The #truth about #PHEICs (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

The truth about PHEICs

Johan Giesecke, on behalf of STAG-IH †

Published: July 05, 2019 / DOI:


The recent decision by the WHO Director-General that the Ebola virus outbreak in DR Congo does not constitute a Public Health Emergency of International Concern (PHEIC)1
has generated controversy, as articulated by the Editors2 of The Lancet. Members of the WHO Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH) have discussed this Editorial and would like to clarify the role of the International Health Regulations (IHR) and the designation of a PHEIC.



I declare no competing interests.

Keywords: Ebola; IHR(2005); PHEIC; Global Health.



Confronting the persisting #threat of the #MERS to #global #health #security (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Confronting the persisting threat of the Middle East respiratory syndrome to global health security

Stanley Perlman, Esam I Azhar, Ziad A Memish, David S Hui, Alimuddin Zumla

Published: July 03, 2019 / DOI:


The Middle East respiratory syndrome coronavirus (MERS-CoV) is a priority zoonotic pathogen of humans highlighted in the WHO research and development blueprint list requiring urgent action 1 because it has epidemic potential, a high fatality rate with no specific treatment or vaccine, and a wide geographical distribution of the host reservoir of dromedary camels in the Middle East, Africa, and Asia. 2


Keywords: MERS-CoV: Global Health.


#Global #alcohol exposure between 1990 and 2017 and #forecasts until 2030: a modelling study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study

Jakob Manthey, MA, Kevin D Shield, PhD, Margaret Rylett, MA, Omer S M Hasan, BA, Charlotte Probst, PhD, Prof Jürgen Rehm, PhD

Published: May 07, 2019 / DOI:




Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global non-communicable disease goals. We present estimates on the main indicators of alcohol exposure for 189 countries from 1990–2017, with forecasts up to 2030.


Adult alcohol per-capita consumption (the consumption in L of pure alcohol per adult [≥15 years]) in a given year was based on country-validated data up to 2016. Forecasts up to 2030 were obtained from multivariate log-normal mixture Poisson distribution models. Using survey data from 149 countries, prevalence of lifetime abstinence and current drinking was obtained from Dirichlet regressions. The prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) was estimated with fractional response regressions using survey data from 118 countries.


Between 1990 and 2017, global adult per-capita consumption increased from 5·9 L (95% CI 5·8–6·1) to 6·5 L (6·0–6·9), and is forecasted to reach 7·6 L (6·5–10·2) by 2030. Globally, the prevalence of lifetime abstinence decreased from 46% (42–49) in 1990 to 43% (40–46) in 2017, albeit this was not a significant reduction, while the prevalence of current drinking increased from 45% (41–48) in 1990 to 47% (44–50) in 2017. We forecast both trends to continue, with abstinence decreasing to 40% (37–44) by 2030 (annualised 0·2% decrease) and the proportion of current drinkers increasing to 50% (46–53) by 2030 (annualised 0·2% increase). In 2017, 20% (17–24) of adults were heavy episodic drinkers (compared with 1990 when it was estimated at 18·5% [15·3–21·6%], and this prevalence is expected to increase to 23% (19–27) in 2030.


Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved, and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure.


Centre for Addiction and Mental Health and the WHO Collaborating Center for Addiction and Mental Health at the Centre for Addiction and Mental Health.

Keywords: Global Health; Alcohol.


The #legal #determinants of #health: harnessing the power of law for #globalhealth and sustainable #development (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

The legal determinants of health: harnessing the power of law for global health and sustainable development

Prof Lawrence O Gostin, JD, John T Monahan, JD, Jenny Kaldor, LLB, Mary DeBartolo, JD, Eric A Friedman, JD, Katie Gottschalk, LLM et al.

Published: April 30, 2019 / DOI:



Health risks in the 21st century are beyond the control of any government in any country. In an era of globalisation, promoting public health and equity requires cooperation and coordination both within and among states. Law can be a powerful tool for advancing global health, yet it remains substantially underutilised and poorly understood. Working in partnership, public health lawyers and health professionals can become champions for evidence-based laws to ensure the public’s health and safety.

Keywords: Global Health; International cooperation.


#Infectious Disease #Threats in the 21rst Century: Strengthening the #Global #Response (Front Immunol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Front Immunol. 2019 Mar 28;10:549. doi: 10.3389/fimmu.2019.00549. eCollection 2019.

Infectious Disease Threats in the Twenty-First Century: Strengthening the Global Response.

Bloom DE1, Cadarette D1.

Author information: 1 Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States.



