Global Disease Eradication Research Articles

Pandemic realism as the indispensable political precondition for global disease eradication

This article examines the politico-scientific mechanism, which leads nations to declare an epidemic or a pandemic finished, irrespective of the actual epidemiological situation at a given time. A historical comparison is made with the famous behavior of Emperor Justinian I (482–565 CE) during the plague pandemic named after him (part of the first plague pandemic). Finally, a reference to the importance of the multidisciplinary study of the history of medicine and the intersection between pandemics and wars is made.

Innovative Development Finance for Health Sector Development: Focusing on the Air Ticket Solidarity Levy System in the Republic of Korea

Financial sustainability has been a perennial problem in international development. Furthermore, among different areas of developmental support, securing sufficient financial resources is particularly significant in the health sector where people’s very lives are at stake. Given the above, we examine innovative development finance (IDF) for the health sector with a particular focus on the air ticket solidarity levy system in the Republic of Korea. After an overview of the origins and the present state of the solidarity tax system, we explain how it was implemented in the context of South Korea’s health ODA (Official Development Assistance). A first-ever health ODA stakeholders’ perception survey with its implications on the airplane tax system follows. For policy suggestions, we suggest incorporating a COVID-19 agenda into the Global Disease Eradication Fund (GDEF) immediately, and to raise public awareness in a timely fashion. We believe the Korean case is significant for both its direct impact in the Eurasian region as an emerging donor, and for its unique position due to its middle-power status whose trajectory could serve as an example to many other nations seeking sustainable financial schemes.

국제질병퇴치기금의 중장기 활용방안: 국제보건이니셔티브 참여 확대와 국제의약품개발파트너십과의 협력을 중심으로

국제질병퇴치기금의 중장기 활용방안: 국제보건이니셔티브 참여 확대와 국제의약품개발파트너십과의 협력을 중심으로

A Novel Recombinant Newcastle Disease Virus Vectored DIVA Vaccine against Peste des Petits Ruminants in Goats.

Peste des petits ruminants virus (PPRV, species: small ruminant morbillivirus) is the causative agent of the eponymous notifiable disease, the peste des petits ruminants (PPR) in wild and domestic sheep and goats. Mortality rates vary between 50% and 100%, causing significant losses of estimated 1.5 to 2 billion US Dollars per year. Live-attenuated PPRV vaccine strains are used in the field for disease prevention, but the application of a more thermostable vaccine enabling differentiation between infected and vaccinated animals (DIVA) would be highly desirable to achieve the goal of global disease eradication. We generated a recombinant Newcastle disease virus (rNDV) based on the live-attenuated NDV Clone 30 that expresses the surface protein hemagglutinin (H) of PPRV strain Kurdistan/11 (rNDV_HKur). In vitro analyses confirmed transgene expression as well as virus replication in avian, caprine, and ovine cells. Two consecutive subcutaneous vaccinations of German domestic goats with rNDV_HKur prevented clinical signs and hematogenic dissemination after an intranasal challenge with virulent PPRV Kurdistan/11. Virus shedding by different routes was reduced to a similar extent as after vaccination with the live-attenuated PPRV strain Nigeria 75/1. Goats that were either not vaccinated or inoculated with parental rNDV were used as controls. In summary, we demonstrate in a proof-of-concept study that an NDV vectored vaccine can protect against PPR. Furthermore, it provides DIVA-applicability and a high thermal tolerance.

The deferred promise of radical cure: pharmaceutical conjugations of malaria in the global health era

This paper explores the changing political economy of malaria drug discovery by tracing the career over the last four decades of a single molecule, tafenoquine. First identified as a promising antimalarial by the US Army in the 1970s, tafenoquine has recently been approved by the Food and Drug Administration for the radical cure of vivax malaria – the first product to receive marketing authorization for this indication in more than 65 years. The new drug is the result of a collaboration between the pharmaceutical company GlaxoSmithKline and the not-for-profit organization Medicines for Malaria Venture, with the financial support of the Bill and Melinda Gates Foundation. The successful development of tafenoquine, the paper argues, signals an important transition within the global health era: from the chemotherapeutic humanitarianism that characterized pharmaceutical efforts against malaria in the early 2000s, towards a period of drug discovery driven by the promise of global disease eradication. The paper uses the example of tafenoquine to advance a more general argument about the multiple and evolving pharmaceutical conjugations of malaria – the articulation of competing visions of the disease around the capabilities (and limitations) of particular molecules.

Using integrated modeling to support the global eradication of vaccine-preventable diseases.

