Tag Archives: Disease

Finding a Heiferlump and curing bovine Tuberculosis

By Gareth Enticott, Cardiff University, UK

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(c) Gareth Enticott

In April 2017, Brian May – the rock star turned badger conservationist – brought together policy makers, scientists, veterinarians and farmers to discuss the continuing problem of bovine tuberculosis (bTB) in badgers and cattle. Whilst most media attention has focused on the controversy of badger culling, my recent paper in Transations of the the Institute of British Geographers, “Navigating veterinary borderlands: ‘heiferlumps’, epidemiological boundaries and the control of animal disease in New Zealand” (Enticott, 2017), examines a fundamental question: how do we even know what bovine tuberculosis is? And, is it the same everywhere, or do we need different ways of seeing disease to meet different local contexts?

Knowing Bovine Tuberculosis

Confronted with disease, most people want to be certain that a disease is present or not – that somehow disease can be routinely and easily diagnosed, and that this diagnosis would be the same anywhere. Such a belief in the universality of disease is popular amongst policy makers and epidemiologists too: it provides the basis for standardised responses to disease throughout an area or country. As my paper shows, though, in the field or on the farm, these universalities can be far from helpful. Rather, than relying on universal perspectives, the paper shows how accepting the mutability of disease by combining different knowledges and understandings can be central to its management.

Heiferlumps and Striking Farmers

The argument made in the paper comes from an historical analysis of attempts to eradicate bTB from New Zealand. Records of meetings held by the Department of Agriculture in New Zealand National Archives show that as the eradication programme was rolled out in the 1960s, the effects upon farmers’ businesses began to be felt, leading many to question the accuracy of the diagnostic tests. The problem was felt most on the West Coast of New Zealand. Farmers here refused to test: their strike causing political consternation. Local vets, too, had their doubts about the accuracy of the test. The problem seemed to be what was known locally as ‘Heiferlumps’ – young cattle testing positive to the skin test used to diagnose bTB, but which had no internal signs of disease at slaughter. One of these vets, Peter Malone, led pleas for a ‘lighter’ interpretation of the test results – what he called ‘reading light’ – but was ignored by senior government vets in the capital, Wellington.

The relationship between vets and farmers on the West Coast and government officials in Wellington turned toxic when Malone admitted to ignoring heiferlumps when interpreting the results of bTB tests. The Department of Agriculture’s leading vet, a Scotsman called Sam Jamieson responsible for the eradication program, and known for his short temper and scientific approach, was outraged. Malone was forbidden from testing, only stoking an air of mutual mistrust between vets and farmers on the West Coast and distant government vets like Jamieson.

In the ensuing controversy, Jamieson turned to a field trial to establish the veracity of the bTB tests and rule out the possibility that there could be local variations in the nature of bTB. It had little effect: although the trial proved the test was good, no test is ever 100% accurate and farmers and vets continued to raise doubts. But rather than more science, what came to settle the dispute was a new kind of science: a version of epidemiology that was not confined to a particular discipline but crossed boundaries to combine different ways of knowing disease .

The paper refers to this new approach as ‘borderland epidemiology’ in which
government vets came to recognize during the 1970’s that bTB was as much a social and moral problem as an epidemiological one. Archive documents show that they began to dispense with the rule-book, and instead working with farmers, to modify and adapt how bTB should be diagnosed, and reflect unique geographical variations. Understanding that managing disease is a balancing act made from negotiations rather than universalisms has since become a principle on which New Zealand has been able to almost eradicate bTB

Lessons for the UK?

Could these experiences from New Zealand be relevant to the management of bTB in the UK? On the one hand, Defra – the government department responsible for managing bTB – look favourably upon the New Zealand approach to managing disease, their recent strategy mentioning them more than any other country (Defra, 2014). Yet, at the same time, there appears to be little room for manouvre to experiment and try new approaches to managing disease. In fact, as revealed at Brian May’s summit, attempts of the kind conducted in the 1970s in New Zealand, but by vets in England, have been ruled illegal and halted, despite their positive impacts upon disease and farmer engagement with disease management process.  In future, however, as my paper argues, adapting and adjusting diagnostics to local geographical variations by working with farmers to develop new kinds of veterinary knowledge may offer the best chance of dealing with disease.

