Critical Thinking in Global Challenges Week 4 Global challenge focus: Infection diseases, Dr Kim Picozzi
Welcome to the second week of this focus on infectious diseases. This week we are going to reflect critically on the advances that have been made in terms of controlling infectious diseases, and the hurdles that we continue to face. In order to put this into context I am going to share with you some of the key events and developments from a global health perspective that I feel have played a major role in forming my personal view of the current infectious disease landscape.
Later, I am going to ask you to work together on the discussion boards, and compare your own reflections to the ones that I have presented here.
Over the last 40 years there have been many changes with regards the global disease landscape, driven in part by the process of globalisation. The global population has almost doubled, from an estimated 3.7 billion in the early 1970s to more than 7 billion today. Many countries also now face a dual burden of disease with non-communicable conditions very much part of our daily lives.
I was born at a time when many childhood viral infectious, such as measles, mumps and chicken pox were common place and was exposed to and survived each infection. Vaccinations against whooping cough, dipetheria, polio and tetanus were however available and while small pox was still a disease risk in some areas of the globe, immunisations against this disease had ended in the UK many years earlier in 1948.
As we looked at last week, by the late 1970s many felt that infectious diseases could now be conquered, and that they were a relic of the past with no place in the 21st century. This story would suggest something rather different, with the first reports of the HIV virus being made in the early 1980s. Thirty years later around 34 million people are living with this infection and almost 30 million more have died; perhaps evidence enough to suggest that infectious diseases are not to be underestimated.
From my viewpoint in the UK, the late 1980s was marked by the emergence of Bovine Spongiform Encephalopathy, a infectious neurological condition in cattle that has been traced back to changes in
the processing of feedstock; consumption of infected meat has also been related to the an equivalent condition in humans. This 'out of the blue' disease event affected the countries economy with predicted loses of many billions of pounds. Later on in 2001, an outbreak of Foot and Mouth Diseases would have similar effects on trade and result in the destruction of around 2% of the national herd. As I mentioned last week, my interest do lie in both animal and human infection and these example help to highlight the economic, as well as personal costs, that such outbreaks can have.
With regards the emergence of infectious human diseases, there have been three pandemics in my lifetime, HIV (mentioned earlier), SARS, and H1N1; work at the University of Edinburgh has suggested that in Scotland it is estimated that almost half of the population may have had this infection, although many may not have realised it at the time. It is interesting to note that all three events can relate their origins to an animal reservoir.
While on this topic I would also like to highlight increases in the appearance of antimicrobial resistance. Once looked on as a 'silver bullet' many antibiotics are no longer as effective within the medical and veterinary setting. The continuing rate of socio-economic drivers such as population density, antibiotic drug use and agricultural practices have all been highlighted as causes for this increase, to the point that experts are now predicting the arrival of the post-antibiotic era.
There have been two disease eradication events in the last forty years, both against viral infections namely small pox by 1980 and Rinderpest in 2011. Rinderpest was an animal contagion, but for societies reliant on livestock for traction, income and protein, the impact of this cattle plague had been devastating.
Looking forward hopes are that both guinea worm and polio may also be conquered soon. The influence of the Millennium Development Goals, viewed by many as the world biggest promise to alleviate the suffering of poverty, will also be concluding in 2015, and the impact of this campaign are being felt on a global scale.
We must also consider the influence that climate change will have with regards infectious diseases. The transformation of ecosystems, following increases in temperatures and rainfall, may well provide suitable habitats for many insect vectors resulting in disease emergence in new and susceptible populations.
Finally, over the last 40 years there have also been two global recessions. You may wonder why I would choose to mention this fact in closing, the fears regarding falls in health investment are commonly voiced as such a time.
The emergence and spread of infectious diseases we have looked at today is intrinsically linked to our changing lifestyles resulting from globalisation
My infectious disease landmarks are based on my own recollections, there will be many other events that you will feel have been omitted, or events that you feel have a greater influence than those that I have highlighted. These will form the basis of our discussions over the next week. With scholars from so many different backgrounds I would like you to work on the discussion board to share your experiences and exchange information about what you feel are the key infectious disease events that have happened in your life time.