Published online by Cambridge University Press: 11 March 2020
This paper argues that the existing definition of pandemics is not nuanced enough, because it is predicated solely on the criterion of spread, rather than on the criteria of spread and severity. This definitional challenge is what I call ‘the conflation problem’: there is a conflation of two different realities of global health, namely global health emergencies (i.e., severe communicable diseases that spread across borders) and nonemergencies (i.e., communicable or noncommunicable diseases that spread across borders and that may be severe). To put this argument forth, this paper begins by discussing the existing and internationally accepted definition of pandemics, its requirements, as well as its strengths (section 1). Section 2 then considers the problem with the standard definition of pandemics (i.e., the conflation problem) and some examples of it. Finally, section 3 evaluates some practical implications of the conflation problem to then explore conceptual clarity as the adequate solution.
Acknowledgements: The author is grateful to Mark Eccleston-Turner and Iain Brassington for comments on earlier drafts of the paper. Special thanks are due to Mary Clare Enright for critical feedback and proofreading, and to Tiffanie Cappello-Lee for her research assistance and many conversations on this topic.
1. Bonneux, L, Van Damme, W. Health is more than influenza. Bulletin of the World Health Organization 2011;89:539–40, at 540CrossRefGoogle ScholarPubMed.
2. Nicoll, A. Planning for uncertainty: A European approach to informing responses to the severity of influenza epidemics and pandemics. Bulletin of the World Health Organization, 2011;89:542–44, at 542CrossRefGoogle Scholar.
3. Kelly, H. The classical definition of pandemic is not elusive. Bulletin of the World Health Organization 2011;89:540–41, at 540CrossRefGoogle Scholar.
4. Barnett, DJ. Pandemic influenza and its definitional implications. Bulletin of the World Health Organization 2011;89:539CrossRefGoogle ScholarPubMed.
5. See note 4, Barnett 2011.
6. Fineberg, HV. Pandemic preparedness and response – Lessons from the H1N1 influenza of 2009. The New England Journal of Medicine 2014;370(14):1335–42, at 1335CrossRefGoogle ScholarPubMed.
7. World Health Organization. What is a pandemic?; available at http://www.who.int/csr/disease/swineflu/frequently_asked_questions/pandemic/en/ (last accessed 13 July 2017)
8. Porta, M. Dictionary of Epidemiology, 6th ed. New York, NY: Oxford University Press; 2014, at 209CrossRefGoogle Scholar.
9. See note 8, Porta 2014, at 93, 209.
10. World Health Organization. WHO Pandemic Phase Descriptions and Main Actions By Phase; available at http://www.who.int/influenza/resources/documents/pandemic_phase_descriptions_and_actions.pdf (last accessed 11 Nov 2019).
11. See note 6, Fineberg 2014, at 1337.
12. See note 10, World Health Organization.
13. See note 6, Fineberg 2014, at 1337.
14. See note 10, World Health Organization.
15. See note 6, Fineberg 2014, at 1337.
16. See note 6, Fineberg 2014, at 1337.
17. See note 10, World Health Organization.
18. See note 6, Fineberg 2014, at 1337.
19. See note 6, Fineberg 2014, at 1337.
20. World Health Organization. Current WHO phase of pandemic alert for Pandemic (H1N1) 2009; available at http://www.who.int/csr/disease/swineflu/phase/en/ (last accessed 11 Nov 2019).
21. See note 6, Fineberg 2014, at 1337.
22. See note 6, Fineberg 2014, at 1337.
23. See note 6, Fineberg 2014, at 1337.
24. World Health Organization. Controlling the global obesity epidemic; available at http://www.who.int/nutrition/topics/obesity/en/ (last accessed 13 July 2017).
25. Swinburn, BA, Sacks, G, Hall, KD, McPherson, K, Finegood, DT, Moodie, ML, Gortmaker, SL. The global obesity pandemic: Shaped by global drivers and local environments. Lancet 2011;378(9793), at 804CrossRefGoogle ScholarPubMed; Meldrum, DR, Morris, MA, Gambone, JC. Obesity pandemic: Causes, consequences, and solutions-but do we have the will? Fertility and Sterility 2017;107(4):833 CrossRefGoogle ScholarPubMed.
26. World Health Organization. World Health Assembly Resolution WHA39.14 Tobacco or health 1985; Warner, KE, Mackay, J. The global tobacco disease pandemic: Nature, causes, and cures. Global Public Health 2006 ;1(1) :65 CrossRefGoogle ScholarPubMed.
27. Editorial. The diabetes pandemic. Lancet 2011;378(9786):9.
28. Milam, J. Ending the Drug Addiction Pandemic: Discovering the Liberating Truth. Houston, TX: Strategic Book Publishing & Rights Agency, LLC; 2013 Google Scholar.
29. Talashek, ML, Gerace, LM, Starr, KL. The substance abuse pandemic: Determinants to guide interventions. Public Health Nursing 1994;11(2):131 CrossRefGoogle ScholarPubMed.
30. World Health Organization. The preventable pain pandemic; available at http://www.who.int/ncds/management/palliative-care/preventable_pain/en/ (last accessed 11 Nov 2019).
31. De Campos, TC. The well-being conception of health and the conflation problem. The New Bioethics 2016;22(1):71 CrossRefGoogle ScholarPubMed; See also De Campos, TC. The Global Health Crisis Cambridge: Cambridge University Press; 2017, at chapter 1CrossRefGoogle Scholar; and De Campos, TC. Health as a basic human need: Would this be enough. The Journal of Law, Medicine & Ethics 2012;40(2):251 CrossRefGoogle Scholar.
32. See note 3, Kelly 2011, at 540.
33. Doshi, P. The Elusive definition of pandemic influenza. Bulletin of the World Health Organization 2011:535 Google Scholar.
34. See note 6, Fineberg 2014, at 1339.
35. See note 6, Fineberg 2014, at 1339.
36. See note 6, Fineberg 2014, at 1339.
37. See note 33, Doshi 2011.
38. World Health Organization. International Health Regulations; 2005, at Article 2.
39. See note 4, Barnett 2011, at 539.
40. See note 6, Fineberg 2014, at 1335.
41. See note 4, Barnett 2011, at 539.
42. See note 4, Barnett 2011, at 539.
43. See note 33, Doshi 2011, at 535.
44. See note 1, Bonneux, Van Damme 2011, at 540.
45. Endicott, T. How to speak the truth. American Journal of Jurisprudence 2001;46:229-48, at 234CrossRefGoogle Scholar.
46. See note 45 Endicott 2001, at 238.
47. World Health Organization. Controlling the global obesity epidemic; available at http://www.who.int/nutrition/topics/obesity/en/ (last accessed 13 July 2017)
48. See note 33, Doshi 2011, at 534; note 1, Bonneux, Van Damme 2011, at 539–40; note 3, Kelly 2011, at 540.
49. See note 1, Bonneux, Van Damme 2011, at 539–40.