Communicable Disease Outbreaks Research Articles

Preventive health care and life style management

The primary cause of death worldwide has shifted in the recent century from communicable diseases to non-communicable diseases. The public health systems continue to face difficulties as a result of outbreaks of communicable diseases. It is acknowledged that changes in human behaviour and lifestyle are risk factors for the current public health issues, which have a substantial impact on wellness and quality of life. In addition to helping to prevent and treat diseases, leading a healthy lifestyle is essential for promoting overall wellbeing. Evidence-based methods for managing one's lifestyle have been made available by modern medicine, yet doing so successfully presents difficulties. The traditional practices of Ayurveda, Yoga, and Meditation appear promising as complementing methods to promote social welfare. The author puts up a fresh viewpoint and model dubbed "Integrative Lifestyle" that is based on data from both contemporary and conventional methods of lifestyle management. Ayurveda has made significant contributions to both the prevention and treatment of ailments. A healthy lifestyle might include behaviour that are outlined in depth in Ayurveda, such as Dincharya (conducts during the day), Ratricharya (conducts during the night), Ritucharya (seasonal conducts), Ahara Vidhi (diet guidelines), and Sadvritta (excellent conducts), among others.

Microfluidic systems for infectious disease diagnostics.

Microorganisms, encompassing both uni- and multicellular entities, exhibit remarkable diversity as omnipresent life forms in nature. They play a pivotal role by supplying essential components for sustaining biological processes across diverse ecosystems, including higher host organisms. The complex interactions within the human gut microbiota are crucial for metabolic functions, immune responses, and biochemical signalling, particularly through the gut-brain axis. Viruses also play important roles in biological processes, for example by increasing genetic diversity through horizontal gene transfer when replicating inside living cells. On the other hand, infection of the human body by microbiological agents may lead to severe physiological disorders and diseases. Infectious diseases pose a significant burden on global healthcare systems, characterized by substantial variations in the epidemiological landscape. Fast spreading antibiotic resistance or uncontrolled outbreaks of communicable diseases are major challenges at present. Furthermore, delivering field-proven point-of-care diagnostic tools to the most severely affected populations in low-resource settings is particularly important and challenging. New paradigms and technological approaches enabling rapid and informed disease management need to be implemented. In this respect, infectious disease diagnostics taking advantage of microfluidic systems combined with integrated biosensor-based pathogen detection offers a host of innovative and promising solutions. In this review, we aim to outline recent activities and progress in the development of microfluidic diagnostic tools. Our literature research mainly covers the last 5 years. We will follow a classification scheme based on the human body systems primarily involved at the clinical level or on specific pathogen transmission modes. Important diseases, such as tuberculosis and malaria, will be addressed more extensively.

Continuity planning for public health crises: Designing workplace redundancies for organizational resilience.

Continuity planning prepares organizations to maintain essential functions despite disruptions to critical infrastructure that occur during crises. Continuity planning is especially important for Public-Safety Answering Points (PSAPs), which must prepare to answer 911 calls and dispatch first responders in all-hazard environments, including public health crises such as the COVID-19 pandemic. However, continuity planning typically focuses on disruptions to cyber-physical infrastructure rather than social infrastructure disruptions that occur when outbreaks of communicable disease limit the ability of essential personnel to perform an organization's essential functions. Reporting findings from interviews with US officials, this study examines how PSAPs decentralized essential personnel by designing redundant workplaces during the COVID-19 pandemic. Realizing existing continuity plans prepared PSAPs to relocate and recentralize essential personnel in a single, shared workplace, officials developed new plans to protect and decentralize telecommunicators across multiple, separate workplaces. To do so, PSAPs achieved passive, standby, and active workplace redundancies that recommend continuity planning objectives and requirements for organizations preparing for future public health crises.

Chickenpox Outbreaks in Three Refugee Camps on Mainland Greece, 2016-2017: A Retrospective Study.

