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Commentary: Challenges to Achieve Conceptual Clarity in the Definition of Pandemics

Published online by Cambridge University Press:  11 March 2020

EDUARDO A. UNDURRAGA Open the ORCID record for EDUARDO A. UNDURRAGA [Opens in a new window]
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Extract

From a scientific standpoint, the world is more prepared than ever to respond to infectious disease outbreaks; paradoxically, globalization and air travel, antimicrobial resistance, the threat of bioterrorism, and newly emerging pathogens driven by ecological, socioeconomic, and environmental factors, have increased the risk of global epidemics.1,2,3 Following the 2002–2003 severe acute respiratory syndrome (SARS), global efforts to build global emergency response capabilities to contain infectious disease outbreaks were put in place.4,5,6 But the recent H1N1, Ebola, and Zika global epidemics have shown unnecessary delays and insufficient coordination in response efforts.7,8,9,10 In a thoughtful and compelling essay,11 Thana C. de Campos argues that greater clarity in the definition of pandemics would probably result in more timely effective emergency responses, and pandemic preparedness. In her view, a central problem is that the definition of pandemics is based solely on disease transmission across several countries, and not on spread and severity together, which conflates two very different situations: emergency and nonemergency disease outbreaks. A greater emphasis on severity, such that pandemics are defined as severe and rapidly spreading infectious disease outbreaks, would make them “true global health emergencies,” allowing for priority resource allocation and effective collective actions in emergency response efforts. Sympathetic to the position taken by de Campos, here I highlight some of the challenges in the definition of severity during an infectious disease outbreak.

Type
Special Section: Causality and Moral Responsibility
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Issue 2 , April 2020 , pp. 218 - 222
Copyright
© Cambridge University Press 2020

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Footnotes

Acknowledgement: This work was partially supported by the Millennium Science Initiative of the Chilean Ministry of Economy, Development, and Tourism, grant ‘Millennium Nucleus for the Study of the Life Course and Vulnerability.’ Study sponsors did not have any role in analysis and interpretation of data; writing the report; or in the decision to submit for publication. I would like to thank Josefina Palacios for thoughtful comments and suggestions.

References

Notes

1. Frieden, TR, Tappero, JW, Dowell, SF, Hien, NT, Guillaume, FD, Aceng, JR. Safer countries through global health security. The Lancet 2014;383(9919):764-6CrossRefGoogle ScholarPubMed.

2. Jones, KE, Patel, NG, Levy, MA, Storeygard, A, Balk, D, Gittleman, JL, et al. Global trends in emerging infectious diseases. Nature 2008;451(7181):990 CrossRefGoogle ScholarPubMed.

3. Hoffman, SJ, Silverberg, SL. Delays in global disease outbreak responses: Lessons from H1N1, Ebola, and Zika. American Journal of Public Health 2018;108(3):329–33CrossRefGoogle ScholarPubMed.

4. See note 3, Hoffman 2018.

5. Hardiman, MC. World Health Organization perspective on implementation of international health regulations. Emerging Infectious Diseases 2012;18(7):1041 CrossRefGoogle ScholarPubMed.

6. Gates, B. The next epidemic—lessons from Ebola. New England Journal of Medicine 2015;372(15):1381–4CrossRefGoogle ScholarPubMed.

7. See note 3, Hoffman 2018.

8. Moon, S, Sridhar, D, Pate, MA, Jha, AK, Clinton, C, Delaunay, S, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet 2015;386(10009):2204–21CrossRefGoogle ScholarPubMed.

9. Nuzzo, JB, Cicero, AJ, Inglesby, TV. The importance of continued US investment to sustain momentum toward global health security. JAMA 2017;318(24):2423–4CrossRefGoogle ScholarPubMed.

10. Lucey, DR, Gostin, LO. The emerging Zika pandemic: Enhancing preparedness. JAMA 2016;315(9):865–6CrossRefGoogle ScholarPubMed.

11. de Campos TC. The traditional definition of pandemics, its moral conflations, and its practical implications: A defense of conceptual clarity in global health laws and policies. Cambridge Quarterly of Healthcare Ethics 2020;29(2):206–218.

12. Rosselló, J, Santana-Gallego, M, Awan, W. Infectious disease risk and international tourism demand. Health Policy and Planning 2017;32(4):538–48CrossRefGoogle ScholarPubMed.

13. Frieden, TR, Damon, IK. Ebola in West Africa—CDC’s role in epidemic detection, control, and prevention. Emerging Infectious Diseases 2015;21(11):1897–905CrossRefGoogle ScholarPubMed.

14. Huber, C, Finelli, L, Stevens, W. The economic and social burden of the 2014 Ebola outbreak in West Africa. The Journal of Infectious Diseases 2018;218(suppl_5):S698–S704 CrossRefGoogle ScholarPubMed.

15. Lee, J-W, McKibbin, WJ. Estimating the global economic costs of SARS. In: Learning from SARS: preparing for the next disease outbreak: Workshop summary. Washington, DC: National Academies Press; 2004, at 92Google Scholar.