The long-term management of global disease eradication initiatives involves numerous inherently dynamic processes, health and economic trade-offs, significant uncertainty and variability, rare events with big consequences, complex and inter-related decisions, and a requirement for cooperation among a large number of stakeholders. Over the course of more than 16 years of collaborative modeling efforts to support the Global Polio Eradication Initiative, we developed increasingly complex integrated system dynamics models that combined numerous analytical approaches, including differential equation-based modeling, risk and decision analysis, discrete-event and individual-based simulation, probabilistic uncertainty and sensitivity analysis, health economics, and optimization. We discuss the central role of systems thinking and system dynamics in the overall effort and the value of integrating different modeling approaches to appropriately address the trade-offs involved in some of the policy questions. We discuss practical challenges of integrating different analytical tools and we provide our perspective on the future of integrated modeling.

Field station as stage: Re-enacting scientific work and life in Amani, Tanzania.

Located high in Tanzania's Usambara Mountains, Amani Hill Station has been a site of progressive scientific endeavours for over a century, pushing the boundaries of botanical, zoological and medical knowledge, and providing expertise for imperial expansion, colonial welfare, national progress and international development efforts. The station's heyday was from the 1950s to the 1970s, a period of global disease eradication campaigns and the 'Africanization' of science. Today, Amani lies in a state of suspended motion. Officially part of a national network of medical research stations, its buildings and vegetation are only minimally maintained, and although some staff report for duty, scientific work has ceased. Neither ruin nor time capsule, Amani has become a quiet site of remains and material traces. This article examines the methodological potentials of re-enactment - on-site performances of past research practices - to engage ethnographically with the distinct temporalities and affective registers of life at the station. The heuristic power of re-enactment resides in its anachronicity, the tensions it introduces between immediacy and theatricality, authenticity and artifice, fidelity and futility. We suggest that re-enacting early post-colonial science as events unfolding in the present disrupts straightforward narratives about the promises and shortfalls of scientific progress, raising provocative questions about the sentiments and stakes of research in 'the tropics'.

Reluctance to Advance the Age of Measles Immunisation: Ethics of Best Bargain, Policies of Denial, and Programs of Verticality

There is much expectation that the unprecedented social and political mobilization of polio initiative must be channelized to eliminate and eradicate measles. However, the fact file of measles in low and middle income countries (LMICs) raises several concerns. Measles surveillance in many of these countries is largely outbreakcentric and measles associated mortality is underestimated because several events are documented as pneumonia deaths even after verbal autopsies. Besides vaccine hesitancy, the social and cultural resistance against polio supplementary immunisation activities (SIAs) witnessed in certain pockets is likely to be higher in case of measles immunisation drives. The timing of measles containing vaccines (MCV1 and MCV2) in the immunisation schedules is also surrounded by some technical and ethical issues that we have been ignoring for decades. A small proportion of measles infection is borne by young infants before reaching eligibility for vaccination. Eradicating measles is going to be a tougher challenge on epidemiological grounds also. With basic reproduction number (R0) ranging from 12 to 18 and herd immunity threshold from 92% to 94%, maintaining very high routine immunisation (RI) coverage for a long period will require a cross-sectoral commitment at all levels of operation in LMICs. There are serious ethical issues related to policy, program and governance as well. Health systems in most of the LMICs are historically conditioned in the culture of verticality to an extent that even those who have an ethical responsibility to represent context-specific local voices end up taking an easier route of generic global narrative. An unstated and unappreciated divide between public health and people’s health looks too big to be bridged in such a milieu of governance. The endgame success of any global disease eradication program would decisively depend on two constituencies-frontline health workers and non-utilizer clients who could have been the utilizers.

The ethics of disease eradication

This paper provides an examination of the ethics of disease eradication policies. It examines three arguments that have been advanced for thinking that eradication is in some way ethically exceptional as a policy goal. These are (1) global eradication has symbolic importance, (2) disease eradication is a global public good and (3) disease eradication is a form of rescue. It argues that none of these provides a good reason to think that individuals have special duties to facilitate eradication campaigns, or that public health authorities have special permissions to pursue them. But the fact that these arguments fail does not entail that global disease eradication is ethically problematic, or that it should not be undertaken. Global eradication of a disease, if successful, is a way of providing an enormous health benefit that stretches far into the future. There is no need to reach for the idea that there is a special duty to eradicate disease; the same considerations that are in play in ordinary public health policy – of reducing the burden of disease equitably and efficiently – suffice to make global disease eradication a compelling goal where doing so is feasible.

From regional pulse vaccination to global disease eradication: insights from a mathematical model of poliomyelitis.

