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1. The tension between host state security and refugee security tends to be set up as a false dichotomy, resulting in the idea that any decision that increases the security of refugees in the host nation decreases the host state’s security. Many in a host state, for instance, believe that refugees who have ethnic or demographic similarities to a subgroup of the host state population threaten host state security because these refugees will naturally align themselves with one side of the host state’s internal conflict. Regardless of the veracity of this idea, it will still build hostility toward refugees in the host state population. Refugees may also be considered as economic or social threats to communities in a host state. Ultimately, this leads to host states to preserve their own security by perpetuating the destabilization of refugees in their country. Host states will prevent permanent structures to be built in refugee camps, will cut funding to tend to refugees over time, and will create barriers for refugees to establish themselves in a way that would ultimately result in them contributing meaningfully to their host nation——all of which is done in the name of maintaining host nation security. What we must realize is that the security of the host nation is directly correlated to the safety and health of the refugees that they host. Organizing refugee camps with intentionality and with the necessary supplies would decrease the rates of criminal and violent activity among refugee populations, would limit the spread of disease through well-maintained water and sanitation, and would develop refugees into functioning members in their host state. These outcomes in turn lessen the likelihood of host state members from being victims of crimes, lessen the likelihood of host state members contracting disease, and increase the economic and social prosperity of the community as refugees become capable of contributing to community well-being.
2. There are two significant factors exacerbate the current international refugee crisis. First is religious conflicts. Of the five of the nations whose displaced people account for 68% percent of all refugees, all five are embroiled in conflicts that center on religious differences. The conflicts that these nations are embroiled in are deep-seated and will not be easily resolved; but in order to repatriate their refugees, it is critical to settle these religious conflicts in a sincere manner. Another factor that exacerbates the international refugee crisis are militant groups. Hezbollah, al-Shabaab, Hamas, Boko Haram, ISIS, the Taliban, and the dozens of other religious and political militant groups not only are part of the conflicts that lead to people becoming refugees, but also exacerbate their situation by abducting or killing refugees, recruiting in refugee camps, and even inciting conflicts within refugee camps. In order to preserve the human rights and well-being of refugees, militant groups’ access to and influence on refugee camps must be reduced.
My name is Justin Cupps, and I am an EMT working as a tech in the Emergency Department at University Hospital in Columbia, MO. I am taking this course as a part of the MIH through INMED. Long term I hope to practice medicine internationally in an underserved community.
1. The relationship between the Sustainable Development Goals and pandemic disease vulnerability is that of a two-way street: Accomplishing the goals will allow us to become more resistant to pandemics around the world, and taking steps to prepare for or prevent the next pandemic will help accomplish the SDGs. For instance, providing clean water and sanitation (goal #6) will decrease incidence of diarrheal disease and other waterborne illness, leading to fewer epidemics; eliminating hunger (SDG #2) will create populations that are generally healthier and more resilient against disease; and providing quality education for everyone (goal #4) will give everyone basic knowledge about the spread of diseases that will lead to safer health behaviors. Taking steps to accomplish the SDGs not only help create a more pandemic-resistant global community, creating a more pandemic-prepared world will create the space necessary to help accomplish the Sustainable Development Goals. Epidemics severely interrupt life and well-being for all people involved. Becoming more prepared for the next epidemic or pandemic will mean less economic disruption due to a faster response time, ultimately leading to economic growth (goal 8); inherent in creating safe cities and communities means having prevention and safety measures in place to protect citizens against disease (goal 11); and limiting the spread of infection over time, along with increased economic opportunity and education, will start to eliminate poverty on a global scale (goal 1). The Sustainable Development Goals and pandemic preparedness are inextricably linked to one another: each informs the other and both must be accomplished in tandem.
2. Applying existing genomic data testing to areas where zoonotic crossover is most likely to occur will be our best method to detect and prevent the next zoonotic disease before it crosses over to the human population. Genomics relies on sampling tissue or water or land and describing the genetic data contained in it both qualitatively (what kind of genetic material is there and where did it come from) and quantitatively (how much was there) in order to identify trends in the data. Applying these principles to commercial farms and to bushmeat markets would be two ways to begin identifying the kinds of diseases existing in these animal populations already, how likely they are to cross over to humans, and develop vaccines against them would be an excellent way to detect the next zoonotic disease before it crosses over. Both of these contexts seem like the most effective way to detect the next zoonotic pandemic threat because SARS, MERS, HIV, Ebola virus, avian and swine influenza were all zoonoses events that likely took place in one of these contexts. With high-throughput research in this field, the next zoonosis could be detected and prevented before it happened.
