Emerging trends in international law concerning global infectious disease control

International cooperation has become critical in controlling infectious diseases. In this article, I examine emerging trends in international law concerning global infectious disease control. The role of international law in horizontal and vertical governance responses to infectious disease control is conceptualized; the historical development of international law regarding infectious diseases is described; and important shifts in how states, international institutions, and nonstate organizations use international law in the context of infectious disease control today are analyzed. The growing importance of international trade law and the development of global governance mechanisms, most prominently in connection with increasing access to drugs and other medicines in unindustrialized countries, are emphasized. Traditional international legal approaches to infectious disease control--embodied in the International Health Regulations--may be moribund.     

对2019年新型冠状病毒肺炎疫情防控的思考

新型冠状病毒肺炎的暴发为人类敲响了一记警钟。新发传染病因其病原体的未知性、流行过程的复杂性、传播速度的快速性给公众健康、社会经济都带来了巨大损失,其防控更是传染病防控的重点。One Health策略是21世纪快速发展的应对全球公共卫生问题的新型措施,它注重人类、动物、环境间的关联性,强调跨学科、跨部门、跨领域的合作,在新发传染病防控方面具有重要意义。本文从One Health的角度对新型冠状病毒肺炎疫情的防控措施进行探讨,进一步阐明One Health策略在新发传染病防控中的重要作用。     

感染性疾病流行现状、防控挑战与应对

近几十年来,尽管全球感染性疾病负担大幅度下降,但传统感染性疾病相关的发病和死亡仍不容忽视。另外,受全球气候变化、快速城市化和人口快速流动等多种因素影响,新发感染性疾病成为全球重要的公共卫生威胁。无论是全球还是我国,均面临传统和新发感染性疾病的双重威胁。新形势下的感染性疾病防控需加强全球合作,强调全社会跨学科、跨部门共同参与。     

Emerging diseases and implications for global trade

Emerging diseases could have a devastating impact on international trade unless there is a change in the traditional approach to disease control and new holistic prevention and control strategies are adopted. The impact that emerging diseases will have on international trade will depend on several factors, such as the nature of the pathogen, the degree of co-ordination and integration between Veterinary Services and Public Health authorities, the ability to rapidly detect and respond to a disease appearance, and the existing trade relationship between countries. Strategies to control emerging diseases will be more effective if competent authorities and veterinary infrastructures in particular, integrate their public and animal health objectives into a single strategy. The co-ordinating role of international standard setting organisations such as the World Organisation for Animal Health (OIE) will be crucial. This paper discusses the events contributing to the appearance and spread of new emerging diseases and examines the changing roles of Veterinary Services and international organisations. Reference is also made to measures that can be taken towards minimising potential trade disruptions caused by the appearance of an emerging disease.     

鼠类与新现传染病

从近些年发生的SARS、高致病性禽流感等新现传染病的流行病学调查结果来看，动物与新现传染病密切相关。许多因素可以导致重要人兽共患病或新现人兽共患病的发生，如环境改变、人类和动物的密切接触、病原因子的变异、农业行为方式改变等。鼠类是多种病原体的储库，这些病原体会导致各种鼠传新现传染病的发生。与鼠类密切相关的新现传染病危害大，种类多，主要包括鼠疫、肾综合征出血热、钩端螺旋体病和莱姆病等。加强国内外合作，建立动物疾病监测网络，改变人类行为方式，维护生态平衡，是控制新现传染病的重要途径。     

A growing global network's role in outbreak response: AFHSC-GEIS 2008-2009

A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense's (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization's (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.     

非洲感染性疾病监测现状

感染性疾病的流行与暴发是危害非洲人民健康和全球卫生安全的主要问题之一。感染性疾病监测体系的建立以及持续、规范、系统地开展监测工作,对于感染性疾病防控至关重要。随着我国“一带一路”战略逐步实施,中非之间交流合作不断深入,积极了解和参与非洲感染性疾病监测与防控工作,有助于保障全球卫生安全和促进中非经贸合作。本文主要从整个非洲、非洲不同区域以及部分非洲国家等3个层面介绍与分析非洲感染性疾病的监测现状,为我国开展输入性感染性疾病防控和卫生援外工作提供参考。     

