Digital Health Communication and Global Public Influence: A Study of the Ebola Epidemic

Scientists and health communication professionals expressed frustration over the relationship between misinformation circulating on the Internet and global public perceptions of and responses to the Ebola epidemic originating in West Africa. Using the big data platform Media Cloud, we analyzed all English-language stories about keyword “Ebola” published from 1 July 2014 to 17 November 2014 from the media sets U.S. Mainstream Media, U.S. Regional Media, U.S. Political Blogs, U.S. Popular Blogs, Europe Media Monitor, and Global Voices to understand how social network theory and models of the networked global public may have contributed to health communication efforts. 109,400 stories met our inclusion criteria. The CDC and WHO were the two media sources with the most inlinks (hyperlinks directed to their sites). Twitter was fourth Significantly more public engagement on social media globally was directed toward stories about risks of U.S. domestic Ebola infections than toward stories focused on Ebola infections in West Africa or on science-based information. Corresponding public sentiments about Ebola were reflected in the policy responses of the international community, including violations of the International Health Regulations and the treatment of potentially exposed individuals. The digitally networked global public may have influenced the discourse, sentiment, and response to the Ebola epidemic.     

Export of health services from developing countries: the case of Tunisia

Although the subject of health services exports by developing countries has been much discussed, the phenomenon is still in its early stage, and its real implications are not yet clear. Given the rapid development in this area, little empirical data are available. This paper aims to fill this gap by providing reliable data on consumption of health services abroad (GATS mode 2 of international service supply). It starts by assessing the magnitude of the volume of international trade in health services. This is followed by an in-depth analysis of the case of Tunisia based on an original field research. Because of the high quality of its health sector and its proximity with Europe, Tunisia has the highest export potential for health services in the Middle-East and North Africa (MENA) Region. Health services exports may represent a quarter of Tunisia's private health sector output and generate jobs for 5000 employees. If one takes into account tourism expenses by the incoming patient (and their relatives), these exports contribute to nearly 1% of the country's total exports. Finally, this case study highlights the regional dimension of external demand for health services and the predominance of South-South trade.     

由援助到共融:从抗击埃博拉看中国参与全球健康治理的变迁

"健康"一直是中国与非洲交流、融合的重要纽带之一。随着中国经济的快速发展和战略转型,中非的全方位合作也将进入"共融"时代,中非之间的健康交流、健康援助正面临着重要的机遇和挑战。总体上来看,中非"健康"经历了由"援助"、"合作"到"共融"三个阶段的变迁。抗击埃博拉疫情中,在国际社会普遍"恐埃"的情况下,中国的反应所折射的内在逻辑既有中非健康援助的历史传承性,也有中国经济快速发展所带来的中非经济"共融"因素的考量。目前中非健康合作已经形成具有官方和非官方层面的双轮驱动机制,也反映了中国参与全球治理理念的变迁。因此,在分析和思考抗击埃博拉疫情中的"中国反应"应该既立足于道义、大国义务与责任的视角,也要看到疫区防控系统脆弱、中非经济逐步"共融"的原因,体现了国际博弈下中国全球治理理念的变迁。     

Globalization and occupational health: a perspective from southern Africa

Increased world trade has generally benefited industrialized or strong economies and marginalized those that are weak. This paper examines the impact of globalization on employment trends and occupational health, drawing on examples from southern Africa. While the share of world trade to the world's poorest countries has decreased, workers in these countries increasingly find themselves in insecure, poor-quality jobs, sometimes involving technologies which are obsolete or banned in industrialized countries. The occupational illness which results is generally less visible and not adequately recognized as a problem in low-income countries. Those outside the workplace can also be affected through, for example, work-related environmental pollution and poor living conditions. In order to reduce the adverse effects of global trade reforms on occupational health, stronger social protection measures must be built into production and trade activities, including improved recognition, prevention, and management of work-related ill-health. Furthermore, the success of production and trade systems should be judged on how well they satisfy both economic growth and population health.     

