Today in an era of interconnected world where international trade and travel are linkages between facets of globalization which offers products and services while travelling to new exotic places as well as brings threats to new emerging diseases. It seems to have stemmed from speedy connections globally which are just a plane ride away. These infectious diseases are widely known among humans, wildlife as well as domestic animals due to the diversity in the genomes of these microorganisms which make them effective to infect plethora of species. It’s a story from about five decades when in the era of antibiotics and vaccines we seemed to be protected and won all battles against these deadly agents. However, their interplay within their genetic make-up to evade immune mechanisms leading to increasing antimicrobial resistances made the situation even worse. (Rees 2013, Cunningham et al 2017). The scary part of the situation is that these infectious diseases can emerge uncalled anytime anywhere on this planet.
Trade has always served as a reservoir of pathogens. In 13th century, deadly plague engulfed the world through their rat reservoirs carried on boats for sailing. Then in 16th and 17th centuries, Aedes aegypti was introduced to the Americans from West Africa through the carriers of slave trade. Many of the infectious agents that ignite these lethal outbreaks are not novel but have evolved with humans for hundreds of thousands of years like Zika since 1940s and viral haemorrhagic fevers such as Crimean-Congo haemorrhagic fever, Lassa fever, Ebola since 1970s (Wu et al 2017). But then suddenly the range and proportion of geographical areas covered increased by 1960s and the deadly realization came into existence in the late 1970s and early 1980s when the world fell in the throes of unprecedented pandemics of genital herpes and AIDS, that actually propelled the suffering into the mainstream. Now they can transmit and infect with greater potency and speed than ever before. They turn up unexpectedly in new geographic location and invade population which have their immune system off guard to them and thus challenge health systems.
History has revealed that epidemiological line of control separating pathogens infecting humans from wildlife and livestock has been defied repeatedly. During twentieth century, reports of around 75% of emerging diseases and 61% of human disease causative agents were zoonotic (Taylor et al 2001). Zoonotic spillover is another pressing threat due to trade and travel, where these microbial agents originating in wild animals tend to enter and affect human population. The transmission can be through person to person or the consumption of infected wildlife or livestock like SARS, Avian Influenza, HIV AIDS (Patz et al 2004, Murray and Daszak 2013). The same is true for Saudi Arabia in 2012 where Middle Eastern Respiratory Syndrome (MERS), a coronavirus which has been transmitted between their animal reservoirs like camel and human. Since then, reports of its spread and transmission have been recorded across globe in Europe, North America, and East and Southeast Asia (Parlak 2015, Zumla et al 2015). Another family of virus, Arboviruses, whose vectors have become ready to harbor and have found their milieu, niches and ecosystem globally. Evidently Dengue, Chikungunya, Zika, Malaria and West Nile have been infecting people via the network of international trade (Alirol et al. 2011, Weaver 2013, Kraemer et al. 2015).
International Trade is such an integral part of the global market that it is nearly impossible to screen all the imports for known pathogen and new deadly threats. Moreover the removal of all physical and regulatory trade barriers has led to efficient spread of pathogens that the speed of detection systems.
A highly significant burden of death tolls in terms of population survival rate, life expectancy and development are indebted to infectious diseases since a long time in history of mankind. About 25% of deaths that occur worldwide are because of the emergence of these infectious diseases (WHO fs310, fauci et al 2005) and neglected tropical diseases also claim lives of more than half million of the people (Bhutta et al 2014). These figures impact the gravity of the mortality rate.
A mitigation strategy of disease management and to overcome risk of spread is more economically efficient than its rescue remedies post outbreak (Graham et al 2008, Voyles et al 2014, Langwig et al 2015). Vaccination has been a well-known and reliable practice. This holds true for many DNA viruses but remains ineffective in case of RNA viruses which easily evade such strategies through their capability to diverse their gene composition via random mutation tactics. It is a proven solution for chicken pox or small pox but remains a problem for Ebola, MERS, SARS, and avian influenza. However, mitigating the risk of emergence of Zoonoses fails to lie under the protection of vaccination which will ineluctably attack immunologically naïve. Diversity of these zoonoses have led them difficult to control due to unprecedented levels of international co-operations, travels and meets. Preclusive measures are need of the hour against their sociodemographic, socioeconomic, environmental, and ecological factors (Pike et al 2014).
It is the most underscored link in the history of epidemics where linkages to source and host cities play an utmost imperative role in the transfer of the infectious material. The 2014 West Africa Ebola Virus Disease (EVD) outbreak, for example, was a local epidemic having a long survival expectancy among the wildlife of Africa. Its outbreak in 2014 as well as it has its origin, after the consumption of a wild animal protein, at Meliandou, located in Gueckedou District, Guinea on 26 December 2013. But the causative agent was Ebola virus got identified by 21 March 2014. Meliandou is known as the Forest Region (Spengler et al 2016, WHO 2016) and it is in close proximity to and shares common border with Guinea, Sierra Leone, and Liberia. However, much of the forest area has been destroyed through mining and timber processing by certain foreign agencies. Due to sharing of common borders there is frequent intercountry movements associated with various activities and thus a channel for entry for various microbial agents. These interplay of deterioration of natural resources and cross-country activities has brought potentially infected wild animals, including the bat species, a natural reservoir of the virus, to thrive into niches in proximity to human settlements [WHO fs-103, Goba et al 2016].