Commentary: Emerging and other communicable diseases

There is an increasing need for integrated, sustainable; and cost-effective approaches to the management of infectious diseases. For example, an emerging disease in one country may already be endemic in another country but nearing elimination in a third. A coordinated approach by WHO towards infectious diseases is therefore needed that will facilitate more effective support of on-going efforts for the prevention and control of endemic diseases, intensify efforts against those diseases targeted for eradication and elimination, and result in better preparedness and response to new and re-emerging diseases. In order to meet these challenges, WHO has created a new Programme on Communicable Diseases (CDS), which will replace the former Division of Emerging and other Communicable Diseases (EMC). The new Programme will better integrate surveillance, prevention, control, and research over the whole spectrum of communicable diseases. CDS will function as focal point for global data and information exchange on infectious diseases, and inter alia, will reinforce laboratory-based surveillance of bacterial, viral, and zoonotic diseases to ensure early detection of threats to international public health. Changes in susceptibility to infectious disease, increased opportunities for infection, and the ability of microbes to adapt rapidly will continue to challenge WHO to improve prevention and control of infectious diseases in the future by establishing strong partnerships with both the private and public sectors.     

International law and communicable diseases

Historically, international law has played a key role in global communicable disease surveillance. Throughout the nineteenth century, international law played a dominant role in harmonizing the inconsistent national quarantine regulations of European nation-states; facilitating the exchange of epidemiological information on infectious diseases; establishing international health organizations; and standardization of surveillance. Today, communicable diseases have continued to re-shape the boundaries of global health governance through legally binding and "soft-law" regimes negotiated and adopted within the mandate of multilateral institutions - the World Health Organization, the World Trade Organization, the Food and Agriculture Organization, and the Office International des Epizooties. The globalization of public health has employed international law as an indispensable tool in global health governance aimed at diminishing human vulnerability to the mortality and morbidity burdens of communicable diseases.     

Global governance,international health law and WHO: looking towards the future

The evolving domain of international health law encompasses increasingly diverse and complex concerns. Commentators agree that health development in the twenty-first century is likely to expand the use of conventional international law to create a framework for coordination and cooperation among states in an increasingly interdependent world. This article examines the forces and factors behind the emerging expansion of conventional international health law as an important tool for present and future multilateral cooperation. It considers challenges to effective international health cooperation posed for intergovernmental organizations and other actors involved in lawmaking. Although full consolidation of all aspects of future international health lawmaking under the auspices of a single international organization is unworkable and undesirable, the World Health Organization (WHO) should endeavour to serve as a coordinator, catalyst and, where appropriate, platform for future health law codification. Such leadership by WHO could enhance coordination, coherence and implementation of international health law policy.     

Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy

Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases. International efforts are being launched to control their dissemination through global surveillance, a major hindrance to which is the failure of some countries to report outbreaks. Current guidelines and regulations on emerging and re-emerging infectious diseases do not sufficiently take into account the fact that when developing countries report outbreaks they often derive few benefits and suffer disproportionately heavy social and economic consequences. In order to facilitate full participation in global surveillance by developing countries there should be: better and more affordable diagnostic capabilities to allow for timely and accurate information to be delivered in an open and transparent fashion; accurate, less sensationalist news reporting of outbreaks of diseases; adherence by countries to international regulations, including those of the World Trade Organization and the International Health Regulations; financial support for countries that are economically damaged by the diseases in question. The article presents two cases--plague in India and cholera in Peru--that illuminate some of the limitations of current practices. Recommendations are made on measures that could be taken by WHO and the world community to make global surveillance acceptable.     

Rolle der Gesundheitsbehörden der Länder bei der Verhütung und Bekämpfung von Infektionskrankheiten

The goal is to describe the structure of administration for the control of infectious diseases in the German states. Internationally there is an increasing risk of potentially global transmission of infectious diseases and therefore increasing need for improved control mechanisms which are viable locally, regionally and internationally. The international public health community must ensure that responses to infectious disease with a potential impact on more than one county entail concerted action, clear communication and decision making by diverse administration agencies. Given Germany's federal structure, the 16 states have differing protocols delineating responsibilities for infection control systems. This paper provides an overview, going into detail only with regard to the administration structure in Hesse. In 2001, the German law governing infectious disease control was amended and significantly expanded. With regard to protection of humans from infectious disease, each state must define its schedule of responsibilities on the resulting scope of duties. Each state in Germany has entrusted the local public health service at the county level with the responsibility for infection prevention and control. As a rule, at the state level both an expert agency and one or more district administration agencies have been installed; these work directly with the Ministry of Health at the state level. In addition to this, Hesse has established a "centre of competence for highly contagious diseases." In the event of an infectious emergency, this network provides special treatment of highly infectious patients and expertise for public health services and the Ministry of Health on a 24-h shift basis. In times of ongoing structural transformation, it is important to emphasize that expertise at the state level is not an alternative to maintaining enough specialised personnel in the public health services themselves. Specialized practitioners are needed to ensure professional and fast-acting responses, both for the prevention and control of infectious diseases.     

