This article is a part of Global Envision's World Health Day 2006: Working Together for Health series.

According to Dr. Tim Evans, Assistant Director-General for Evidence and Information for Policy, World Health Organization:
"There is a chronic global shortage of health workers, as a result of decades of underinvestment in their education, training, salaries, working environment and management. This has led to a severe lack of key skills, rising levels of career switching and early retirement, as well as national and international migration. In sub-Saharan Africa, where all the issues mentioned above are combined with the HIV/AIDS pandemic, there are an estimated 750,000 health workers in a region that is home to 682 million people. By comparison, the ratio is ten to 15 times higher in OECD countries, whose ageing population is putting a growing strain on an over-stretched workforce. Solutions to this crisis must be worked out at local, national and international levels, and must involve governments, the United Nations, health professionals, non-governmental organizations and community leaders."

"There is no single solution to such a complex problem, but ways forward do exist and must now be implemented. For example, some developed countries have put policies in place to stop active recruitment of health workers from severely understaffed countries. Some developing countries have revised their pay scales and introduced non-monetary incentives to retain their workforce and deploy them in rural areas. Education and training procedures have been tailored to countries' specific needs. Community health workers are helping their communities to prevent and treat key diseases. Action must be taken now for results to show in the coming years."

This article takes a look at global pandemics, and how medical professionals worldwide trained as "detectors" would be the best way to halt the spread of a disease before it became a global threat.

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A few times each year, the world is reminded that a pandemic threat is immanent. In 2003, it was SARS. Today, it is a potential avian virus similar to the one that killed 30 million people after 1914.

"Bird flu" has already shown that it can jump from fowl to humans, and now even to cats, which indicates that it might be the next global killer. But there are many other potential pandemics, and many are not even viruses. Bacteria, prions, parasites, and even environmental factors could suddenly change in a way that slays us. It is widely predicted that when this happens, the economic and human losses will exceed that of any previous war.

Indeed, it is humbling to remember that some of history's most deadly invasions were carried out by single-cell organisms, such as cholera, bubonic plague, and tuberculosis. Countries with the resources to do so are making resistance plans against pandemics - limited strategies that would protect their own citizens. Most governments are hoping that early detection will make containment possible.

Initial warning signs of a pandemic are most likely to appear in the developing world, but detection nodes should be positioned in every country, with the least possible expense. This is not as difficult as it sounds. The key is to harness existing infrastructure.

Containment depends heavily on vaccines, but vaccines are only part of the answer. While they are a good defense against many viruses, each vaccine is highly specific to the threat. Viruses are parasites to cells, and each virus attacks a particular type of cell. The virus is shaped so that it can drill into a particular feature of that cell and inject parts of itself inside, confusing the cell into making more viruses and destroying itself in the process. With their very specific forms, the most effective anti-viral vaccines must be designed for a narrow range of factors.

Sometimes the tailored nature of viruses works in our favor. For example, they usually find it difficult to jump between species, because they would have to change their structure. But if large numbers of a host - say, birds - encounter a great number of people, eventually the virus will find a way to prosper in a new type of cell.

Birds are the greatest concern today only because the spread is easy to see. But AIDS jumped from monkeys and several types of flu jumped from swine. Deadly mutations of any kind need to be identified urgently, so that an effective vaccine can be designed before the strain becomes comfortable in the human body. Unfortunately our present methods of detection are not sensitive enough.

This is even more worrying when you realize that scientists should also be monitoring bacteria, prions, and parasites. There are more bacteria than any other life form. Many live harmlessly in our bodies and perform useful functions. They evolve and adapt easily, which means that they learn to sidestep our drugs over time. Bacteria should be checked for two types of mutation: adaptation by a hostile form that enables it to become super-immune to drugs, or a deadly mutant strain that appears in one of the multitude of "safe" bacteria.

Prions are a relatively new discovery. They are made from proteins similar to those that the body uses during healthy operations, which means that they are able to fool the body's tools into making more prions. They have only recently been recognized as the cause of several infectious diseases, including mad cow disease and Creutzfeldt-Jakob Disease, which kill by crowding out healthy brain cells. Many nerve, respiratory and muscle diseases might also be caused by prions.

Finally, parasites, simple animals that infect us, are already classified as pandemics. Malaria afflicts 300 million people and is the world's biggest killer of children. Many parasites are worms: hookworm (800 million people infected), roundworm (1.5 billion), schistosomes (200 million), and the worm that causes Elephantiasis (150 million).

Medical infrastructure exists everywhere, in some form. It also tends to be the least corrupt of institutions in regions where that is a problem. Medical centers and clinics would be expected to investigate the cause of ailments in a large number of their patients, even in cases where the symptoms seem common.

There are also antagonists that are currently ignored. Environmental chemicals and particulates might warrant their own categories. Or consider combinations of problems, such as these chemical infectors mixing with airborne pollens, and apparently pushing up incidences of asthma. New fungal infections are even scarier and might be harder to treat.

The bottom line is that we can't predict where the threat will emerge, so we need a distributed, intelligent detection system. In practical terms, how should it be built?

"Detectors" would have to be expert enough to know when an ordinary-looking symptom is actually an emergency. They would be located everywhere, with an emphasis on vulnerable regions. Initial warning signs of a pandemic are most likely to appear in the developing world, but detection nodes should be positioned in every country, with the least possible expense. This is not as difficult as it sounds. The key is to harness existing infrastructure.

Medical infrastructure exists everywhere, in some form. It also tends to be the least corrupt of institutions in regions where that is a problem. Medical centers and clinics would be expected to investigate the cause of ailments in a large number of their patients, even in cases where the symptoms seem common. A small amount of additional scientific expertise and lab equipment would need to be added to a public health system that serves ordinary needs.

Enhancing existing resources would be effective for two reasons. First, illness is more likely to be reported in a city hospital than at a specialist institute. Second, the investment would boost latent public health in that region. For poor regions, investment in equipment and training would have to come from wealthier counterparts. Rich countries could justify the expense in terms of the savings that would result from early detection of a major threat. Tropical climates and urban slums are humanity's front line against pandemics, and they should be equipped properly.

Public health is an important asset for any nation. With so much at stake, it makes sense to place sentinels near every swamp, city, public market, and farmyard on earth.




Contributed by H. T. Goranson, the Lead Scientist of Sirius-Beta Corp and formerly a Senior Scientist with the US Defense Advanced Research Projects Agency. Reprinted with permission from Project Syndicate.

To read another Global Envision article about globalization and health, see Health a Growing Global Concern.

Online resources about pandemics.




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