Mass-vaccination campaigns are an important strategy in the global fight against poliomyelitis and measles. The large-scale logistics required for these mass immunisation campaigns magnifies the need for research into the effectiveness and optimal deployment of pulse vaccination. In order to better understand this control strategy, we propose a mathematical model accounting for the disease dynamics in connected regions, incorporating seasonality, environmental reservoirs and independent periodic pulse vaccination schedules in each region. The effective reproduction number, Re, is defined and proved to be a global threshold for persistence of the disease. Analytical and numerical calculations show the importance of synchronising the pulse vaccinations in connected regions and the timing of the pulses with respect to the pathogen circulation seasonality. Our results indicate that it may be crucial for mass-vaccination programs, such as national immunisation days, to be synchronised across different regions. In addition, simulations show that a migration imbalance can increase Re and alter how pulse vaccination should be optimally distributed among the patches, similar to results found with constant-rate vaccination. Furthermore, contrary to the case of constant-rate vaccination, the fraction of environmental transmission affects the value of Re when pulse vaccination is present.

P1-370 Lessons for zoonotic disease and vector eradication in New Zealand from past successes

IntroductionRegional and global disease eradication remains attractive for epidemiologists and policy makers (Science 2010;330:1736–9). New Zealand has successfully eradicated endemic brucellosis and hydatids. It recently eradicated the southern saltmarsh mosquito...

An evaluation of the sensitivity of acute flaccid paralysis surveillance for poliovirus infection in Australia

BackgroundWorld Health Organization (WHO) targets for acute flaccid paralysis (AFP) surveillance, including the notification of a minimum rate of AFP among children, are used to assess the adequacy of AFP surveillance for the detection of poliovirus infection. Sensitive surveillance for poliovirus infection in both developed and developing countries is essential to support global disease eradication efforts. We applied recently developed methods for the quantitative evaluation of disease surveillance systems to evaluate the sensitivity of AFP surveillance for poliovirus infection in Australia.MethodsA scenario tree model which accounted for administrative region, age, population immunity, the likelihood of AFP, and the probability of notification and stool sampling was used to assess the sensitivity of AFP surveillance for wild poliovirus infection among children aged less than 15 years in Australia. The analysis was based on historical surveillance data collected between 2000 and 2005. We used a surveillance time period of one month, and evaluated the ability of the surveillance system to detect poliovirus infection at a prevalence of 1 case per 100 000 persons and 1 case per million persons.ResultsThere was considerable variation in the sensitivity of AFP surveillance for poliovirus infection among Australian States and Territories. The estimated median sensitivity of AFP surveillance in Australia among children aged less than 15 years was 8.2% per month at a prevalence of 1 case per 100,000 population, and 0.9% per month at a prevalence of 1 case per million population. The probability that Australia is free from poliovirus infection given negative surveillance findings following 5 years of continuous surveillance was 96.9% at a prevalence of 1 case per 100,000 persons and 56.5% at a prevalence of 1 case per million persons.ConclusionGiven the ongoing risk of poliovirus importation prior to global eradication, long term surveillance is required to provide a high degree of confidence in freedom from poliovirus infection in Australia, particularly if a low prevalence of infection is assumed. Adherence to the WHO surveillance targets would considerably improve the sensitivity of surveillance for poliovirus infection in Australia.

Free, at last! The progress of new disease eradication campaigns for Guinea worm disease and polio, and the prospect of tackling other diseases.

Infectious diseases have moulded the development of the human species more than any other biological or abiological factor. They have influenced not only our biology, but also our history and political development; from the outcome of wars to the success of empires, and from the pace of technological advance to the structure of society itself. The introduction of smallpox to the Americas by European conquerors, for example, devastated the indigenous populations and destroyed mighty empires and advanced societies. In the 1400s, the Black Death killed between 30% and 60% of the European population, and continued to blight the continent intermittently until the eighteenth century with severe and lasting social, economic and political consequences. Similarly, the 1918–19 Spanish flu killed more people in less than one year than did the horrifying battlefields of the First World War. Even without causing major pandemics, persistent infectious diseases such as malaria, tuberculosis or measles have been imposing their burden on humanity with no less devastating effects. ![][1] The use of hygienic practices and the development of vaccines and antibiotics have given modern doctors and public health experts the edge over infectious diseases. Yet, many experts have long debated how to rid humanity of the worst diseases once and for all. So far, this has been a matter of rather academic and political debate, although global disease eradication—the complete elimination of a pathogen—became a reality in 1980 when smallpox was officially consigned to history (see Sidebar A; Figs 1,2). Despite this significant success, and despite the enormous advances made by the biomedical sciences during the last century, many infectious and potentially eradicable diseases continue to take their toll on humankind, particularly on the poorest of the world's people. However, some promising developments and successes during the past few years have rekindled the hope … [1]: /embed/graphic-1.gif

Successful planning: Some lessons in global disease eradication programs

a Dr. Sehgal has recently retired born the World Health Organization in which he served as regional health education advisor, Brazzville and Country Program Coordinator, Zambia. He was previously the national director of Health Education, Government of India. Dr. Sehgal was visiting professor at the University of Hawaii in the Spring of 1984.