Displaced populations face disproportionately high risk of communicable disease outbreaks given the strains of travel, health care circumstances in their country of origin, and limited access to health care in receiving countries. Understanding the role of demographic characteristics in outbreaks is important for timely and efficient control measures. Accordingly, this study assesses chickenpox outbreaks in three large refugee camps on mainland Greece from 2016 - 2017, using clinical line-list data from Médecins du Monde (MdM) clinics. Clinical line-list data from MdM clinics operating in Elliniko, Malakasa, and Raidestos camps in mainland Greece were used to characterize chickenpox outbreaks in these camps. Logistic regression was used to compare the odds of chickenpox by sex, camp, and yearly increase in age. Incidences were calculated for age categories and for sex for each camp outbreak. Across camps, the median age was 19 years (IQR: 7.00 - 30.00 years) for all individuals and five years (IQR: 2.00 - 8.00 years) for cases. Males were 55.94% of the total population and 51.32% of all cases. There were four outbreaks of chickenpox across Elliniko (n = 1), Malakasa (n = 2), and Raidestos (n = 1) camps. The odds of chickenpox when controlling for age and sex was lower for Malakasa (OR = 0.46; 95% CI, 0.38 - 0.78) and Raidestos (OR = 0.36; 95% CI, 0.24 - 0.56) when compared Elliniko. Odds of chickenpox were comparable between Malakasa and Raidestos (OR = 1.49; 95% CI, 0.92 - 2.42). Across all camps, the highest incidence was among children zero-to-five years of age. The sex-specific incidence chickenpox was higher for males than females in Elliniko and Malakasa, while the incidence was higher among females in Raidestos. As expected, individuals five years of age and under made up the majority of chickenpox cases. However, 12% of cases were teenagers or older, highlighting the need to consider atypical age groups in vaccination strategies and control measures. To support both host and displaced populations, it is important to consider risk-reduction needs for both groups. Including host communities in vaccination campaigns and activities can help reduce the population burden of disease for both communities.

Developing the risk-based model of scheduled sanitary-epidemiologic control of prepared food providers

The relevance of the study is determined by a substantial change in the structure of services offered by prepared food providers and a growth in outbreaks of communicable diseases due to violations of the mandatory sanitary-epidemiological requirements by prepared food providers and nutrition units in establishments. The aim of this study was to develop the methodical support for the risk-based model of the sanitary-epidemiological control over economic entities operating as prepared food providers. The study was accomplished following the enquiry of the RF Chief Sanitary Inspector. The general principles of risk calculation and identification of risk categories of an economic activity and production facilities remaining intact, a suggestion is to take a value of a temporary exposure criterion for prepared food providers as equal to 1.0 when determining numbers of exposed population. This is justified since a time of a contact with a potential infectious agent in food is of no significance. In addition to that, the model development entails mandatory consideration of population with risks of negative exposures due to consuming food offered by takeaways. The study results indicate that consideration of takeaway food and correct consideration of people’s contacts with a potentially hazardous infectious agent lead to a substantial increase in levels of health risks. Accordingly, there is a growth in the share of economic entities, which, according to potential risks of health harm for consumers, can be assigned into the categories of ‘extremely high risk’ and / or ‘high risk’ (from 1.3 to 8.2 % and from 1.7 to 32 % accordingly in the Perm oblast and Moscow oblast as two pilot regions).The resulting structure of risk categories economic entities are assigned into is more adequate to the current sanitary-epidemiological situation in the country and provides reliable protection for consumers’ health. The prospects of the model development involve accumulation and science-intense analysis of digital branch and interdepartmental data on the branch functioning, results of control and surveillance activities, and health impairments in population associated with risk factors typical for activities performed by prepared food providers.

Cовершенствование риск-ориентированной модели планового санитарно-эпидемиологического контроля деятельности объектов общественного питания

The relevance of the study is determined by a substantial change in the structure of services offered by prepared food providers and a growth in outbreaks of communicable diseases due to violations of the mandatory sanitary-epidemiological requirements by prepared food providers and nutrition units in establishments. The aim of this study was to develop the methodical support for the risk-based model of the sanitary-epidemiological control over economic entities operating as prepared food providers. The study was accomplished following the enquiry of the RF Chief Sanitary Inspector. The general principles of risk calculation and identification of risk categories of an economic activity and production facilities remaining intact, a suggestion is to take a value of a temporary exposure criterion for prepared food providers as equal to 1.0 when determining numbers of exposed population. This is justified since a time of a contact with a potential infectious agent in food is of no significance. In addition to that, the model development entails mandatory consideration of population with risks of negative exposures due to consuming food offered by takeaways. The study results indicate that consideration of takeaway food and correct consideration of people’s contacts with a potentially hazardous infectious agent lead to a substantial increase in levels of health risks. Accordingly, there is a growth in the share of economic entities, which, according to potential risks of health harm for consumers, can be assigned into the categories of ‘extremely high risk’ and / or ‘high risk’ (from 1.3 to 8.2 % and from 1.7 to 32 % accordingly in the Perm oblast and Moscow oblast as two pilot regions).The resulting structure of risk categories economic entities are assigned into is more adequate to the current sanitary-epidemiological situation in the country and provides reliable protection for consumers’ health. The prospects of the model development involve accumulation and science-intense analysis of digital branch and interdepartmental data on the branch functioning, results of control and surveillance activities, and health impairments in population associated with risk factors typical for activities performed by prepared food providers.