1. When political leaders make public statements that are detrimental to public health, health leaders must respond to dispel the statements and policies. The goal of health leaders should not be to attack the leaders themselves or attempt to discredit them, but rather to have public policy and information be informed by sound scientific studies and data. It is the responsibility of health leadership to compile the data that would refute any such claims by politicians, and if the data is not available, then to conduct the studies themselves with robust peer review. It would be necessary for national health leaders to publicly dispute these claims and develop proposals for evidence-based policy that should be implemented in place. And lastly, health leaders should meet with politicians privately to discuss matters like this so as to convince them to take action that is substantiated by good data for the benefit of the citizens. These are good avenues for taking steps away from health misinformation or denialism towards evidence-based public policy that also lower the likelihood of politicians and health leaders arguing unproductively.
2. The Treatment Action Campaign has been critical in increasing access to HIV ARV medications globally. Initially this organization fought to change the precedent and law in South Africa that prevented generic ARVs from being provided for the poor population of South Africa that suffered from HIV/AIDS. They did this through public demonstration, media campaigns, and legal action. After years of laboring for this goal one step at a time, TAC was able to provide lawful access to ARVs that were affordable to every South African. They have continued to campaign for this cause through today, seeking to expand access, education, and prevention of HIV infection throughout South Africa. Without this organization, untold hundreds of thousands would have died from AIDS going untreated in the last 25 years.
1. One detrimental outcome to the spread of misinformation relating to the COVID-19 pandemic is that individuals are more likely to become stuck in medically ill-advised behaviors. As the article demonstrated, there is a significant likelihood of individuals generating a false memory in conjunction with a news headline that is falsified (22.56%), and these false memories are may be more likely to occur if the false information happens to align with the individual’s particular beliefs. This poses the possibility of a dangerous cycle forming amidst the “infodemic” that occurred throughout the COVID-19 pandemic. For instance, if a person believed that vaccines were more harmful to people than helpful prior to the pandemic and then subsequently read a false article or headline that stated that Pfizer and Moderna vaccines had exceptionally high complication rates that were ignored during development, then this individual would likely develop a false memory associated with that article, believing it to be true and factual as anchored in their “experience.” This would then give them another data point that supports their views on vaccination, thus reinforcing their belief, leading to an even less likely chance that they would complete the primary course of the COVID-19 vaccination. This cycle of reinforcing ill-informed beliefs and behaviors through misinformation is one of the biggest challenges societies must face in the recovery stage of the pandemic.
2. One way that social media leaders can safeguard against misinformation is to rewrite their data mining algorithms as it pertains to news stories. Current social media algorithms take user data and analyze it against mass data sets to try to identify what other posts, news stories, videos, etc. the person may be interested in reading and then suggest them to the user. This is how targeted advertisements on platforms like facebook and instagram have become eerily accurate. In many ways this practice is beneficial, connecting people to companies, interest groups, and influencers that they would have not otherwise discovered. However, in applying this data mining to news feeds, social media platforms inadvertently create a digital echo chamber for their users to enter into whenever they begin scrolling on their phones or computers. As a result, people may only have one side of arguments and discussions presented to them on social media, leaving it up to them to search out voices on the other side of the issues–a phenomenon that often does not happen. While things like fact checking committees and banners that warn against misinformation may be beneficial, modifying how social media feeds are curated in order to be more equivocal would have a broader impact.
1. Recency bias is the tendency to remember things that happened more recently as more prominent and it generally guides public health decision making to be reactive instead of proactive. Immediately after epidemics, investment in public health programs centered on recovery, research, and preparedness is prioritized by governments and international agencies. This was demonstrated after the SARS, swine flu, and Ebola virus outbreaks. Then, as months and years pass, the urgency for public health measures to be prioritized fades and preparing for the next epidemic falls by the wayside. Most of the time governments spend is in a reactive phase waiting for the next epidemic to happen because (prior to the SARS-CoV-2 pandemic) a large majority of our time was spent not living in an epidemic. Hopefully governments, NGOs, public health officials, and international agencies will learn from the COVID epidemic and begin to invest in the measures necessary to prepare and prevent the next epidemic outbreak.
