Epidemic focus
This is a rapid ‘need to know’ spotlight on current infectious disease threats. It is not intended to be an exhaustive list of cases and outbreaks but a focus on reasons for concern about specific infectious diseases currently posing threats to global public health.
Global epidemic response: an evolving conversation
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Epidemic and pandemic diseases have threatened humans since before history began, but the ‘conversations’ that have brought about a collective response are a relatively new phenomenon.
In 1851, a cholera pandemic that raged across Europe prompted the first of a series of International Sanitary Conferences, aimed at better control of these outbreaks, culminating in the first International Sanitary Regulations (agreed in Paris 1912).
In the 1920s, the League of Nations Health service began issuing reports about pathogens considered a threat. By April 1926, this was established as a regular service, providing information about cases of what were then 5 notifiable diseases under the International Sanitary Regulations - cholera, yellow fever, plague, typhus, and smallpox- in what was then the first version of the Weekly Epidemiological Record.
Over the years, the list of notifiable diseases was reduced to four (plague, yellow fever, cholera and smallpox) under the revised International Health regulations (1969) then three by 1980 after successful vaccination campaigns eradicated smallpox in 1979.
But by 2007, after bird flu (H5N1) emerged in 1997, followed by severe acute respiratory syndrome (SARS) in 2003, the conversation changed. It was clear the world needed a different approach and the International Health Regulations (2005) developed an algorithm requiring countries to inform the WHO of any event potentially posing an international public health threat. Four criteria for such a threat were laid out: it had to be unusual, severe, likely to spread, likely to hamper international travel and trade. Under the IHR (2005) WHO should be notified of any infectious hazards, or chemical or radionuclear threats with these characteristics.
Such ‘conversations’ made better ‘listeners’ of many countries which established stronger surveillance systems. Better surveillance led to better identification of threats. At the same time, the increase in mobility, air traffic and urbanization made outbreaks spread faster and further. In 2014-2015, a total of 119 countries were threatened by 272 epidemic events due to pandemic and epidemic diseases.
However, in the ten years since the IHR (2005) were drafted, major global events such as H1N1 pandemic influenza 2009, MERs CoV , Ebola in West Africa, Zika virus in the Americas have shaken the world, injecting urgency into the conversation, creating demand for revision of international instruments governing global health.
In May 2016, a review undertaken to take stock of the implementation of the IHR (2005) was presented to the World Health Assembly (WHA). The results were mixed: the IHR (2005) are robust, but the implementation is uneven. Many pockets of vulnerability threatening global health security remain allowing, for instance, the unprecedented international spread of Ebola virus in 2014. The world is only as strong as its weakest links.
Recent epidemics of international concern are also shaping institutions and the global health landscape. Another feature of this year’s WHA was the establishment of new programme for outbreaks and health emergencies. This is a profound change in the function of the World Health Organization, establishing a new health emergencies programme to deliver rapid support to countries to prevent, detect and respond to emergencies. This demonstrates the interest and concern with which the international community views not only epidemics and pandemics as but all health emergencies such as humanitarian emergencies. This is a serious conversation indeed.