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  • What would mitigation strategies to deal with future pandemi

    2019-06-11

    What would mitigation strategies to deal with future pandemic risks of zoonotic disease look like? Analyses of emerging disease trends during the past six decades have shown that Ebola fits the calculate the molarity pattern. This pattern involves zoonotic spillover from wildlife or livestock driven by changes in land use, crop choices, migration patterns, animal husbandry, trade, transport, and travel. The west African Ebola outbreak, similar to previous outbreaks of Ebola, HIV, SARS, influenza, and most other emerging diseases, probably began with a zoonotic spillover from a wildlife reservoir, in this case thought to be bats. Targeted programmes for behaviour change, focusing on incentives for bushmeat hunting, should be part of the mitigation strategy. This approach was trialled in central Africa, with education programmes designed to reduce the consumption of primates found dead in forests, and has been shown to offer a cost-effective way to mitigate the risk of an Ebola outbreak. Additionally, projects aimed to reduce dependency on bushmeat need to be supported, either through creative approaches to farming of some wildlife species, or by expansion of livestock production, with appropriate biosecurity and surveillance to prevent emergence of other zoonoses.
    Access to health-care information for citizens is a key determinant to reach both the Millennium Development Goals (MDGs) and the emerging post-2015 Sustainable Development Goals, but this challenge has repeatedly been relegated to the sidelines. What might kickstart progress? An obvious candidate is the mobile phone, which is becoming ubiquitous in low-income and middle-income countries. It is vital that citizens in these countries have access to actionable health-care information, largely because they typically have no access to trained health workers. People who need medical attention in such contexts are especially vulnerable to ineffective or even harmful treatment from parents, lay carers, or traditional healers; in these settings, mistreatment and delays in obtaining effective treatment can contribute to increased morbidity and mortality. For example, findings from a study in India showed that four in ten children with acute diarrhoea were incorrectly given less to drink than normal, potentially increasing their risk of death from dehydration. We recently commissioned a survey of 1700 projects of mobile technology for health (known as mHealth). Our findings showed that none of these services provided essential, actionable, offline guidance for direct use by citizens addressing the range of acute health-care situations commonly encountered in low-resource settings, and very few provided any such content at all (an example is HealthPhone, see below).
    What few people thought possible little more than a decade ago is now reality: scientific and operational advances are greatly reducing the number of deaths from HIV. The number of infant infections has decreased by 58% between 2001 and 2013 and mother-to-child transmission (MTCT) of HIV might well be eliminated in the next few years. By contrast, the prevention and management of hepatitis B virus (HBV) infection lags well behind, at least in sub-Saharan Africa. The Global Burden of Disease Study highlighted the importance of chronic hepatitis B and its effect on health, which is equivalent to that of tuberculosis or malaria. Worldwide about 240 million people have chronic hepatitis B. In sub-Saharan Africa more than 8% of the population are chronic carriers of HBV, the effect of which is compounded by the high HIV prevalence. Hepatocellular carcinoma is the second most common cause of cancer in African men and third most common cause of cancer in African women, with more than 75% of cases being related to chronic hepatitis B, despite the availability of a safe and effective vaccine for more than two decades.
    Regarding the Comment by Jeff Waage and colleagues (May, 2015) about governing the UN Sustainable Development Goals (SDGs), we appreciate the authors\' perspectives on the process of finalising the SDGs and agree with their recommendations to develop new and more accountable governance structures that work across sectors. As a result, the Pan American Health Organization (PAHO) has begun to incorporate the Health in All Policies framework, putting it into practice across the region of the Americas. We view it calculate the molarity as an important mechanism to find synergies between the third SDG explicitly related to health and the 16 others, which all have the potential to affect health.