About the author: Gareth Enticott is Reader in Human Geography in the School of Geography and Planning. His research focuses on biosecurity, practices of environmental regulation and governance, and scientific controversies in animal health. His main focus is on the ongoing controversy surrounding bovine Tuberculosis in the UK, as well as the management of the disease in New Zealand.  His work has helped inform policy on bovine Tuberculosis in England and Wales.

books_icon Defra (2014) The Strategy for Achieving Officially Bovine Tuberculosis Free Status for England, London: Defra. 

books_icon Enticott, G. (2017), Navigating veterinary borderlands: ‘heiferlumps’, epidemiological boundaries and the control of animal disease in New Zealand. Trans Inst Br Geogr, 42: 153–165. doi:10.1111/tran.12155

60-world2 Midley O (2017) Rock star Brian May hosts bovine TB debate https://www.fginsight.com/news/rock-star-brian-may-hosts-bovine-tb-debate-20023 FG Insight 

The world needs to be concerned: Pathological lives

By Steve Hinchliffe, University of Exeter

“The diversity and geographical distribution of influenza viruses currently circulating in wild ad domestic birds are unprecedented since the advent of modern tools for virus detection and characterization. The world needs to be concerned” (WHO 2015: emphasis added).

Bird flu might be about pathological birds, spreading diseases.  Or is it about pathological lives, a sense that our economies and modes of organising life are in themselves causing concern?

This week half a million birds have been culled in Niigata, Japan in order to contain a highly pathogenic avian influenza virus (HPAIV or bird flu).  On the Friesian island of Texel in The Netherlands, 500 birds have been killed from a related strain, resulting in the closure of an important nature reserve.  Towards the end of 2016, this strain of influenza is busy circulating in 14 countries, affecting wild and domestic birds in Hungary, Germany and France.

In the UK, yet to report any HPAIV infections this year, a 30-day Avian Influenza Prevention Zone has been announced. Farmers and keepers of zoological collections are being encouraged to move birds indoors and to improve biosecurity for ‘housed’ flocks. Biosecurity suggests that housing birds on its own is not enough. Vigilance is needed as HPAIV can also move via staff, boots, equipment, rodents and so on. Meanwhile, and lest anyone should be uncertain about the ‘smoking gun’ in this matter, the Department for Environment and Rural Affairs (DEFRA) announced an enhancement of surveillance of wild birds. As a consortium of scientific experts suggests (2016), viral evolution and geographical spread (phylogeography) strongly supports the proposition that migrating wild birds are spreading the viruses. Wild bird surveillance is regarded as a necessary measure to secure domestic flocks.

Concern here is not only for the livelihoods of farmers, or even the balance sheets of national economies (avian influenzas are notifiable and trade-limiting diseases). Nor is it solely a matter for the welfare of wild and domestic birds (though generally it is the latter who are least equipped in evolutionary terms to live with infection). There are also fears for public health. These avian influenza viruses are only a few mutations away from ‘learning’ how to not only infect people (some of them already do that) but also transmit between people (not something that they have managed to do, yet). They are what are known as PPPs, potential pandemic pathogens. With the swarm of influenzas currently circulating, the chances are that the alphabet and numerical soup of ‘promiscuous’ H5-clades (H5N1, H5N6, H5N8 etc) as well as H7s (H7N9) will reassort or shuffle components. This ‘natural’ process of gene exchange and editing is the main reason that the WHO have cause “to be very concerned”.

What are we to make of this concern, what indeed is to be done about this swirling cloud of viruses and birds? The first point to note is that avian flu has been around for a long time, circulating in wild birds without too much of an issue. So current concern is undoubtedly related to recent developments in “virus detection and characterization” (WHO 2015). But this can’t be the whole story. A second point concerns changing stakes and biologies. The relatively recent explosion in global poultry numbers is both a reason for greater economic concern but also a driver of viral shifts. As inexpensively produced protein-rich diets become a worldwide norm, poultry populations, growth rates and metabolisms have changed accordingly. The result is a new set of conditions for viral selection and evolution. As any epidemiologist will tell you, a microbe can only become deadly or pathogenic if there are the right environmental and host conditions. Bird numbers and altered bodies have, in short, made the planet more ‘infectable’.

pathological

In a book just published in the RGS-IBG series, my co-authors and I call this entanglement of microbes, hosts, environments and economies ‘pathological lives’. The term allows us to investigate how these lives have become dangerous to themselves in a world of accelerated throughput and biological intensity. In contrast to the recent global consortium that reviewed the evidence on avian influenzas, we do more than focus on transmission (or the outward movement of a disease agent across space). Rather, we also investigate the conditions for the emergence, persistence and transformation of avian influenzas and other zoonotic diseases, and importantly highlight the changing intensities and enhanced ‘infectability’ of our farming and public health systems.

