THE IMPACT OF GLOBALIZATION ON INFECTIOUS DISEASE EMERGENCE AND CONTROL

Exploring the Consequences and Opportunities

Workshop Summary

Stacey Knobler, Adel Mahmoud, Stanley Lemon, Leslie Pray Editors

Forum on Microbial Threats

Board on Global Health

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary THE IMPACT OF GLOBALIZATION ON INFECTIOUS DISEASE EMERGENCE AND CONTROL Exploring the Consequences and Opportunities Workshop Summary Stacey Knobler, Adel Mahmoud, Stanley Lemon, Leslie Pray Editors Forum on Microbial Threats Board on Global Health INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary THE NATIONAL ACADEMIES PRESS 500 FIFTH STREET, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. Support for this project was provided by the U.S. Department of Health and Human Services’ National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Agency for International Development; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; and the Merck Company Foundation. The views presented in this report are those of the editors and attributed authors and are not necessarily those of the funding agencies. This report is based on the proceedings of a workshop that was sponsored by the Forum on Microbial Threats. It is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Microbial Threats. The content of those sections is based on the presentations and the discussions that took place during the workshop. Library of Congress Cataloging-in-Publication Data The impact of globalization on infectious disease emergence and control : exploring the consequences and opportunities : workshop summary / Stacey Knobler, Adel Mahmoud, Stanley Lemon, editors ; Forum on Microbial Threats ; Board on Global Health. p. ; cm. Includes bibliographical references. ISBN 0-309-10098-4 (pbk.) 1.Communicable diseases—Prevention—Congresses. 2. Communicable diseases—Prevention—Case studies—Congresses. I. Knobler, Stacey. II. Mahmoud, Adel A. F. III. Lemon, Stanley M. IV. Forum on Microbial Threats. V. Institute of Medicine (U.S.). Board on Global Health. [DNLM: 1. Communicable Disease Control—Congresses. 2. Communicable Diseases—transmission—Congresses. 3. Disease Outbreaks—prevention & control—Congresses. 4. Disease Transmission—prevention & control—Congresses. 5. Health Policy—Congresses. 6. International Cooperation—Congresses. WA 110 I339 2006] RA643.I47 2006 362.196’9—dc22 2005036813 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624–6242 or (202) 334–3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. COVER: The background for the cover of this workshop summary is a photograph of a batik designed and printed specifically for the Malaysian Society of Parasitology and Tropical Medicine. The print contains drawings of various parasites and insects; it is used with the kind permission of the Society.

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary FORUM ON MICROBIAL THREATS STANLEY M. LEMON (Chair), Dean, School of Medicine, The University of Texas Medical Branch, Galveston P. FREDRICK SPARLING (Vice Chair), J. Herbert Bate Professor Emeritus of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill MARGARET HAMBURG (Vice Chair), Senior Scientist, Nuclear Threat Initiative/Global Health & Security Initiative, Washington, D.C. DAVID ACHESON, Chief Medical Officer, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Rockville, Maryland RUTH L. BERKELMAN, Rollins Professor and Director, Emory University, Center for Public Health Preparedness and Research, Rollins School of Public Health, Atlanta, Georgia ROGER G. BREEZE, Chief Executive Officer, Centaur Science Group, Washington, D.C. STEVEN J. BRICKNER, Research Advisor, Pfizer Global Research and Development, Pfizer Inc., Groton, Connecticut JOSEPH BRYAN, Interim Laboratory Director, Office of Medical Services, Department of State, Washington, D.C. NANCY CARTER-FOSTER, Director, Program for Emerging Infections and HIV/AIDS, U.S. Department of State, Washington, D.C. GAIL H. CASSELL, Vice President, Scientific Affairs, Eli Lilly & Company, Indianapolis, Indiana MARK FEINBERG, Vice President for Policy, Public Health & Medical Affairs, Merck Vaccine Division, Merck & Co., West Point, Pennsylvania J. PATRICK FITCH, Chemical & Biological National Security Program Leader, Lawrence Livermore National Laboratory, Livermore, California S. ELIZABETH GEORGE, Deputy Director, Biological and Chemical Countermeasures Program, Department of Homeland Security, Washington, D.C. JESSE L. GOODMAN, Director, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland EDUARDO GOTUZZO, Director, Instituto de Medicina Tropical– Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Peru JO HANDELSMAN, Professor of Plant Pathology, College of Agricultural and Life Sciences, University of Wisconsin, Madison