2. An investment that I think should be first in the line of investments necessary to end pandemics around the world is in vaccines. First, resources need to be invested in order to distribute vaccines against pneumonia, malaria, meningitis, and other vaccine-preventable diseases in low-income nations. Spending the money to do this would save millions of lives in these nations every year, as well as offset millions of dollars in caring for the ill at the time of illness. Preventing disability associated with these diseases would also mean less strain on healthcare systems in these nations as well as increased economic output because these people are able to work. The payoff of this investment seems well worth the cost of producing and distributing these vaccines that are already developed. It also offers a unique opportunity for private sector companies to lend their resources and expertise to help protect the well being of individuals around the world, an opportunity not often offered by public health policy decisions. Second, we should invest time, money, and personnel into developing a universal influenza vaccine. Making a shelf-stable and cost-effective flu vaccine that protects against all strains of the virus for a protracted period of time would save healthcare systems millions of dollars and save millions of lives. Preventing the pandemic threats that we can prevent is the first crucial step in this global process.
1. There are numerous advantages to implement widespread COVID-19 testing in populations. It would allow almost real time analysis of case load, transmission rates, and relative rates between variants in communities. Rapid testing could prevent transmission of disease in healthcare settings by allowing patients to test themselves at home. Testing also allows for efficient contact tracing that helps limit the spread of disease by implement “rings” of quarantine around an individual that can transmit COVID.
2. While there are many desirable outcomes from population-wide testing for COVID-19, there are still obstacles to implementing it. As the first figure in the article demonstrates, rapid antigen tests are sensitive for only a portion of clinical stage of infection, leading to a noticeable rate of false negatives that can continue to spread the disease around the population. rt-PCR and other highly specific quantitative testing requires expensive equipment that is not feasible for every single community to have. And then the costs to produce and distribute testing equipment to every person in every population would be exorbitant. Though these challenges require complex solutions, investing the time and money to eliminate the barriers to responsible population-wide testing is worth it in order to quell the next surge of COVID-19 infections.
1. The most common objection to the COVID-19 vaccine that I have heard from family, friends, and patients is the speed with which is was developed. I imagine this hesitation is rooted in experiences relating to diseases like polio, smallpox, hepatitis B, HPV, and other diseases——diseases whose vaccines took decades to develop and produce. COVID-19 is no less deadly of a disease than these, and thus weariness surrounding the development of a disease with such quickness is reasonable in this light. It is the government’s responsibility to acknowledge this fear, understand where it is rooted, and utilize tailored approaches to convince people of the vaccine’s safety despite how rapidly it was developed. The most important strategy governments must utilize is to first, underscore that no corners were cut in the development or production of the vaccine, and second, welcome any scrutiny into the matter that the public brings. If we are confident that it is true that this vaccine was developed with haste without being unsafe or unethical, then we should be confident that any investigation would make those claims self-evident, even to people who are skeptical. Allowing people to prove to themselves in this sense that the development was safe will not only increase the number of people willing to get the vaccine, but also validate the government as a reliable and trustworthy source of health information. The reality is that anyone who would get the vaccine willingly has already done so; efforts now should be targeted to get those who are skeptical or resistant vaccinated.
2. The government’s assumption that vaccine access was the primary hurdle to achieve vaccination rates that would develop a “herd immunity” against COVID-19. Many reasoned that making the vaccine free would solve this problem, but this failed to account for the distrust in the safety of the vaccine that has plagued the world since the vaccine became available. Amidst concerns with the speed of its development, its safety, and conspiracy theories relating to the vaccine, making it free to the public without addressing these concerns allowed people to read their own beliefs onto the action of the government. For instance, if someone believed that the vaccine wasn’t safe, and governments were simply using their populations as guinea pigs to test its safety, then that person could easily believe that the government making the vaccine free to all was simply a ploy to have a bigger test population. The government assumed that the vaccine would be welcomed by all, when they should have assumed the vaccine would have received some resistance. Proactively preparing for pushback would have helped more people get vaccinated quicker, leading to fewer cases and deaths associated with COVID-19.
