Tag Archives: disease transmission

The scalar politics of infectious disease governance in an era of liberalised air travel

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By Helen Pallett

British_Airways_G-XLED,_Hatton_Cross-Heathrow_Airport_(14082633427)

Image credit: Au Morandarte

Fears about the continued spread of the incurable Ebola virus have reached new heights in recent days, linked to uncertainties about the ability to contain diseases in an era of liberalised air transport. Over the last eight months around 916 people have died of the disease in Guinea, Liberia and Sierra Leone. It now appears the disease has spread to Lagos in neighbouring Nigeria, with eight confirmed cases. In recent months several international aid workers, healthcare workers and missionaries have also fallen victim to the disease, travelling back to Europe and North America for treatment, prompting fears about the greater spread of the disease. Subsequently, the WHO has now labelled the current outbreak as an ‘international emergency’.

In a paper from 2011 in the Transactions of the Institute of British Geographers, Lucy Budd and colleagues considered the impacts of liberalised air transport and changes in infectious disease governance in the aftermath of the SARS and H1N1 infectious disease scares. They argued that vast increases in air passenger numbers and the growing frequency and geographical extent of long haul flights raised new challenges for international disease governance and sanitary preemption. This increased global mobility of human populations creates within itself the potential for this mobility to be disrupted and curtailed through the spread of pathogens. Infectious disease governance and prevention depends on the cooperation of a web of national, regional and global agencies – with different and sometimes contested responsibilities – while practices of disease containment must be performed within in an increasing number of highly localised sites, from the airport security line, to the local clinic and the morgue.

The ongoing Ebola outbreak points to further scalar concerns around the governance of deadly infection diseases. Recent debates have focussed on the potential for using experimental treatments imported from the West to treat Ebola victims in attempt to improve the disease’s 50% mortality rate and curtail its further spread. A key question around this is to what extent standards of bioethics within the countries where these experimental treatments were developed should also be imported to the affected countries, counselling caution around the use of untested treatments. Furthermore, whilst the treatment of the disease requires the participation of international agencies, experts and technologies, it must also understand and respect the specific values and practices of Ebola victims and their families in order to be effective.

So whilst there are clear ethical dimensions to the governance of the Ebola outbreak there is also a strong scalar dimension. The successful containment and treatment of the disease depends not only on international and national cooperation, but on the micro-practices within the multiple locations of the sanitary border.

books_icon Lucy Budd, Morag Bell & Adam Warren 2011 Maintaining the sanitary border: air transport liberalisation and health security practices at UK regional airports. Transactions of the Institute of British Geographers 36(2): 268-279.

60-world2 Nigeria fears fourth Ebola frontline after infected man lands in Lagos The Guardian, August 13

60-world2 WHO: Ebola ‘an international emergency’, BBC News, August 8

60-world2 Dan O’Connor Terrifying as the Ebola epidemic is, we must not use our research ethics The Guardian, August 14

Influenza

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I-Hsien Porter

Influenza is an airborne viral disease that, according to the World Health Organisation, can cause 250,000 to 500,000 deaths each year. In the UK, £1.2 bn was spent preparing for last winter’s swine flu pandemic. Although an independent review described this response as “proportionate and effective”, around 34 million doses of swine flu vaccine were stockpiled and never used.

In Geography Compass, Christopher Furhmann asks whether we can predict the spread and scale of influenza outbreaks more accurately. Influenza outbreaks commonly occur in winter, so Furhmann investigates a connection with weather and climate. However, no clear causal link between climate and influenza (in terms of the timing of an epidemic, its severity or spatial distribution) is found.

Furhmann argues that there are three obstacles to establishing whether influenza is climate controlled. The first is that researchers vary in their approaches to studying the disease. The extent to which clinical tests can be applied outside of laboratory controlled conditions is uncertain. Second, it is unclear whether increases in winter mortality rates are a result of influenza itself or complications arising from the disease. Third, direct climate effects on the influenza virus and its transmission are complicated by indirect effects on human behaviour. This creates uncertainties over the impacts of a changing climate on disease.

This complexity creates a need for a multidisciplinary approach to researching influenza, something that geographers are well placed to engage with.

BBC News coverage of swine flu, from which many of the statistics quoted here are drawn.

Christopher Furhmann (2010) “The effects of weather and climate on the seasonality of influenza: what we know and what we need to know.” Geography Compass 4 (7): 718-730