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1. New Findings on Links between Urban Expansion and Viral Disease in Vietnam Offer Lessons for COVID-19

Author:
James H. Spencer, Sumeet Saksena, and Jefferson Fox
Publication Date:
04-2020
Content Type:
Commentary and Analysis
Institution:
East-West Center
Abstract:
The current COVID-19 pandemic, which started in Wuhan, China, underscores what the public health community has warned about for more than two decades—the risk of viral diseases capable of spreading from animal to human hosts. The first outbreaks of “bird flu” (highly pathogenic avian influenza—HPAI, subtype H5N1)—raised similar concerns 20 years ago, concerns that have persisted with the outbreak of SARS in 2002–2004 and COVID-19 today. A recent study compared information on infrastructure and other aspects of economic development in Vietnam with outbreaks of avian influenza. While this research focuses on avian influenza in Vietnam, the study of links between infrastructure characteristics and new and reemerging health risks has broad applicability, especially given the global importance of today’s rapidly expanding urban landscapes.
Topic:
Infectious Diseases, Urban, and COVID-19
Political Geography:
China, Asia, and Vietnam

2. Bird Flu — It’s What’s for Dinner: What Human Population Growth and Climate Change Mean for the Future of Avian Influenza Outbreaks

Author:
Nahid Bhadelia
Publication Date:
07-2017
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
China is currently experiencing its fifth epidemic of “bird flu,” or avian influenza H7N9, since 2013 when it was first noted to cause human infections. The virus, which is mainly transmitted from poultry to humans, is also prone to limited human-to-human transmission. To date, there have been 1,258 human cases, with one-third of those cases (460) occurring during this year’s epidemic alone.[1] There are many “subtypes” of avian influenza circulating in birds around the world and most of these viruses cause limited or no human infections. However, two avian influenzas subtypes causing high human mortality have jumped from birds to humans in the last decade, H5N1 and then H7N9. The significant potential of this class of viruses to cause a human pandemic is a global public health concern, particularly because the conditions leading to the rise of these infections are becoming more favorable — for the viruses.
Topic:
Climate Change, Environment, Health, and Infectious Diseases
Political Geography:
China, Asia, and Global Focus

3. Antimicrobial Resistance as an Emerging Threat to National Security

Author:
Maxine Builder
Publication Date:
01-2015
Content Type:
Working Paper
Institution:
Atlantic Council
Abstract:
Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
Topic:
Health, National Security, Infectious Diseases, and Health Care Policy
Political Geography:
United States, China, United Kingdom, America, and Europe