1. Vaccines offer great benefit and face serious challenges as a means of preventing the spread of infectious disease. Vaccines are pound-for-pound the most efficient way of preventing disease provided they can elicit an effective humoral response; they’ve reduced incidences of measles, pertussis, polio, and other deadly infections that previously threatened humanity; and they are simple, needing few doses to offer people years of protection against illnesses. But they face challenges: Certain pathogens lack antigens that can be used as an effective vaccine basis (e.g., HIV, hepatitis C, Lyme disease, malaria). Vaccines can take weeks to produce en mass, so defending a population through vaccine campaigns requires anticipatory creation of the vaccine in order to be timely. And lastly, a large movement against vaccinating children in recent years has taken hold in Western Europe and America. Refusing these vaccines make it possible for diseases that were eradicated or controlled to begin causing illness again.
2. There are a number of ways that health professionals can best communicate with the population during times of crisis, and all of them center on fostering and maintaining trust between the people and their leaders. First, leaders must be quick to acknowledge the problem, being equivocal about what information they know and what information they do not know. Lying either by omitting known information or by pretending to know more than what is definitely known will both breed distrust. Then, communicating with empathy for the situations and threats that people face during epidemics in addition to showing respect is good practice for officials. Lastly, health leaders must encourage the best practices possible for people to follow. If there is no change in people’s behaviors to keep them safe during epidemics or pandemics, then we as leaders have done them no good. All of these practices are imperative during times of health crisis.
1. Joan Liu faced a particularly difficult set of obstacles when trying to contain Ebola in West Africa. There were very few health workers to begin with in Liberia; the ones that were there were not prepared to contain an outbreak of the Ebola virus; and the national governments in the region, Liberia, Sierra Leone, and Guinea, were slow to respond to the outbreak. This was catastrophic circumstances for when Ebola broke out in the region. Moreover, the WHO and world governments were even slower to respond with aide, failing to recognize how dire the situation truly was. In contrast, DA Henderson began with support from the WHO and many world powers; was well equipped in man-power to tackle epidemic outbreaks of smallpox, along with manning vaccination campaigns; and he was able to mobilize the technologies needed to prevent the transmission of smallpox or contain its spread throughout the globe. It appears that the success of epidemic control is primarily influenced by access to manpower, international support, and access to/mobilization of necessary technologies.
2. Three characteristics that make resilient health systems: 1. Rapid response measures in place before an epidemic strikes, 2. Vision for improving the health of a population, and 3. Private and public sectors contributing to disease prevention and control.
1. Of the ten imperatives put forward by the article, three stand out as most important to pursue wholeheartedly as health leaders in the “recovery” stage of the pandemic that we are in. First is to provide staff support and well-being. Leaders need to acknowledge that all that they dream up as a means to prepare for the next pandemic, or endemic diseases (COVID, influenza, RSV, etc.) is all carried out by their staff. Healthcare staffing shortages are still rampant around the country, and those who remain in healthcare are suffering the consequences of operating in a taxed and overwhelmed system for years. A common thread that I have noticed in my work environment is that no one feels that they have the right channels to give feedback through, or perhaps that the leadership will not listen to or acknowledge their feedback. If environments like this one persist, it will only lead to more people leaving healthcare, worsening the condition of the systems even more. Emphasizing this imperative set forth by the article will help build trust and confidence in health leadership, lessen burnout among staff, and improve the system through the frontline feedback. Second, is to “Reassess Priorities Explicitly and Regularly and Provide Purpose, Meaning, and Direction.” This imperative will protect against health systems missing the goal. Refining and explicitly stating the desired outcomes of a health system ensures that everyone knows what they are working toward together. Unifying the vision will help everyone make better decisions about how to get there. If this does not happen in the recovery phase, then when systems are put back into emergency phase and the outcome is not clear, then people will not have any idea on how to make a decision that helps best accomplish the goal, rendering the system ineffective. Last, the imperative to communicate clearly and regularly to foster trust is crucial in this recovery state. Public confidence in health leaders, systems, and technology was shattered during the pandemic. Dedicating clear effort to restoring that trust with the public through honesty and transparency will better prepare us for the next epidemic or pandemic. The public will be much more willing to go along with guidelines and recommendations if they trust the people that they are coming from. If we do not focus on these three imperatives in this stage of the pandemic, then when the next disease strikes, we will suffer the same ways we did in COVID-19.
