Long-term public health support needed to tackle infectious disease outbreaks

(Press-News.org) Outbreaks of infectious diseases, such as swine flu (H1N1) threaten global health and should be considered by funding agencies and humanitarian organizations as development issues rather than emergency situations, requiring long-term support and investment, according to US experts writing in this week's PLOS Medicine.

The authors from several US institutions, led by Tiffany Bogich from Princeton University, reached these conclusions by reviewing nearly 400 serious international public health events. They found that the disruption to, or lack of, public health infrastructure was the major driving factor of infectious disease outbreaks, contributing 40% overall. In contrast, other main driving factors, such as climate and weather and war and famine had a much lesser role, each contributing less that 10% to infectious disease outbreaks.

Based on these findings, the authors argue that there is a mismatch between the drivers of infectious disease outbreaks and current trends in public health spending as shown by the current donor trend of favoring disease-specific global health programs. The authors argue that this mismatch may be at the cost of strengthening public health infrastructure and development in the long term.

They argue: "Stronger public health infrastructure, for example, expanded surveillance, better diagnostic capacity, and rapid reporting and control, in developing countries will likely help prevent localized outbreaks of newly emerged pathogens becoming pandemic."

The authors recommend a way forward. They say: "We propose a systems approach within development agencies to address pandemic prevention at the intersection of people and their environment where the risk of disease emergence is highest."

The authors continue: "To achieve this goal, mainstream development funding, rather than emergency funding, is required."

The authors add: "Not only will this better address the most significant global health threats, but it will also provide the broad scale first line of defense against the next unknown contagion."

### Funding: We acknowledge Google.org and a National Science Foundation Human and Social Dynamics 'Agents of Change' award (BCS – 0826779 & BCS-0826840), two NIH National Library of Medicine grants (5G08LM009776 and 5R01LM010812), the Research and Policy for Infectious Disease Dynamics (RAPIDD) program of the Science and Technology Directorate, U.S. Department of Homeland Security, and the Fogarty International Center, NIH and the generous support of the American people through the United States Agency for International Development (USAID) Emerging Pandemic Threats PREDICT. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: DC is the director of USAID's Avian Influenza and Other Emerging Threats Unit. All other authors have declared that no competing interests exist.

Citation: Bogich TL, Chunara R, Scales D, Chan E, Pinheiro L, et al. (2012) Preventing Pandemics Via International Development: A Systems Approach. PLoS Med 9(12): e1001354. doi:10.1371/journal. pmed.1001354

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CONTACT:

Tiffany L. Bogich
Princeton University, Dept of Ecology & Evolutionary Biology,
Princeton, New Jersey, United States of America John S. Brownstein
Harvard Medical School, Department of Pediatrics, Boston,
Massachusetts, United States of America tbogich@princeton.edu (TLB); John.Brownstein@childrens.harvard.edu (JSB)