Pandemic Preparedness in the Aged Care Sector: A systematic literature review

Infectious disease outbreaks in aged care services present challenges for consumers and staff. The vulnerability of users of aged care services and a lack of preparedness on the part of aged care services to manage the risk associated with viral disease transmission was particularly evident during the COVID-19 pandemic.We used the PRISMA Method to review the available literature systematically. This qualitative review of the literature on pandemic preparedness assessed eight high-quality research papers and identified themes that emerged to support aged care services in preparing for future pandemics. These articles provided insight into what aged care services require to increase their capacity to respond to communicable disease outbreaks.Four themes emerged from the literature reviewed: Staff Training and Development, Safety Culture, Creating a Safe Environment by planning for contingencies and Risk and Resource Management (including resourcing for Personal Protective Equipment (PPE), Leader Presence and Time Responses and Clear, Consistent Messaging) were the dominant themes in the literature. The researchers found that using guidelines and checklists is helpful but only if they are clear, not complex and do not take too long to read. Risk strategies in future must also focus on the resources required to protect staff, families, and consumers. This paper also provides recommendations that will allow aged care services to respond to future communicable disease outbreaks more effectively. Such measures include the need for a planning methodology that incorporates ready access to PPE, the use of meaningful communication, increased hazard and risk awareness and the need to create a safety culture within the service based on sound values, attitudes and behaviours of leaders and staff.

A History of COVID-19 Handling in Indonesia: A Review of Legal Strategies

Objective: To combat the Covid-19 pandemic of 2020-2022, the Indonesian Government may use legal politics. Due to this, its legal politics should adhere to the philosophical, sociological, and juridical foundations outlined in Indonesia's health laws and regulations.   Method: Literature reviews were conducted throughout this article to research and interpret health laws and regulations, as well as policies governing infectious disease outbreaks. Normative juridical principles are incorporated into writing as well as qualitative analysis.   Result: The result of this study indicates that Indonesia's Legal Politics or Legal Policies are not only aimed at preventing health problems, but also at anticipating how the Covid-19 pandemic will impact state finances and stabilize the national economy. As a result, the Government chooses legal policies that combine the Health Constitution, Communicable Disease Outbreak Constitution, Regional Emergency Constitution, and Disaster Management Constitution. Covid-19's legal policies are intended to prevent health problems as well as anticipate state finances' effects.   Conclussion: It can be concluded that the Legal Politics or Legal Policies chosen by the Government of Indonesia in dealing with Covid-19 are not only focusing on the health problem alone but also anticipating the financial consequences and impact of the Covid-19 pandemic on the state's budget and stabilization of the national economy.

Attitudes and perceptions toward COVID-19 virus and vaccines among a Somali population in Northern Wisconsin.

The study's aim was to gain a qualitative understanding of vaccine beliefs and attitudes toward COVID-19 among Somali residents living in Northern Wisconsin (WI). While vaccination rates are significantly lower among Black and Hispanic populations, those with lower educational levels, and in rural areas, minimal is known about Somali population perspectives of COVID-19 vaccination rates. Through qualitative methodology employing focus groups for data collection and the inclusion of Somali interpreters, we explored Somali community viewpoints regarding these topics. Focus group interviews were transcribed verbatim with subsequent transcripts reviewed and analyzed by the research team to identify themes. The overarching theme was Protecting self, others, and community. Most participants accepted vaccinations, and the COVID-19 vaccine specifically, to protect themselves, others, and their community. Factors contributing to vaccine update included trusting local messengers, including public health nurses; valuing collective memory associated with previous communicable disease outbreaks; believing religion supported vaccine protective actions; and following recommended government and media advice. Study results suggest strategies for increasing community outreach to newly resettled refugee and immigrant minority groups, establishing trust between community members, nurses, and other public health personnel, and facilitators for connecting health messaging to Somali cultural and religious beliefs to promote public health and safety.