The result is that instead of biosecurity being a matter for segregating domestic life, ‘closing the hi-tech barn door’ so to speak, a more searching issue arises. We question the sustainability and security of the kinds of intensive protein production that are now, paradoxically, being rolled out across the planet as the solution to the problem that they may in fact have helped to generate. As we demonstrate in Pathological Lives, diseases have complex, multifactorial causes. The traffic of viruses, wild bird assisted or not, can only be regarded as a necessary rather than sufficient cause of a diseased ecology.

About the author: Steve Hinchliffe is Professor or Human Geography at the University of Exeter. His research draws together insights from Science and Technology Studies (STS), particularly actor network theory, and Geography. Steve is author and editor of numerous books and articles on issues ranging from risk and food, to biosecurity, human-nonhuman relations and nature conservation.

References

books_icon Hinchliffe S., Bingham N., Allen J,. Carter S,. 2016 Pathological Lives: Disease, Space and Biopolitics  RGS-IBG Book Series. Wiley-Blackwell. ISBN: 978-1-118-99760-4

books_icon The Global Consortium for H5N8 and Related Influenza Viruses (2016). “Role for migratory wild birds in the global spread of avian influenza H5N8.” Science 354(6309): 213-217.

60-world2 WHO (2015). Warning signals from the volatile world of influenza viruses. Influenza. Geneva, Switzerland, World Health Organisation.

Climate change and human health: how COP21 has helped

By Joseph J. Bailey, University of Nottingham, UK.

The potential adverse impacts of climate change on natural and human environments are prominent in the media, but impacts on human health are seemingly discussed less often. In The Geographical Journal, Papworth et al. (2015) write about the multifaceted nature of climate change in relation to human health. Examples of health impacts include: heatstroke, injuries from disasters, infectious diseases (water-borne and vector-borne), malnutrition, food poisoning, lung diseases, and allergies (see their figure 3, which also lists required adaptations; p. 415). A key impact also listed therein is that of mental health, which reduces resilience of individuals and societies to the aforementioned health problems and environmental change. For example, links between mental health and climate change have been recently reported in Australian farmers.

Drought and flooding can have huge impacts on agricultural landscapes and, consequently, human health. Western Madagascar, author’s own (© Joseph J. Bailey).

Drought and flooding can have huge impacts on agricultural landscapes and, consequently, human health. Western Madagascar, author’s own (© Joseph J. Bailey).

The 21st Conference of the Parties (COP21) in Paris in December 2015, which, amongst much else, miraculously forged an emissions agreement between 187 countries, has helped to more prominently bring some of these issues surrounding human health to the public eye. The decisions made at COP21 may help us to mitigate, and adapt to, future impacts of climate change on human health. Indeed, a central aspect of the agreement is “the right to health” and the director of the World Health Organisation (WHO), Dr Maria Neira, said that the Paris agreement “pushes countries to develop adaptation plans that will protect human health from the worst impacts of climate change”. More broadly, WHO referred to COP21 as “a historic win for human health”.

The success of COP21 in relation to human health will not be measurable for some time, but it has hopefully put in place the infrastructure required to encourage adaptive approaches to climate change from local to international scales that will ultimately benefit human health, and the health of the wider environment. Some people are cynical of us actually preventing a temperature rise more than 2°C this century. However, I would argue that the fact that so many countries came together, spoke, and made a range of legally binding commitments is highly encouraging. It represents progress on a path towards greater use of renewable energy and more sustainable policies and practices, which can only be a good thing for human, and indeed the planet’s, health as we move forwards, even if the specific targets are not met.

– – – – –

books_icon Papworth, A., Maslin, M. & Randalls, S. (2015) Is climate change the greatest threat to human health? The Geographical Journal, 181, 413–422. (View online).

60-world2 WHO report: “New climate change agreement a historic win for human health”. (Online, last accessed 15th Jan 2016)

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

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

Badgers, borderlands and biosecurity

By Helen Pallett

Bio-Security_Warning_Sign_-_geograph.org.uk_-_1213945

Picture credit: Paul Farmer

Concerns about the threats to food and agricultural systems, and to well-loved landscapes and green spaces, from animal and plant diseases have been an ongoing theme in Britain for many years, and have received much media coverage in recent weeks. This media coverage has focussed largely on the eventual and much-debated piloting of the badger cull by the UK Government, aimed at reducing the spread of Bovine Tuberculosis and therefore ameliorating its effects on cattle and the resulting financial losses for farmers. The spread of ash dieback and other tree diseases have also been an area of increasing interest throughout the year, quietly simmering in media coverage and public discourse. Not to mention frequent discussions of swine flu, bird flu and other potential human pandemics.

