Special Reports Emerging Infections and the Public Health/Security Interface Emerging infectious diseases (EID) as defined by the Institutes of Medicine are “New, reemerging or drug-resistant infections whose incidence in humans has increased…. or whose incidence threatens to increase in the near future” (IOM, 1992). Factors contributing to the emergence of infectious diseases are many, including but not limited to human demographics and behavior, economic development and urbanization, international travel and commerce, microbial adaptation and change, breakdown of public health measures, climate and weather, poverty and social inequity, war and famine, lack of political will, and intent to harm. The wisdom of the expanded IHR (2005) framework becomes abundantly clear when considering the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, thought by many to be the primary motivating factor behind the updated regulations. As quoted by James Hughes during the Forum, “The SARS experience…. made one lesson clear early in its course: inadequate surveillance and response capacity in a single country can endanger national populations and the public health security of the entire world” (Heymann & Rodier, 2004). Robust biosurveillance must be present, but the vigilance of medical communities, from the clinician to the laboratorian, veterinarian, research scientist, or public health official, cannot be understated. The astute communicative individual is often crucial. Involvement and inclusion of many disciplines is the intent of the “One Health” initiative (http://www.onehealthinitiative.com), which seeks to strengthen collaboration in preparation for diseases affecting both animal and human populations. Ideally, surveillance systems must include the agricultural and veterinary communities, to identify risks before human illness occurs (Pike et al., 2010). Much discussion also centered around the mobility of militaries during times of natural disaster. Local or national public health assets are unlikely to have mobile medical or laboratory capabilities. Many militaries do have these capabilities, in addition to their logistical and transportation support. From the Russian perspective, several examples of military-civilian cooperation were described, from the Armenia 1988 earthquake to the Chernobyl nuclear accident. “A robust public health system—in its science, capacity, practice, and through its collaborations with clinical and veterinary medicine, academia, industry and other public and private partners—is the best defense against any microbial threat” (IOM, 2003). The value of partnerships was emphasized, not just from the “One Health” perspective, but multi-sectoral cooperation among different governmental, industry, and private partnerships and collaborations. Transparency, political will, advance planning, addressing training and education, and making communication a priority are all needed for improving preparedness and response. The concept of the IHR (2005) encouraging discussions between the “security” and “public health” communities was discussed at length. Militaries, according to the strictest and most conservative way of thinking, are responsible for the security of the nation they represent. From the perspective of aggressive actions of others, and within the context of infectious diseases, this means the intentional release of a biological agent with the intent to do harm or disrupt. But militaries are also responsible for the general public health of their forces. Through the centuries, measures to prevent and treat infectious diseases within militaries have often yielded dividends for civilian public health. A few examples among
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Volume I, No. 1, 2011
Journal of Healthcare, Science and the Humanities