COVID-19 health and safety challenges on construction sites: unfolding novel dimensions for construction industries in developing countries

A sudden COVID-19 outbreak has significantly impacted construction site health and safety (H&S). Against this backdrop, this paper aimed to explore the major challenges for pandemic management in implementing COVID-19 H&S measures on construction sites, particularly in developing countries. Following a comprehensive literature review, a total of 20 relevant challenges were identified. A self-completion questionnaire survey involving Malaysian construction practitioners was further employed to prioritize these challenges using descriptive statistics. Finally, a factor analysis unfolded five major underlying dimensions of these challenges, relating to lack of resources and inherent nature of construction, negligence and ignorance, low-wage blue-collar workforce, ineffective H&S management and poor sanitizing and disinfecting strategies. This work is a valuable reference in assisting industry practitioners to further enhance H&S performance during a communicable disease outbreak such as the COVID-19 pandemic. In particular, the findings highlighted the current deficiencies of the H&S system in the context of a developing country and the necessity to devise responsive strategies in curbing the transmission of future diseases.

Ethical conflicts experienced by community nurses: A qualitative study.

Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. To identify ethical conflicts experienced by community nurses. Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.

Methicillin-resistant Staphylococcus aureus (MRSA) clusters in neonatal intensive care units (NICUs) and other neonatal units in New York State (NYS), 2001 to 2017

New York State (NYS) mandates reporting of all hospital-associated communicable disease outbreaks. We describe trends in NYS surveillance for neonatal unit methicillin-resistant Staphylococcus aureus (MRSA) outbreaks, the evolution of national MRSA infection prevention and control (IPC) recommendations, and IPC measures taken by NYS neonatal units. We evaluated trends of reported neonatal unit MRSA outbreaks by etiology from 2001 to 2017. We reviewed all reports and the use of IPC recommendations over time. From 2001 to 2017, 124 MRSA outbreaks were reported in 47 hospital neonatal units, with a total of 1,055 laboratory-confirmed infant cases, 18 infant deaths, and 52 laboratory-confirmed staff cases. The number of outbreaks increased with the level of care. During the study period, a higher proportion of hospitals reported implementing IPC measures, including reinforcing hand hygiene compliance (increased from 79.2% to 95.1%) and enhancing environmental cleaning and disinfection (increased from 4.2% to 78.0%) as well as performing active surveillance testing (AST) on exposed neonates (increased from 4.2% to 51.2%) and molecular testing on MRSA-positive isolates (increased from 5.3% to 18.9%). From 2001 to 2017, IPC measures in neonatal units increased in parallel with expanded national IPC recommendations. However, MRSA outbreaks in neonatal units continued to be frequent occurrences in NYS.

Cross-border collaboration and capacity-building for improved health emergency response planning in Southern Africa

Background Many countries were ill prepared for the COVID-19 pandemic and the sudden border closures introduced to stem contagion. To address this planning and response gap, Health Systems Trust and the US Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine jointly implemented a capacity-building project among eight Southern African countries during 2022. The intention was to strengthen collaboration among the countries in implementing public health emergency response strategies. Shared analysis of cross-border movement patterns, and building neighbouring countries’ capacity to identify priority areas for such response planning, strengthened relationships for communicating health risks and events. Approach This chapter presents findings from project participants’ perspectives on whether and how the project supported improved regional collaboration for emergency responses to public health events, and their perceptions of how the project strengthened their border health systems. Country delegates were convened in multi-sectoral regional and sub-regional meetings and workshops to facilitate cross-border public health information-sharing and co-ordination, and to align surveillance for emergency preparedness and response. They drafted procedures to: strengthen cross-border and multi-sectoral communication; prioritise points of entry for cross-border co-ordination; map population movement patterns; and identify national and regional border health priorities. Training focused on points of entry to enhance planning for future disease outbreaks by introducing the Population Connectivity Across Borders Toolkit for analysing population movement data to guide the design of public health interventions. Conclusions Collaboration with global and regional institutions strengthened the countries’ ability to comply with International Health Regulations in responding to communicable disease outbreaks. The outcomes indicate that sustained engagement, refinement of standard operating procedures, and multilateral agreements that ensure balancing of country priorities with global health requirements, can be achieved. Continued analysis of and reflection on country work plans are needed to assess similarities and differences in priority identification, which will guide future training and development of regional strategies to build stronger border health systems.

