems to have had more
impact on the country’s political life, than on the health of its citizens.

On May 1, even though no single confirmed case was found, the government suspended direct flights from Mexico to Shanghai. For more than
two months, it was the only country conducting on-board temperature What has the WHO done in response to H1N1? How has China reacted?
checks and quarantining groups of passengers. By early July, China had What does this suggest about the strength of control of the WHO ?
thrown tens of thousands people – including foreign school children on
summer vacation – into government designated facilities.  the World Health Organization has advised against travel
restrictions. China ignored and set up stringent travel barriers.
This draconian approach to disease control The article suggests a travel ban is not effective.
flew in the face of the World Health Why? WHO can only ever advise does not have legal power.
Organization’s explicit advice against travel
restrictions. Since both exit screening and WHO study which showed that travel
travel bans were recommended by the same restrictions did not delay transmission of
organization during the 2003 SARS epidemic, SARS
the new WHO advice has drawn sharp
criticism from some of Asia’s leading
scientists. In crediting travel restrictions with
containing the spread of SARS, the critics
nonetheless forgot a 2004 WHO study which
showed that travel restrictions did not delay
transmission of SARS. The influenza virus
poses a particular challenge for border
screening: unlike SARS, it can be transmitted by carriers without any outward symptoms.
The influenza virus is much more infectious, and moves too fast to be contained in the
same way as SARS. No wonder that less than a third of the cases in China were identified
through stringent border screening measures. 

Give 2 reasons why countries may be reluctant to
implement a travel ban:
Effect the economy – affecting travel and trade
Not only do the travel restrictions and quarantine measures have limited benefit in stopping the
spread of disease, but they also generate disturbing effects on the already bruised world economy,
affecting travel and trade, dissuading the very kind of transparency and openness essential for a
global response to disease outbreaks. Mexico, which like China imposed drastic social distancing
measures, incurred the cost of $2.3 billion in the first week after the outbreak. Draconian and
intrusive pandemic control may also undermine a country’s surveillance capacity – people who show symptoms might choose to shun public
health authorities for fear of quarantine or stigmatization. Worse, these measures squandered limited health resources reserved for more
severely virulent microbes. As Laurie Garrett of the Council on Foreign Relations has noted, by July signs of fatigue and resource depletion had
already set in most of the world. 

Case study of the role that one NGO has played in

dealing with a disease outbreak within one country
at national and local level.

Using p.355/356, explain how the British Red Cross helped

mitigate cholera in Haiti.
 - Delivering clean drinking water to 300,000 people living in camps in Port -au-Prince.
- A massive hygiene program, building 1300 latrines serving 250,000 people.
- Providing medical supplies to the main hospital in Saint Marc in the affected area.
- Treating 18,700 cases of cholera in treatment units in La Piste camp in Port-au-Prince and in Port-a-Piment camp in Southwest Haiti.
- Raising awareness among local people on how to avoid infection and of the characteristic symptoms of cholera. Volunteers went from door to door
informing people how to keep safe. Local radio, newspapers and other media also used to reach as many people as possible.

What impacts did this intervention have? Give specific details.

Thanks to the efforts of the British Red Cross, the cholera epidemic was brought under control. In 2011 there were 35,000 new cases a month; by 2014 this
figure had fallen to 2200.

Discussion – PLACE. Haiti is an LIDC. It benefits from increased global mobility more than it loses out. Do you agree with this statement? Why?

Predominately yes, as if a problem were to arise like a natural disaster or a disease outbreak, global mobility has allowed aid to be given in Haiti almost
instantly in the form of people, ideas, technology.
Easier to receive aid
More at risk likely o receive disease diffusion, LIDCs capability to combat that lower.

TIME- is the reliance on aid agencies like the British Red Cross a good long term strategy? Why?

Not a good long-term strategy since the aid results in the receiving country to become heavily reliant. Can’t economically grow. -
In terms of food aid – When aid is given to LIDCs in the form of food, the local farmers go out of business as they are unable to sell their crops due to
competition - and thus they can no longer carry on their business to supply the nation with food and it results in a food shortage which results in foreign food
aid. A positive feedback loop – that keeps people in the cycle of poverty.

Short term yes – as it can simply save lives.

Proper sanitation and latrines / clean water – decent water management infrastructure – this will solve the problem – lack of money/investment to do this –
so you nee dmoeny/ investment to do this – decent governeace – you need people willing to build it.

Extra reading from Red Cross website:

1) How many CTCs and CTUs and why important?

 Haiti – made chloroeo exist.

Yes for LIDCs – not able to combat very well due to low money.

Talk about how they can't change the infrastructure of the area cos the government has to do that

Increasing global mobility makes disease risk worse. TWE do you agree?

Conclusion / key argument