Employer-Sponsored Insurance, Health Care Cost Growth, and the Economic Performance of U.S. Industries

Objective. To estimate the effect of growth in health care costs that outpaces gross domestic product (GDP) growth ("excess" growth in health care costs) on employment, gross output, and value added to GDP of U.S. industries.
Study Setting. We analyzed data from 38 U.S. industries for the period 1987–2005. All data are publicly available from various government agencies.
Study Design. We estimated bivariate and multivariate regressions. To develop the regression models, we assumed that rapid growth in health care costs has a larger effect on economic performance for industries where large percentages of workers receive employer-sponsored health insurance (ESI). We used the estimated regression coefficients to simulate economic outcomes under alternative scenarios of health care cost inflation.
Results. Faster growth in health care costs had greater adverse effects on economic outcomes for industries with larger percentages of workers who had ESI. We found that a 10 percent increase in excess growth in health care costs would have resulted in 120,803 fewer jobs, US$28,022 million in lost gross output, and US$14,082 million in lost value added in 2005. These declines represent 0.17 to 0.18 percent of employment, gross output, and value added in 2005.
Conclusion. Excess growth in health care costs is adversely affecting the economic performance of U.S. industries.     

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria,HIV/AIDS,and Tuberculosis,West Africa

Response to the 2014–2015 Ebola outbreak in West Africa overwhelmed the healthcare systems of Guinea, Liberia, and Sierra Leone, reducing access to health services for diagnosis and treatment for the major diseases that are endemic to the region: malaria, HIV/AIDS, and tuberculosis. To estimate the repercussions of the Ebola outbreak on the populations at risk for these diseases, we developed computational models for disease transmission and infection progression. We estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 (2,564–12,407) in Guinea; 1,535 (522–2,8780) in Liberia; and 2,819 (844–4,844) in Sierra Leone. The 2014–2015 Ebola outbreak was catastrophic in these countries, and its indirect impact of increasing the mortality rates of other diseases was also substantial.     

Evolution of Ebola Virus Disease from Exotic Infection to Global Health Priority,Liberia, Mid-2014

Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country’s health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers.     

Resultados y retos en salud pública ante la alerta por Ébola: una perspectiva desde Cataluña

The Ebola outbreak in Guinea Conakry was notified to the World Health Organization (WHO) in March 2014. It is the most complex Ebola outbreak to date, affecting Guinea Conakry as well as the surrounding countries and with a risk of the disease spreading outside Africa. For this reason, the World Health Organization declared this Ebola outbreak an international public health emergency in August 2014. The Public Health Agency of Catalonia, through the Spanish Alert and Emergencies Coordination Network, initiated public health actions in March 2014, developing a single protocol of action to be applied by all the health care providers in the whole Catalan territory, advice for travellers and voluntary workers arriving from affected countries and a weekly newsletter addressed to health professionals. At the same time, the Ebola Analysis and Monitoring Committee and the Ebola Scientific and Advisory Committee were established. More than 9600 professional health workers attended training sessions and informative sessions. From August 2014, the Catalan Epidemiological Surveillance Emergency Service (SUVEC) reported 117 suspected Ebola cases, of which only 3 met the epidemiological and clinical criteria leading to the activation of the action protocol. All 3 cases proved negative for Ebola. Also, 95 voluntary workers were monitored, 52% of whom were female and 74% had returned from Sierra Leone. Dealing with the suspected Ebola cases required a detailed advance preparation and planning, with a coordinated effort between the epidemiological and health-care network, and all the agents involved, as well as precise, realistic and appropriate risk communication. The prior screening of suspected Ebola cases by the SUVEC meant the immediate protocol was activated only in the cases that met the epidemiological and clinical criteria. This is a key point to be reinforced in any future international public health alerts.     

Identifying and addressing the governance accountability problem

Successive global health crises – from HIV and AIDS to SARS and H5N1 to Ebola – highlight one of the most pressing challenges to global health security: the GAP – the governance accountability problem. Introduced in 2014 in the book entitled, HIV/AIDS and the South African state: The responsibility to respond, this article takes up Alan Whiteside’s challenges, in a book review in these pages, to offer a more comprehensive analysis of the GAP. The GAP [?ehovi?, A. B. (2014). HIV/AIDS and the South African state: The responsibility to respond. Ashgate Global Health.] posits that there is a disconnect between ad hoc, state and non-state interventions to respond to an epidemic crisis, and the ultimate guarantee for health (security), which remains legally vested with the state. The existence and expansion of such ad hoc solutions result in a negligence: a failure of re-ordering of health rights and responsibilities for health between such actors and the accountable state. The GAP aims to highlight this disjunction. This article first defines the GAP. Second, it asks two questions: First, what is the contribution of the GAP thesis to understanding the emerging health security landscape? Second, what can the GAP offer in terms of practical insight into viable solutions to the re-ordering of state/non-state-based responsibility and accountability for global health security?     