A key point of contention in the  media coverage of the badger cull is the extent to which the policy can be justified by the current scientific evidence (for example, see here). And indeed this has long been the terms on which this debate has rested in government. Furthermore, substantial efforts to collect the necessary data to justify or rule out that badger cull policy, including the controlled trials overseen by Lord Krebs in the 1990s, have proved inconclusive, or have been claimed by both sides of the debate as evidence in their favour. In many corners of the media, the scientific evidence is seen as insufficient to draw firm conclusions on the likely effectiveness of a cull or even to determine baseline figures such as the number of badgers in an area in order to assess the outcomes of the current pilot.

A recent paper by Steve Hinchliffe and colleagues in the Transactions of the Institute of British Geographers, has gone further than challenging merely the evidential basis for such approaches to dealing with the spread of disease, by questioning the very assumptions about and geometries of disease on which they rest. The destruction of ‘pathological’ badgers and infected trees are both illustrative of attempts to contain the spread of disease; to limit the geographical extension of diseased, unhealthy bodies. For Hinchliffe and colleagues this approach has a distinctive and fixed geometry, which they argue is out-dated and misguided.

The authors offer three critiques of enclosure as a practice of biosecurity. Firstly, they contend that borders between different species, environments and geographical areas are necessarily permeable for “life to live”. They act as contact points which can be enriching as well as threatening. Secondly, they argue that the containment of life is no guarantee of safety as there can be multiple threats to biosecurity from within any given population or group. Finally, Hinchliffe and colleagues critique the theories of disease on which approaches to containment are based, with their assumptions that disease occurs when new pathogens cross into a population. They argue, in contrast that disease does not always emerge from outside of population, but rather is often already present, emerging instead through a complex set of mutations and translations.

As a result these authors advocate an understanding of and approach to disease which recognises the existence of pathogens in all forms of life. For them it is most important to be aware on a much more fine-grained level of how different organisms circulate, through trade and other forms of travel, and how they are entangled in relationships with other species and populations in different ways and with different levels of intensity. This fine-grained analysis would be likely to recommend  localised ways of dealing with the problems of Bovine tuberculosis or Ash dieback which are based on a detailed understand of multi-species interactions, in contrast to the national level policies based on large data sets which are currently pursued. They would advocate an approach not about building and securing borders, but exploring the rich interactions occurring in the borderland’s of our food and trade systems.

books_icon Steve Hinchliffe, John Allen, Stephanie Lavau, Nick Bingham & Simon Carter, 2013 Biosecurity and the topologies of infected life: from borderlines to borderlands Transactions of the Society of British Geographers  38 531-543

60-world2 Badger cull: first photo of shot animal emerges The Guardian, 16 September

60-world2 In pursuing the badger cull, the government is being anti-science The Guardian, 26 August

60-world2 Badger cull: key questions answered The Guardian, 27 August

60-world2 Somerset badger cull numbers quizzed in the commons BBC News, 13 September

60-world2 Ash dieback spreads to Minehead woodland BBC News, 13 September

Influenza

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

The Geopolitics of Disease

H1N1 confirmed cases worldwide. Darker shading represents higher numbers of cases

by Matthew Rech

A state of national emergency was declared in America last week as the H1N1 virus claimed its thousandth victim. Widespread in 46 of America’s 50 states, swine flu has necessitated precautions, say White House officials, not unlike those taken by coastal areas before a hurricane (Harris, 2009).

Further to the World Health Organisation’s stark declarations many months ago, America’s determined actions (which bypass certain federal laws) demonstrate the truly global nature of this problem. However, whilst remembering that the ‘national’ is but one node in a muti-scalar hierachy from which, at all levels, preventative actions are taking place, and taking into account the spatial etymology of the word ‘pandemic’, we begin to uncover alternate geographies of the crisis.

Going beyond thinking of disease and epidemic as simply outbreaks of microbial pathogens, to thinking of its geographies and politics, forms the basis of a recent paper by Alan Ingram in Geography Compass. Since the end of the Cold War, suggests Ingram, disease has often been described in geopolitical terms, but there remains little elaboration on the true meaning of disease in this context.

From the scholarship around the spatialization of governance, biopolitics, political economy and critical geopolitics, there remains “considerable scope to investigate further the ways in which disease becomes geopolitical” (1). Becasue disease and its effects is widespread, and becasue it is an unavoidable part of human experience, the “development of a more comprehensive and more relevant understanding of geopolitics, disease and the intersections between them” (11) should be a priority not just for those interested in health inequalities.

60% world Read Paul Harris’ report on Guardian Online

60% world Read Ingram, A (2009) The Geopolitics of Disease. Geography Compass. 3. 1-14