The emergence and persistence of the anti-vaccination movement.

Vaccine hesitancy is a significant threat to public health and the anti-vaccination movement has played a significant role in communicable disease outbreaks. This commentary discusses the history and tactics of vaccine denialists and anti-vaccination groups. Anti-vaccination rhetoric is robust on social media platforms, and vaccine hesitancy has proven to impede the uptake of both established and new vaccines. Effective counter-messaging is needed to preemptively discredit vaccine denialists and reduce their influence on vaccine uptake. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Physicians' Perspectives on Vaccinations

Protective vaccinations are crucial for preventing infectious diseases and their complications, offering a high safety profile and minimal adverse effects. However, vaccine hesitancy has emerged as a public health concern, leading to outbreaks of communicable diseases. This study aims to investigate the attitudes towards vaccinations among doctors and nurses, as well as their knowledge level and vaccination frequency. The research employed a cross-sectional design and collected data using an anonymous questionnaire. The study was conducted in southern Poland, involving Primary Healthcare Centers and hospitals. A total of 878 paper surveys were collected among 542 doctors and 336 nurses.

Rapid Establishment of a Biospecimen Resource To Study the Global Impact of COVID-19 Vaccines.

The emergence and explosive spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 highlighted the need to rapidly develop curated biobanks to inform the etiology, diagnosis, and treatment options for global outbreaks of communicable diseases. Recently, we undertook efforts to develop a repository of biospecimens from individuals aged 12 and older who were to be vaccinated against coronavirus disease 19 (COVID-19) with vaccines developed with support from the United States Government. We planned to establish 40 or more clinical study sites in at least six countries to collect biospecimens from 1,000 individuals, 75% of whom were to be SARS-CoV-2 naive at the time of enrollment. Specimens would be used to (i) ensure quality control of future diagnostic tests, (ii) understand immune responses to multiple COVID-19 vaccines, and (iii) provide reference reagents for the development of new drugs, biologics, and vaccines. Biospecimens included serum, plasma, whole blood, and nasal secretions. Large-volume collections of peripheral blood mononuclear cells (PBMCs) and defibrinated plasma were also planned for a subset of subjects. Participant sampling was planned at intervals prior to and following vaccination over a 1-year period. Here, we describe the selection of clinical sites for specimen collection and processing, standard operating procedure (SOP) development, design of a training program for tracking specimen quality, and specimen transport to a repository for interim storage. This approach allowed us to enroll our first participants within 21 weeks from the study's initiation. Lessons learned from this experience should benefit the development of biobanks in response to future global epidemics. IMPORTANCE The ability to rapidly create a biobank of high-quality specimens in response to emergent infectious diseases is critical to allow for the development of prevention and treatment, as well as to effectively monitor the spread of the disease. In this paper, we report on a novel approach to getting global clinical sites up and running within a short time frame and to monitor the quality of specimens collected to ensure their value in future research efforts. Our results have important implications for the monitoring of the quality of biospecimens collected and to design effective interventions to address shortcomings, where needed.

Polio-philanthropy in Africa: A narrative review.

Polio eradication efforts including polio-philanthropy have been coordinated and sustained since 1988, with the introduction of the Global Polio Eradication Initiative (GPEI). The polio fight is sustained in the name of evidence-based benevolence or beneficent philanthropy from which Africa has benefited immensely. With the recorded polio cases as of 2023, more efforts and funds are required to eradicate polio. Hence, it is not yet "Uhuru." Using the Mertonian lens, this study examines polio-philanthropy in Africa, its unintended consequences, and crucial dilemmas, which could impact the polio fight and polio-philanthropy. This is a narrative review that relies on secondary sources obtained through a thorough literature search. Only studies published in English were utilized. The study synthesized relevant literature in line with the study objective. The following databases were consulted: PubMed, philosopher's index, web of knowledge, Google Scholar, and Sociological Abstracts. Both empirical and theoretical studies were utilized for the study. Despite significant achievements, the global initiative has shortcomings when examined through the Mertonian lens of manifest and latent functions. The GPEI sets a unilinear goal within multiple challenges. The activities of the philanthropic giants manifest in disempowering rigor, multisectoral neglect, and parallel (health) systems, sometimes, inimical to the national health system. Most philanthropic giants often operate vertically. It is observed that, apart from funding, the last phase of polio-philanthropy will be defined by some crucial factors, the 4Cs: Communicable disease outbreaks, Conflict, Climate-related disasters, and Conspiracy theory, which could impact the prevalence or resurgence of polio. The polio fight will benefit from the persistent drive to reach the finish line as scheduled. The latent consequences or dysfunctions are general lessons for GPEI and other global health initiatives. Therefore, decision-makers should calculate the net balance of consequences within global health philanthropy for appropriate mitigation.