Ebola in West Africa—CDC’s Role in Epidemic Detection,Control, and Prevention

Since Ebola virus disease was identified in West Africa on March 23, 2014, the Centers for Disease Control and Prevention (CDC) has undertaken the most intensive response in the agency’s history; >3,000 staff have been involved, including >1,200 deployed to West Africa for >50,000 person workdays. Efforts have included supporting incident management systems in affected countries; mobilizing partners; and strengthening laboratory, epidemiology, contact investigation, health care infection control, communication, and border screening in West Africa, Nigeria, Mali, Senegal, and the United States. All efforts were undertaken as part of national and global response activities with many partner organizations. CDC was able to support community, national, and international health and public health staff to prevent an even worse event. The Ebola virus disease epidemic highlights the need to strengthen national and international systems to detect, respond to, and prevent the spread of future health threats.     

Estimates of Outbreak Risk from New Introductions of Ebola with Immediate and Delayed Transmission Control

While the ongoing Ebola outbreak continues in the West Africa countries of Guinea, Sierra Leone, and Liberia, health officials elsewhere prepare for new introductions of Ebola from infected evacuees or travelers. We analyzed transmission data from patients (i.e., evacuees, international travelers, and those with locally acquired illness) in countries other than the 3 with continuing Ebola epidemics and quantitatively assessed the outbreak risk from new introductions by using different assumptions for transmission control (i.e., immediate and delayed). Results showed that, even in countries that can quickly limit expected number of transmissions per case to <1, the probability that a single introduction will lead to a substantial number of transmissions is not negligible, particularly if transmission variability is high. Identifying incoming infected travelers before symptom onset can decrease worst-case outbreak sizes more than reducing transmissions from patients with locally acquired cases, but performing both actions can have a synergistic effect.     

Public Health Emergency of International Concern (PHEIC) has Declared Twice in 2014; Polio and Ebola at the Top

BackgroundThe current Ebola outbreak in West Africa and the large scale wild Polio virus outbreak in several countries are the top most issues among international public health and scientific communities'' debates and concerns. These two outbreaks were judged to be declared as Public Health Emergency of International Concern (PHEIC) during 2014. This is the first time ever to have such circumstance of two PHEICs at the same time.DiscussionPHEIC, which has to be declared by WHO Director General after a recommendation of IHR Emergency Committee; is observed to start in countries with fragile health system and conflict areas. Then it rapidly spread to threaten the global public health. The year 2014 has uniquely witnessed declaration of two events as PHEIC according to IHR (2005); Polio and Ebola Virus Disease (EVD). Both outbreaks are caused by viruses such as H1N1 which was previously declared as PHEIC in 2009.SummaryPublic Health Emergencies of International Concern in 2014 occurred in countries with weak health systems and conflicts and threatening the whole globe. International collaborative work is required to contain the event and to mobilize resources/capacities between countries. Moreover, public health surveillance systems as core capacity for IHR (2005) should be strengthened in all countries with focus on those with limited capacity and ongoing conflicts. The ultimate aim is timely detection of potential PHEIC events in the future along with early preparedness and response plans.     

Pesticide exports from U.S. ports, 2001-2003

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class 1a and 1b pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Quality improvement of health systems in an epidemic context: A framework based on lessons from the Ebola virus disease outbreak in West Africa

Quality improvement (QI) in health generally focuses on the provision of health services with the aim of improving service delivery. Yet QI can be applied not only to health services but also to health systems overall. This is of growing relevance considering that due to deficiencies in health systems, the main countries affected by Ebola virus disease (EVD) outbreak in West Africa (2014–2016) were insufficiently prepared for the epidemic, and according to the WHO, epidemics are increasingly becoming a threat to global health. Our objective is to analyze QI constraints in health systems during that EVD epidemic and to propose a practical framework for QI in health systems for epidemics in developing countries. We applied a framework analysis using experiences shared at the “Second International Quality Forum” organized by the University of Heidelberg and partners in July 2015 and information gathered from a systematic literature review. Empirical results revealed multiple deficiencies in the health systems. We systemized these shortfalls as well as the QI measures taken as a response during the epidemic. On the basis of these findings, we identified six specific “priority intervention areas,” which ultimately resulted in the synthesis of a practical QI framework. We deem that this framework that integrates the priority intervention areas with the WHO building blocks is suitable to improve, monitor, and evaluate health system performance in epidemic contexts in developing countries.     