Emerging infectious disease: global response,global alert

Despite spectacular progress in the eradication of infectious diseases, malaria and tuberculosis are making a comeback in many parts of the world. After years of decline, plague, diphtheria, dengue, meningococcal meningitis, yellow fever, and cholera have reappeared as public health threats. In the last 20 years [before 1997] more than 30 new and highly infectious diseases have been identified, including Ebola-type hemorrhagic fever, HIV/AIDs, and hepatitis C. Antibiotic resistance has also emerged during this period, and fewer new antibiotics are being produced because of high development costs and licensing. Drugs no longer offer protection or cure for many infectious diseases, and consequently more people need hospitalization with higher treatment costs. The causes of the appearance of new diseases and the resurgence of old ones include the rapid increase in international travel, the growth of mega-cities with high population densities, inadequate safe water and sanitation, food-borne diseases by the globalization of trade, and human penetration into remote animal and insect habitats. Meanwhile, resources for public health are being reduced, with the result that either the appearance of new diseases or resistance to drugs go unnoticed. A recent example is the human immunodeficiency virus, which went unrecognized until a large number of people got infected. For this very reason the 1997 World Health Day featured the theme of emerging infectious diseases and global response. Such forums are held to help countries rebuild the foundations of disease surveillance and control, while the public and private sectors may be encouraged to develop better techniques for surveillance to confront a common global threat.     

世界卫生组织应对新型冠状病毒肺炎的机制

新型冠状病毒肺炎的大流行是这个时代的全球卫生危机,也是我们目前所面临的最大挑战。在世界范围内,传染病的管理关键在于遵守国际法规,进行国际合作,以追求共同利益和价值。WHO是联合国系统下管理和控制疾病传播的专门性国际组织。本文对WHO应对传染病的防控机制、新型冠状病毒肺炎疫情的应对措施以及努力方向进行综述,以期为全球新型冠状病毒肺炎疫情控制提供参考。     

Dengue and dengue hemorrhagic fever: research priorities]

Dengue is one of the most important infectious diseases in tropical and subtropical countries. At present, the only strategy available to reduce the incidence of dengue is vector control. The World Health Organization and the Pan American Health Organization have called on all nations to take the needed steps to help diminish the burden of this disease and its medical and socioeconomic impact. It is hoped that it will be possible to reverse the increase in dengue and help control its spread through a coordinated, effective international response, along with epidemiological, clinical, and virological research that brings together the most advanced methods and techniques. This piece summarizes the most up-to-date information on dengue, analyzes current epidemiologic trends in the Region of the Americas, discusses the main global and Western Hemisphere initiatives to control the disease, and presents the main areas of research that should be developed in the immediate future.     

Health and foreign policy: influences of migration and population mobility

International interest in the relationship between globalization and health is growing, and this relationship is increasingly figuring in foreign policy discussions. Although many globalizing processes are known to affect health, migration stands out as an integral part of globalization, and links between migration and health are well documented. Numerous historical interconnections exist between population mobility and global public health, but since the 1990s new attention to emerging and re-emerging infectious diseases has promoted discussion of this topic. The containment of global disease threats is a major concern, and significant international efforts have received funding to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome). Migration and population mobility play a role in each of these public health challenges. The growing interest in population mobility's health-related influences is giving rise to new foreign policy initiatives to address the international determinants of health within the context of migration. As a result, meeting health challenges through international cooperation and collaboration has now become an important foreign policy component in many countries. However, although some national and regional projects address health and migration, an integrated and globally focused approach is lacking. As migration and population mobility are increasingly important determinants of health, these issues will require greater policy attention at the multilateral level.     

抗艾滋病、结核病和疟疾全球基金与主要捐赠国的合作及其对中国的启示

抗击艾滋病、结核病和疟疾的全球基金是一个旨在通过公私合作伙伴关系,加速终结艾滋病、结核病和疟疾等传染病流行的国际融资机构。全球基金成立20年以来,为艾滋病、结核病和疟疾流行的控制做出了重要贡献,影响力日益扩大。本文详细介绍了全球基金的治理结构以及筹资与分配模式,比较分析了主要捐赠国家与全球基金的合作方式,以及中国与全球基金的关系,并为中国参与全球基金等全球卫生多边平台提出了相应的政策建议。     

Emerging pathogen of wild amphibians in frogs (Rana catesbeiana) farmed for international trade

Chytridiomycosis is an emerging disease responsible for a series of global declines and extinctions of amphibians. We report the causative agent, Batrachochytrium dendrobatidis, in North American bullfrogs (Rana catesbeiana) farmed for the international restaurant trade. Our findings suggest that international trade may play a key role in the global dissemination of this and other emerging infectious diseases in wildlife.     

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.