[Development and application syndromic surveillance and early warning system in border area in Yunnan Province].

Objective: To establish a dynamic syndromic surveillance system in the border areas of Yunnan Province based on information technology, evaluate its effectiveness and timeliness in the response to common communicable disease epidemics and improve the communicable disease prevention and control in border areas. Methods: Three border counties were selected for full coverage as study areas, and dynamic surveillance for 14 symptoms and 6 syndromes were conducted in medical institutions, the daily collection of information about students' school absence in primary schools and febrile illness in inbound people at border ports were conducted in these counties from January 2016 to February 2018 to establish an early warning system based on mobile phone and computer platform for a field experimental study. Results: With syndromes of rash, influenza-like illness and the numbers of primary school absence, the most common communicable disease events, such as hand foot and mouth disease, influenza and chickenpox, can be identified 1-5 days in advance by using EARS-3C and Kulldorff time-space scanning models with high sensitivity and specificity. The system is easy to use with strong security and feasibility. All the information and the warning alerts are released in the form of interactive charts and visual maps, which can facilitate the timely response. Conclusions: This system is highly effective and easy to operate in the detection of possible outbreaks of common communicable diseases in border areas in real time, so the timely and effective intervention can be conducted to reduce the risk of local and cross-border communicable disease outbreaks. It has practical application value.

Disease and Dissent: Epidemics as a Catalyst for Social Unrest

Abstract We identify a set of potential theoretical mechanisms that link the outbreak and spread of communicable diseases to temporal and spatial patterns of social unrest. Despite the proliferation of research since 2020 analyzing the social impact of the Covid-19 pandemic, we examine the broader relationship between less severe epidemic outbreaks and their social consequences. Epidemics, as well as the policies that governments implement to tackle them, often generate acute grievances among the public and create new opportunities for collective dissent, the combination of which promotes unrest. Nonetheless, perceived opportunities for unrest are influenced by the scale and scope of the disease outbreak, and particularly lethal disease outbreaks may therefore offset the incentives for collective mobilization. We examine these relationships using sub-national data on communicable disease outbreaks and geo-located social unrest events data in 60 African and Latin American countries from 1990 to 2017 and find support for our argument. However, we observe a curvilinear relationships between the severity of the epidemic and the incidence of unrest.

Investing in the Prevention of Communicable Disease Outbreaks: Fiscal Health Modelling-The Tool of Choice for Assessing Public Finance Sustainability.

National strategies for preparedness for future outbreaks of COVID-19 often include timely preparedness with vaccines. Fiscal health modelling (FHM) has recently been brought forward as an additional analysis by defining the public economic impact from a governmental perspective. As governments are the main decision-makers concerning pandemic preparedness, this study aimed to develop an FHM framework for infectious diseases in the Netherlands. Based on the Dutch COVID-19 outbreak of 2020 and 2021 and publicly available data on tax income and gross domestic product (GDP), the fiscal impact of COVID-19 was assessed using two approaches. Approach I: Prospective modelling of future fiscal impact based on publicly available laboratory-confirmed COVID-19 cases; and Approach II: Retrospective assessment of the extrapolated tax and benefit income and GDP. Approach I estimated the consequences that can be causally linked to the population counts reducing income taxes by EUR 266 million. The total fiscal loss amounted to EUR 164 million over 2 years (excluding pension payments averted). The total losses in terms of tax income (2020 and 2021) and GDP (2020) (Approach II), were estimated at, respectively, EUR 13.58 billion and EUR 96.3 billion. This study analysed different aspects of a communicable disease outbreak and its influence on government public accounts. The choice of the two presented approaches depends on the perspective of the analysis, the time horizon of the analysis and the availability of data.