Ebola virus disease: Biological and diagnostic evolution from 2014 to 2017

The Ebola virus disease outbreak observed in West Africa from March 2014 to June 2016 has led to many fundamental and applied research works. Knowledge of this virus has substantially increased. Treatment of many patients in epidemic countries and a few imported cases in developed countries led to developing new diagnostic methods and to adapt laboratory organization and biosafety precautions to perform conventional biological analyses. Clinical and biological monitoring of patients infected with Ebola virus disease helped to determine severity criteria and bad prognosis markers. It also contributed to showing the possibility of viral sanctuaries in patients and the risk of transmission after recovery. After a summary of recent knowledge of environmental and clinical viral persistence, we aimed to present new diagnostic methods and other biological tests that led to highlighting the pathophysiological consequences of Ebola virus disease and its prognostic markers. We also aimed to describe our lab experience in the care of Ebola virus-infected patients, especially technical and logistical changes between 2014 and 2017.     

Pesticide Exports from U.S. Ports, 2001–2003

Abstract

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class la and Ib pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Globalization and health: results and options

The last two decades have witnessed the emergence and consolidation of an economic paradigm which emphasizes domestic deregulation and the removal of barriers to international trade and finance. If properly managed, such an approach can lead to perceptible gains in health status. Where markets are non-exclusionary, regulatory institutions strong and safety nets in place, globalization enhances the performance of countries with a good human and physical infrastructure but narrow domestic markets. Health gains in China, Costa Rica, the East Asian "tiger economies" and Viet Nam can be attributed in part to their growing access to global markets, savings and technology. However, for most of the remaining countries, many of them in Africa, Latin America and Eastern Europe, globalization has not lived up to its promises due to a combination of poor domestic conditions, an unequal distribution of foreign investments and the imposition of new conditions further limiting the access of their exports to the OECD markets. In these developing countries, the last twenty years have brought about a slow, unstable and unequal pattern of growth and stagnation in health indicators. Autarky is not the answer to this situation, but neither is premature, unconditional and unselective globalization. Further unilateral liberalization is unlikely to help them to improve their economic performance and health conditions. For them, a gradual and selective integration into the world economy linked to the removal of asymmetries in global markets and to the creation of democratic institutions of global governance is preferable to instant globalization.     

Influence and opportunity: reflections on the U.S. role in global public health

Today's global health crisis illustrates many of the transnational governance challenges the United States faces today. In the arena of global health, the United States can create a new role for itself by moving beyond a national-interest paradigm and strengthening its "soft power" position in health. Health in recent administrations has moved beyond being "just" a humanitarian issue to being one with major economic and security interests. Despite U.S. unilateralism, new approaches to global health governance are being developed by other actors, who have influenced the U.S. agenda and made important contributions. Yet a larger leader is still needed, especially in identifying and following a sound legal and regulatory global health governance system; bringing political legitimacy; and setting priorities. Responsible political action is needed to develop a new mindset and lay the groundwork for better global health in the future.     

泰国参与全球和区域卫生安全治理的经验和启示

泰国通过参与全球和区域卫生安全治理不仅改善了本国的卫生和经济状况，而且提高了泰国在东亚地区乃至全球范围内卫生安全领域的影响力和话语权。中国和泰国同属东亚地区发展中国家，泰国参与全球和区域卫生安全治理的经验和途径对中国具有借鉴价值。本文分析泰国在宏观、中观和微观层面如何主动参与全球和区域卫生安全治理，对于提高中国在卫生安全治理领域的参与度和影响力有重要启发，同时为中国加强与联合国系统机构和东南亚国家的卫生安全合作提供案例。     

The economic implications of greater global trade in livestock and livestock products.

The Uruguay Round of the General Agreement on Tariffs and Trade (GATT) established the World Trade Organization to supervise the reduction of barriers to, and liberalisation of, world trade. The application of sanitary and phytosanitary measures will be standardised to avoid use for protectionist purposes by countries or regional trade blocks. Harmonisation of animal disease control measures within regional blocks is essential if benefits to freer trade are to occur, but this harmonisation must be balanced against potential disease risks and costs associated with disease outbreaks. World trade in livestock products is concentrated among developed countries, although developing countries are responsible for approximately a third of poultry meat imports and exports. Despite liberalisation, the share of global trade by developing countries is unlikely to increase greatly in the short term. The benefits of trade and of freer trade are emphasised. Examples are given of the impacts of trade barriers on developing countries and of the harmonisation of European Union animal health standards. Economic implications for the future of greater global trade are assessed.