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary CAROLE A. HEILMAN, Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland DAVID L. HEYMANN, Executive Director, Polio Eradication, World Health Organization, Geneva, Switzerland PHIL HOSBACH, Vice President of New Products and Immunization Policy, Sanofi Pasteur, Swiftwater, Pennsylvania JAMES M. HUGHES, Director, Global Infectious Diseases Program, Emory University, Atlanta, Georgia STEPHEN JOHNSTON, Professor, Director, University of Texas Southwestern Medical Center, Dallas GERALD T. KEUSCH, Assistant Provost for Global Health, Boston University School of Medicine, and Associate Dean for Global Health, Boston University School of Public Health, Boston, Massachusetts LONNIE KING, Dean, College of Veterinary Medicine, Michigan State University, East Lansin GEORGE KORCH, Chief, Medical Science and Technology Program for Chemical and Biological Defense, Defense Threat Reduction Agency, Ft. Belvoir, Virginia JOSHUA LEDERBERG, Raymond and Beverly Sackler Foundation Scholar, The Rockefeller University, New York, New York JOSEPH MALONE, Director, Department of Defense Global Emerging Infections System, Walter Reed Army Institute of Research, Silver Spring, Maryland LYNN MARKS, Senior Vice President of Infectious Diseases, Medicine Development Center, GlaxoSmithKline, Collegeville, Pennsylvania STEPHEN S. MORSE, Director, Center for Public Health Preparedness, Columbia University, New York, New York MICHAEL T. OSTERHOLM, Director, Center for Infectious Disease Research and Policy, and Professor, School of Public Health, University of Minnesota, Minneapolis GEORGE POSTE, Director, Arizona BioDesign Institute, Arizona State University, Tempe DAVID A. RELMAN, Associate Professor of Medicine and Associate Professor of Microbiology and Immunology, Stanford University, Stanford, California GARY A. ROSELLE, Program Director for Infectious Diseases, Central Office, Veterans Health Administration, Department of Veterans Affairs, Washington, D.C. ANNE SCHUCHAT, Acting Director, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary JANET SHOEMAKER, Director, Office of Public Affairs, American Society for Microbiology, Washington, D.C. BRIAN STASKAWICZ, Professor, Department of Plant and Microbial Biology, University of California, Berkeley TERENCE TAYLOR, President and Executive Director, International Institute for Strategic Studies, Washington, D.C. Liaisons ENRIQUETA BOND, President, Burroughs Wellcome Fund, Research Triangle Park, North Carolina NANCY CARTER-FOSTER, Director, Program for Emerging Infections and HIV/AIDS, U.S. Department of State, Washington, D.C. EDWARD McSWEEGAN, Program Officer, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland Staff EILEEN CHOFFNES, Director, Forum on Microbial Threats STACEY KNOBLER, Former Director, Forum on Microbial Threats LESLIE PRAY, Science Writer ELIZABETH KITCHENS, Research Associate KIM LUNDBERG, Research Associate KATHERINE McCLURE, Research Associate KATE SKOCZDOPOLE, Senior Program Assistant

