By Stevie Kiesel, GMU Biodefense PhD student
November 5 was a great day for doing your civic duty. If you were near Arlington, Virginia, you could stop by your polling place to vote and then head to George Mason University (GMU) for a panel discussion. The discussion, co-sponsored by the GMU Next Gen Global Health Security Network and the GMU Biodefense Discussion Group, centered on the One Health concept, a “collaborative, multisectoral, and transdisciplinary approach” with “the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.” While One Health is not a new concept, humanity’s increasing interconnectedness makes it ever more relevant. For example, as humans expand into new geographic areas, they come into closer contact with animals, increasing the risk of zoonotic disease spread. Additionally, habitat disruptions—whether caused by farming practices, deforestation, or climate change—can provide novel ways for diseases to pass to animals and then on to humans. Successful public health policy thus requires “the cooperation of human, animal, and environmental health communities.”
The panel included Dr. Jarod Hanson and Dr. Taylor Winkleman, who both have military experience as well as veterinary backgrounds, and Dr. Michael E. von Fricken, who specializes in vector-borne diseases around the world. These speakers brought their real-world experience on topics such as disease surveillance, funding for disease prevention, information sharing and collaboration with international partners, and the fight to get good information to all stakeholders during a disease outbreak. Throughout this discussion, three needs emerged: (1) to empower local public health actors and understand local context, (2) to focus more on prevention, and (3) to convert policies and plans into action.
The panel had insightful discussions on the need to understand local context and empower people and local public health communities. Local context is important for combating misinformation and getting a more accurate understanding of conditions on the ground. For example, the public health community must understand why a country may be disincentivized to report a disease outbreak in its early stages, when it is more easily controlled. Authoritarian governments who maintain tight messaging control may not want to admit to an active outbreak, or the economic drawbacks of announcing an outbreak may be so severe that leaders try to hide what’s going on. If a country’s economy relies heavily on tourism or trade, an outbreak could have severe consequences—though not as severe as the consequences of a local outbreak becoming uncontrolled.
As another example, in some areas with a history of exploitation via colonialism, there is a reluctance to share biological samples from outbreak victims because of concerns that developed countries will use those samples (“natural resources”) to make a (potentially profitable) vaccine or treatment. The fear is twofold: that native natural resources are being taken to develop a product without proper compensation, and that once the product is developed it may be priced out of reach for the communities who provided the samples in the first place. Institutional distrust has presented many challenges, notably in recent Ebola outbreaks in the Democratic Republic of Congo and West Africa. Understanding local mindsets and sensitivities, as well as increasing public trust to fight the spread of misinformation, is therefore a key component of disease prevention and response.
All three panelists agreed that prevention is a smart, less risky approach to the management of infectious diseases. Rather than trying to stop a disease in this era of global trade and international air travel, public health stakeholders at all levels should work toward improving prevention mechanisms. A constant policy struggle is determining how much prevention is worth, when weighed against the many other priorities in the U.S. government’s budget. As one panelist argued, we rightly view September 11th as a tragedy because it killed 2,977 people. But in the 2017-2018 flu season, nearly 80,000 people in the U.S. died from this vaccine-preventable disease. In 2018, the World Health Organization estimates that there were 1.3 million tuberculosis deaths globally. If the number of preventable deaths is a key argument for a policy’s importance, preventing infectious diseases is one of the world’s most important responsibilities.
Finally, the panel presented several suggestions to improve U.S. response to infectious diseases. One positive step would be to operationalize and put money behind the high-level strategic plans that currently exist to address infectious disease threats. While a great deal of money goes to the Department of Defense for force protection, more resources should be spent at places like the Departments of State, Health and Human Services, and Homeland Security to improve domestic prevention and surveillance capabilities. Another key suggestion is to improve science communication in the United States, particularly communications to policymakers. One panelist spoke to the different cultures among politicians and scientists and how their very different perspectives and even terminology can obfuscate effective discussions between them. Fortunately, these are exactly the types of communication skills the GMU Biodefense Program imparts on its students.