2. One example of people centered leadership that I have experienced is in the ER that I work in. Our supervisors do two things that “puts staff first.” First, they are quick to help reconcile. In the fast paced and high stress environment in the ER, it’s almost impossible to avoid conflict between staff members. The supervisors do well to not simply ignore this or let it slide, but are quick to help resolve conflict between staff members so that we can continue to provide care for patients as a team. Second, our supervisors intentionally ask for our feedback. They understand that they are not the ones providing care day in and day out, that they are not transporting patients, restocking rooms, or communicating between departments. When they find a nurse or a tech who is frustrated by something, they always ask that staff member why they’re frustrated, and how they can change something as a supervisor to help make the workflow better for us to provide care.
Elizabeth, I think you’re precisely correct that in order to change other practitioner’s minds about utilizing non-evidence based treatments we have to get to the root of why they have chosen to do that. Drawing people out to address faulty motives and help them evaluate their motivations is key to helping someone have lasting change.
1. In just one sentence to the public, I would say, “Get vaccinated as soon as you can.” I think this is the most poignant advice to give to the general public to prevent COVID-19 infections because in my experience in the emergency department, the patients who come in and need BiPAP, CPAP, intubation, and other respiratory interventions have not been vaccinated. I am utterly baffled by this phenomenon in the public: Despite the fact that COVID has affected them and their loved ones deeply, they still do not seem willing to take the basic steps to help prevent and protect them from infection. This speaks deeply to the psychology of public health and motivating people to participate in good practice. It is a difficult thing to accomplish. Yet because most people in the Western world have predominantly given up on masking and social distancing altogether, vaccination seems to be the most direct approach to preventing the spread of COVID-19.
2. Analogy and comparison speak deeply to every person. I would approach with a question about a common disease and a poor treatment. “Would you treat an upper respiratory infection with antibiotics?” The answer is likely no, because most upper respiratory infections are caused by viruses. It’s not hard to reason with them that the reason why they would not do that is because there is thousands of data sets that show that such a treatment is ineffective. When they arrive at this conclusion, I would ask, “Why do you treat COVID with _______? Is there data to support it?” This approach is pretty simple, and the key for it to being effective is to show genuine care for them and to do this with gentleness and respect. If we approach judgmentally, then it’s likely they will feel attacked and it will result in them doing the exact opposite of what we hope they would do. Doing this with care and concern for them will demonstrate that you chose to bring this up to them not only for the good of their patients, but also their own good. This will much more likely result in them changing their practice.
1. The immediacy and danger of a disease are often the forces that drive treatments, preventative measures, and cures forward. While there are many scientific factors that can prevent a vaccine from being developed, the change in interest of a vaccine against SARS-CoV-1 indicates that the perception of the threat of the disease was a much greater influence. When a new, mysterious, and fatal respiratory illness presented in Southern China, the fact that we knew next to nothing about the disease meant that the perceived threat (i.e., how likely people felt that this could directly harm or affect them and the world) was large. Over the course of two years, though, there were only a few more than 8,000 cases ever reported, the disease was contained with relative effectivity with international safety precautions, and much of the perceived threat never came true for most people. When the perception of the threat of a disease lessens, then public attention and funding to develop vaccines drops with it. Any effort to gain public attention on the issue again can be waived away as “fear-mongering.” A direct comparison can be made to the SARS-CoV-2 pandemic. There have been more than 600 million cases in the course of three years, international containment efforts were ineffective at keeping the disease contained, the economic and social consequences have shaken the world, and there is seldom a person on the planet who does not know someone who has had COVID-19. The perceived threat of the disease was in fact much lower than what many people had anticipated, and with the public attention that the pandemic received, it is no surprise that an effective vaccine was developed in under two years and is being distributed globally. Social factors are very influential in the response to an epidemic.
2. We ought to be preoccupied with Ebola virus as a disease because this disease has the capability to disrupt the world profoundly. Previously, the disease has had a very high transmissibility, requiring healthcare workers to utilize biosafety level 4 precautions; has been very deadly, ranging between 30% and 90% fatality rate; and has affected the working age population worst. If the disease were to mutate in a particular way that allowed it to spread even more rapidly, or perhaps crossed over from animals in a more populous place than West Africa, then Ebola could take a serious toll on the world. In the same way that the COVID-19 pandemic stressed healthcare systems, economies, and people, an ebola pandemic would exact a similar toll on the world——a world which at the moment is still recovering from the COVID pandemic. In the case of Ebola, patients could develop much more severe illness, stressing healthcare systems and causing more shortages than COVID-19 did. Everyone has a vivid image of the threat that pandemic diseases pose to the globe. Ebola could very easily cause such a pandemic, and for this reason, we need to begin planning for it.