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary BOARD ON GLOBAL HEALTH DEAN JAMISON (Chair), Senior Fellow, Fogarty International Center, National Institutes of Health, Bethesda, Maryland YVES BERGEVIN, Chief, Health Section, UNICEF, New York, New York JO IVEY BOUFFORD, Professor, Robert F. Wagner Graduate School of Public Service, New York University, New York RICHARD FEACHEM, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland MARGARET HAMBURG, Vice-President for Biological Programs, Nuclear Threat Initiative, Washington, D.C. GERALD KEUSCH, Director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland JEFFREY KOPLAN, Vice-President for Academic Health Affairs, Emory University, Atlanta, Georgia ADEL MAHMOUD, President, Merck Vaccines, Whitehouse Station, New Jersey MAMPHELA RAMPHELE, Managing Director, The World Bank, Washington, D.C. MARK ROSENBERG, Executive Director, Task Force for Child Survival and Development, Emory University, Decatur, Georgia JAIME SEPULVEDA AMOR, Director, Instituto Nacional de Salud Publica, Cuernavaca, Mexico DONALD BERWICK (IOM Council Liaison), Clinical Professor of Pediatrics and Health Care Policy, Harvard Medical School, Boston, Massachusetts DAVID CHALLONER (IOM Foreign Secretary), Vice-President for Health Affairs, University of Florida, Gainesville Staff PATRICK KELLEY, Director HARRIET BANDA, Senior Project Assistant ALLISON BERGER, Project Assistant STACEY KNOBLER, Senior Program Officer KATHERINE McCLURE, Research Assistant LAURA SIVITZ, Research Associate DIANNE STARE, Research Assistant/Administrative Assistant

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary Reviewers All presenters at the workshop have reviewed and approved their respective sections of this report for accuracy. In addition, this workshop summary has been reviewed in draft form by independent reviewers chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the Institute of Medicine (IOM) in making the published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. The Forum and IOM thank the following individuals for their participation in the review process: Nick Drager, Department of Ethics, Trade, Human Rights and Law World Health Organization, Geneva, Switzerland. Johannes Sommerfeld, Special Programme for Research and Training in Tropical Diseases (TDR) World Health Organization, Geneva, Switzerland. Mary Wilson, Harvard University, Boston, Massachusetts The review of this report was overseen by Melvin Worth, M.D., Scholar-in-Residence, National Academies, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the editors and the institution.

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary Preface The Forum on Emerging Infections was created in 1996 in response to a request from the Centers for Disease Control and Prevention and the National Institutes of Health. The goal of the Forum is to provide structured opportunities for representatives from academia, industry, professional and interest groups, and government1 to examine and discuss scientific and policy issues that are of shared interest and that are specifically related to research and prevention, detection, and management of infectious diseases. In accomplishing this task, the Forum provides the opportunity to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them directly; hence, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its strengths are the diversity of its membership and the contributions of individual members expressed throughout the activities of the Forum. In September of 2003 the Forum changed its name to the Forum on Microbial Threats. 1   Representatives of federal agencies serve in an ex officio capacity. An ex officio member of a group is one who is a member automatically by virtue of holding a particular office or membership in another body.

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary ABOUT THE WORKSHOP We live in a time of unprecedented human movement and interaction. As transborder mobility of humans, animals, food, and feed products increases, so does the threat of the spread of infectious disease. While new global markets have created economic opportunities and growth, the benefits have not been equally distributed, and the risks—especially the health risks—of our increasingly interconnected and fast-paced world continue to grow. Although the burden is greatest for the developing world, infectious diseases are a growing threat to all nations. The resurgence of malaria is a dramatic example of the effects of globalization on disease trends. Twenty years ago, more than 80percent of the world’s population lived in malaria-free or controlled areas. But today, malaria is the most prevalent vectorborne disease, with more than 40 percent of the world’s population living in endemic areas. Furthermore, with increased air travel and human movement, imported malaria is on the rise in Europe and North America. The AIDS pandemic and the global spread of the annual influenza virus further illustrate how vulnerable even industrialized nations are to unexpected outbreaks and the spread of infectious disease in today’s globalized society. However, the same globalizing forces that create such rampant opportunity for pathogens also can provide mechanisms for innovative, global efforts to control infectious diseases. A new network of international public health partners is emerging. Multinational partnerships are contributing to the increased availability of drugs and vaccines, the development of health care infrastructures in developing countries, and better public health education programs worldwide. The global proliferation of technology and information has the potential to improve the identification, surveillance, containment, and treatment of disease in both developed and developing countries. Growing international cooperation may lead to more robust and transparent reporting regarding disease outbreaks and control efforts. Distance learning, training, and research exchange programs are creating improved access for scientific and medical professionals. On April 16 and 17, 2002, the Forum on Emerging Infections held a working group discussion on the influence of globalization on the emergence and control of infectious diseases. Through invited presentations and participant discussion, the workshop explored the impact of increasingly integrated trade, economic development, human movement, and cultural exchange on patterns of disease emergence; identified opportunities for countering the effects of globalization on infectious diseases; examined the scientific evidence supporting current and potential global strategies; and considered newly available response methods and tools available for use by