16. Kostova, D, Cassell, CH, Redd, JT, Williams, DE, Singh, T, Martel, LD, et al. Long-distance effects of epidemics: Assessing the link between the 2014 West Africa Ebola outbreak and U.S. exports and employment. Health Economics 2019:1–14 Google ScholarPubMed.

17. Doshi, P. The elusive definition of pandemic influenza. Bulletin of the World Health Organization 2011;89:532–8CrossRefGoogle ScholarPubMed.

18. Swinburn, BA, Sacks, G, Hall, KD, McPherson, K, Finegood, DT, Moodie, ML, et al. The global obesity pandemic: shaped by global drivers and local environments. The Lancet 2011;378(9793):804–14CrossRefGoogle ScholarPubMed.

19. Warner, K, Mackay, J. The global tobacco disease pandemic: Nature, causes, and cures. Global public health 2006;1(1):65–86 CrossRefGoogle ScholarPubMed.

20. Fineberg, HV. Pandemic preparedness and response—lessons from the H1N1 influenza of 2009. New England Journal of Medicine 2014;370(14):1335–42CrossRefGoogle ScholarPubMed.

21. See note 11, de Campos 2020.

22. See note 11, de Campos 2020

23. See note 13, Frieden 2015.

24. Chowell, G, Viboud, C, Simonsen, L, Merler, S, Vespignani, A. Perspectives on model forecasts of the 2014–2015 Ebola epidemic in West Africa: Lessons and the way forward. BMC Medicine 2017;15(1):42 CrossRefGoogle ScholarPubMed.

25. Meltzer, MI, Santibanez, S, Fischer, LS, Merlin, TL, Adhikari, BB. Modeling in real time during the Ebola response. Morbidity and Mortality Weekly Report 2015;65(3):85–9Google Scholar.

26. Nicoll, A, Ammon, A, Amato, A, Ciancio, B, Zucs, P, Devaux, I, et al. Experience and lessons from surveillance and studies of the 2009 pandemic in Europe. Public Health 2010;124(1):14–23 Google ScholarPubMed.

27. Peters, DH, Keusch, GT, Cooper, J, Davis, S, Lundgren, J, Mello, MM, et al. In search of global governance for research in epidemics. The Lancet 2017;390(10103):1632–3CrossRefGoogle ScholarPubMed.

28. See note 25, Meltzer 2015.

29. See note 2, Jones 2008.

30. See note 25, Meltzer 2015.

31. World Health Organization (WHO). Emergencies preparedness, response. Disease Outbreak News. In. Geneva: WHO; 2019; available at https://www.who.int/csr/don/en/ (last accessed 5 Nov 2019).

32. See note 31, WHO 2019.

33. See note 24, Chowell 2017.

34. Mercer, GN, Glass, K, Becker, NG. Effective reproduction numbers are commonly overestimated early in a disease outbreak. Statistics in Medicine 2011;30(9):984–94CrossRefGoogle Scholar.

35. Britton, T, Scalia Tomba, G. Estimation in emerging epidemics: Biases and remedies. Journal of The Royal Society Interface 2019;16(150):20180670 CrossRefGoogle ScholarPubMed.

36. See note 6, Gates 2015.

37. Merianos, A, Peiris, M. International health regulations (2005). The Lancet 2005;366(9493):1249–51CrossRefGoogle ScholarPubMed.

38. Undurraga, EA, Carias, C, Meltzer, MI, Kahn, EB. Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: Lessons for the Global Health security agenda. Infectious Diseases of Poverty 2017;6(1):159 CrossRefGoogle ScholarPubMed.

39. See note 20, Fineberg 2014.

40. Gostin, LO, Friedman, EA. A retrospective and prospective analysis of the west African Ebola virus disease epidemic: Robust national health systems at the foundation and an empowered WHO at the apex. The Lancet 2015;385(9980):1902–9CrossRefGoogle Scholar.

41. See note 8, Moon 2015.

42. See note 9, Nuzzo 2017.

43. See note 1, Frieden 2014.

44. See note 6, Gates 2015.

45. See note 38, Undurraga 2017.

46. Doshi, P. Calibrated response to emerging infections. BMJ 2009;339:b3471Google ScholarPubMed.

47. See note 38, Undurraga 2017.

48. Bogoch, II, Creatore, MI, Cetron, MS, Brownstein, JS, Pesik, N, Miniota, J, et al. Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 West African outbreak. The Lancet 2015;385(9962):29–35 CrossRefGoogle ScholarPubMed.

49. Lessler, J, Chaisson, LH, Kucirka, LM, Bi, Q, Grantz, K, Salje, H, et al. Assessing the global threat from Zika virus. Science 2016;353(6300):aaf8160 CrossRefGoogle ScholarPubMed.

50. Colizza, V, Barrat, A, Barthelemy, M, Vespignani, A. The role of the airline transportation network in the prediction and predictability of global epidemics. Proceedings of the National Academy of Sciences of the United States of America 2006;103(7):2015–20CrossRefGoogle ScholarPubMed.

51. Hufnagel, L, Brockmann, D, Geisel, T. Forecast and control of epidemics in a globalized world. Proceedings of the National Academy of Sciences 2004;101(42):15124–9CrossRefGoogle Scholar.

52. See note 17, Doshi 2011.