The recent trend in livelihood suggest that there is change in the demands and resources of people for which they tend to incline more towards cities. But owing to lifestyle the cities remain unplanned and thousands of millions of people thrive in unhygienic and crowded places. Such conditions have reduced the survival rates of such populations as these cities can serve as best breeding grounds for various infectious diseases. The best example is Zika outbreak in Brazil. Another factor is the high prevalence of various communicable and noncommunicable diseases including STDs (Sexually Transmitted Diseases) which lead to immunologically compromised people and increase the vulnerability of such population to unprecedented infections (Alirol et al 2011, Li et al 2012). Conditions cohesive to comorbidity can exaggerate the susceptibility rates to zoonotic pathogens and worsen the survival expectancy (Weiss and McMichael 2004). For instance, If first SARS carrier had entered in Durban (which has high incidence of AIDS in its vicinity) rather than in the more planned, protective and hygienic environment of Toronto, the outcome may have been much more terrible and adverse (Weiss and McMichael 2004).
Trade in pork or pork product has made us encountered with a severe disease recently. An exemplary is UK in 2001 where an outbreak of hoof and mouth disease cost the lives of around 2 million sheeps and cattle with financial loss of $10 billion. Another one is African swine fever- a grave disease of pigs- outspread in Caucasus region. Rice fields across East Asia are heavily populated by poultry, ducks and are a proven reservoir of HPAI carrying waterfowl (Martin et al 2011, Gilbert et al 2014). The reiterated outbreaks of avian influenza has set an alarming stage for the growing risks of epidemics (Webby and Webstter 2003).
When new viruses or old ones which have become highly evolved potent strains, attack impoverished or weakened health systems, have a much greater survival rate. Due to this mortality rate among human and livestock populations got increased. In the 2014-15 Ebola epidemic where 11,000 out of the total affected West Africans died but on the other hand every American infected during that period survived. The striking difference is due to sound financial status and access to health care facilities on time. While all this had been possible at the National Institutes of Health in Bethesda, Maryland, but it wasn’t in many of the places like Gueckedou, Guinea leading to high mortality rates consequently. Similar story happened to occur in many parts of Africa, including Angola, where an outbreak of yellow fever threatened the lives of around 2500 people out of which 300 died. This outbreak could have been prevented if the at-risk communities would have been vaccinated (vaccine developed in 1936) but the health care systems failed to reach to people to save their lives. In 2006, WHO with the support of Gavi ramped up their efforts to increase the vaccine coverage rates. Similarly, failure to control the epidemic outbreak of 2014 case of Ebola virus in Guinea was due to extreme poverty, weakened healthcare infrastructure and other administrative bodies as a consequence of years of civil war, lack of basic immunities, faulty education systems, impaired societal norms, and local orthodox customs such as washing the dead body before burial (Fineberg and Wilson 2010, 528306). This exemplifies the complex and interrelated nature of factors involved in infectious disease emergence.
According to the reports of NASA/NOAA, 2015 was the hottest year on record. In a report released by world’s leading experts on environmental health, The Lancet in June 2015 argued that “the implications of climate change for a global population of 9 billion people threatens to undermine the last half century of gains in development and global health,” including the spread of disease vectors. For example, for all the diseases spread by the Aedes mosquito and for Aedes reaching new places and people, the stark point is climate change as mosquitoes thrive proficiently in warm and moist environments. Similarly, the impact of spread of Bird flu, cholera are Lyme disease are worse by climate change.
Various multilateral regimes have been introduced by international governing bodies to overcome serious implications posed by infectious disease spread like TRIPS, FAO Codex Alimentarius Commission standards on food safety, International Health Regulations by WHO. These are governed by various international agreements, customary international law, general principles of law recognized by civilized nations, judicial decisions, writings of the most highly qualified publicists of the various nations and soft laws. These are further subcategorized into International Trade Law, International human rights law, international environmental law, intellectual property law, oceans and law of the sea, international maritime law, international arms control law and bioethics. The field to combat Emerging Infectious Diseases was galvanized by the creation of “special pathogens branch,” by the WHO at the Centre for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA [C. to R 2001, WHO] with the objective to integrate measures to ignite the driving force behind research, investment and related activities. It is aimed to know the emergence of new infectious deadly diseases, including Neglected Tropical Diseases (NTDs) and their re-emergence in the same population as well as new demographic populations after a long dormant period. Further a resolution was adopted by the 66th World Health Assembly of the WHO (WHA66.12) in May 2013 to find out the ways to improve the health and social well-being of affected populations. Various other international bodies, organizations and committees have put forward their initiatives and financial commitments in the same direction (Bill and Melinda 2012), NEJMra064142). Funds for research related activities for NTDs were covered through the Bill & Melinda Gates Foundation although these were not listed among the United Nation’s Millenium Development Goals (MDGs) (Bill and Melinda Gates Foundation). Then in early 2012 the historic London Declaration on NTD was adopted with a financial commitment of at least US$ 785 million by major stakeholders including the World Bank, the Bill & Melinda Gates Foundation, WHO, various government and pharmaceutical companies towards the attainment of these goals (London Declaration_NTD, WHO 2012).
The new and recurrent tendency of infectious diseases are a complex amalgamation of social, economic, demographic, environmental and microbiological factors. This circle of continuum of infection is under the influence of number of driving forces which have created this planet a favorable breeding ground for the disposal of infectious agents. The predisposing factors like deforestation, changes in land use patterns, urbanization, global warming, malnutrition, poor health care system, inaccessible health provisions, uncontrolled population growth, anti-governance factors and anti-national elements are required to be met on criteria of high priority. There is an increasing toll worldwide on the health of diverse demographic populations and in response to such threats, there is a need for a multidisciplinary efforts from all the communities including quarantine regulations, health, medicine, international laws governing trade and migration to implement effective caution with prevention.
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