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary private industry, public health agencies, regulatory agencies, policy makers, and academic researchers. During the last session of the workshop, Forum members, panel discussants, and the audience commented on issues and next steps that they consider priority areas for action. ORGANIZATION OF WORKSHOP SUMMARY This workshop summary was prepared for the Forum membership in the name of the editors, with the assistance of staff and consultants. The sections of this summary that are not specifically attributed to an individual reflect the views of the editors exclusively—they do not reflect the views of the Institute of Medicine (IOM) or of the organizations that sponsor the Forum on Microbial Threats. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop. The globalization workshop functioned as a venue for dialogue among representatives from many sectors about their beliefs on subjects that may merit further attention. The reader should be aware that the material presented here reflects the views and opinions of those participating in the workshop and not the deliberations of a formally constituted IOM study committee. Moreover, these proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter. This summary is organized as a topic-by-topic description of the presentations and discussions from the workshop. The purpose is to present lessons from relevant experience, delineate a range of pivotal issues and their respective problems, and put forth some potential responses as described by the workshop participants. The Summary and Assessment discusses the core messages that emerged from the working group discussions. Chapter 1 summarizes the presentations and discussions related to the increasing cross-border and cross-continental movements of people, products, pathogens, and power, and how these affect the emergence and spread of infectious diseases. Chapter 2 provides a summary of the presentations and discussions that revolved around the changing global landscape and how this could exacerbate the emergence and global spread of infectious diseases. Chapter 3 focuses on the opportunities and obstacles surrounding the global application of knowledge, tools, and technology that result from increasing globalization. Chapter 4 summarizes the means by which sovereign states and nations must adopt a global public health mind-set and develop a new organizational framework to maximize the opportunities and overcome the challenges created by globalization and build the necessary capacity to respond effectively to emerging infectious disease threats.

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary ACKNOWLEDGMENTS The Forum on Microbial Threats and IOM wish to express their warmest appreciation to the individuals and organizations who gave valuable time to provide information and advice to the Forum through participation in the workshop (see Appendix A for a list of speakers). The Forum is indebted to the IOM staff who contributed during the course of the workshop and to the production of this workshop summary. On behalf of the Forum, we gratefully acknowledge the efforts led by Stacey Knobler, director of the Forum, and Leslie Pray, technical consultant, who dedicated much effort and time to developing the workshop agenda, and thank them for their thoughtful and insightful approach and skill in translating the workshop proceedings and discussion into this summary. Finally, the Forum also thanks sponsors that supported this activity. Financial support for this project was provided by the U.S. Department of Health and Human Services’ National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; and the Merck Company Foundation. The views presented in this workshop summary are those of the editors and workshop participants and are not necessarily those of the funding organizations. Adel Mahmoud, Chair Stanley Lemon, Vice-Chair Forum on Microbial Threats

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary Contents     SUMMARY AND ASSESSMENT   1 1   A WORLD IN MOTION: THE GLOBAL MOVEMENT OF PEOPLE, PRODUCTS, PATHOGENS, AND POWER   21 2   EXAMINING THE CONSEQUENCES: A CHANGING LANDSCAPE   49 3   THE GLOBAL APPLICATION OF KNOWLEDGE, TOOLS, AND TECHNOLOGY: OPPORTUNITIES AND OBSTACLES   80 4   CREATING A FRAMEWORK FOR PROGRESS   124     Appendixes     A   Agenda   175 B   International Law, Infectious Diseases, and Globalization   181 C   Changing Vector Ecologies: Political Geographic Perspectives   197 D   Social Aspects of Public Health Challenges in Period of Globalization: The Case of Russia   206

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The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities - Workshop Summary THE IMPACT OF GLOBALIZATION ON INFECTIOUS DISEASE EMERGENCE AND CONTROL

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