The world has developed an elaborate global health system as a bulwark against known and unknown infectious disease threats. The system consists of various formal and informal networks of organizations that serve different stakeholders; have varying goals, modalities, resources, and accountability; operate at different regional levels (i.e., local, national, regional, or global); and cut across the public, private-for-profit, and private-not-for-profit sectors. The evolving global health system has done much to protect and promote human health. However, the world continues to be confronted by longstanding, emerging, and reemerging infectious disease threats. These threats differ widely in terms of severity and probability. They also have varying consequences for morbidity and mortality, as well as for a complex set of social and economic outcomes. To various degrees, they are also amenable to alternative responses, ranging from clean water provision to regulation to biomedical countermeasures. Whether the global health system as currently constituted can provide effective protection against a dynamic array of infectious disease threats has been called into question by recent outbreaks of Ebola, Zika, dengue, Middle East respiratory syndrome, severe acute respiratory syndrome, and influenza and by the looming threat of rising antimicrobial resistance. The concern is magnified by rapid population growth in areas with weak health systems, urbanization, globalization, climate change, civil conflict, and the changing nature of pathogen transmission between human and animal populations. There is also potential for human-originated outbreaks emanating from laboratory accidents or intentional biological attacks. This paper discusses these issues, along with the need for a (possibly self-standing) multi-disciplinary Global Technical Council on Infectious Disease Threats to address emerging global challenges with regard to infectious disease and associated social and economic risks. This Council would strengthen the global health system by improving collaboration and coordination across organizations (e.g., the WHO, Gavi, CEPI, national centers for disease control, pharmaceutical manufacturers, etc.); filling in knowledge gaps with respect to (for example) infectious disease surveillance, research and development needs, financing models, supply chain logistics, and the social and economic impacts of potential threats; and making high-level, evidence-based recommendations for managing global risks associated with infectious disease.

KEYWORDS: antimicrobial resistance (AMR); epidemic; global health; global health systems; infectious disease; outbreak; pandemic; pandemic preparedness and response

PMID: 30984169 PMCID: PMC6447676 DOI: 10.3389/fimmu.2019.00549

Keywords: Infectious Diseases; Emerging Diseases; Global Health.


#Policy and #Science for #GlobalHealth #Security: Shaping the Course of #International Health (Trop Med Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Trop Med Infect Dis. 2019 Apr 10;4(2). pii: E60. doi: 10.3390/tropicalmed4020060.

Policy and Science for Global Health Security: Shaping the Course of International Health.

Berger KM1, Wood JLN2, Jenkins B3,4, Olsen J5, Morse SS6, Gresham L7, Root JJ8, Rush M9, Pigott D10,11, Winkleman T12, Moore M13, Gillespie TR14,15, Nuzzo JB16, Han BA17, Olinger P18, Karesh WB19, Mills JN20, Annelli JF21, Barnabei J22, Lucey D23, Hayman DTS24.

Author information: 1 Gryphon Scientific, LLC, 6930 Carroll Avenue, Suite 810, Takoma Park, MD 20912, USA. 2 Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK. 3 Brookings Institution, 1775 Massachusetts Avenue NW, Washington, DC 20036, USA. 4 Women of Color Advancing Peace, Security and Conflict Transformation, 3695 Ketchum Court, Woodbridge, VA 22193, USA. 5 Rosalynn Carter Institute for Caregiving, Georgia Southwestern State University, 800 GSW State University Drive, Americus, GA 31709, USA. 6 Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA. 7 Ending Pandemics and San Diego State University, San Diego, CA 92182, USA. 8 U.S. Department of Agriculture, National Wildlife Research Center, Fort Collins, CO 80521, USA. 9 Gryphon Scientific, LLC, 6930 Carroll Avenue, Suite 810, Takoma Park, MD 20912, USA. 10 Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA 98121, USA. 11 Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK. 12 Next Generation Global Health Security Network, Washington, DC 20001, USA. 13 RAND Corporation, 1200 South Hayes St., Arlington, VA 22202, USA. 14 Population Biology, Ecology, and Evolution Program, Emory University, Atlanta, GA 30322, USA. 15 Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, USA. 16 Center for Health Security, Johns Hopkins University School of Public Health, Pratt Street, Baltimore, MD 21202, USA. 17 Cary Institute of Ecosystem Studies, Box AB Millbrook, NY 12545, USA. 18 Environmental, Health and Safety Office (EHSO), Emory University, 1762 Clifton Rd., Suite 1200, Atlanta, GA 30322, USA. 19 EcoHealth Alliance, 460 West 34th Street, New York, NY 10001, USA. 20 Population Biology, Ecology, and Evolution Program, Emory University, Atlanta, GA 30322, USA. 21 Practical One Health Solutions, LLC, New Market, MD 21774, USA. 22 Plum Island Animal Disease Center, Department of Homeland Security, Greenport, NY 11944, USA. 23 Department of Medicine Infectious Disease, Georgetown University, 600 New Jersey Avenue, NW Washington, DC 20001, USA. 24 EpiLab, Infectious Disease Research Centre, School of Veterinary Science, Massey University, Private Bag, 11 222, Palmerston North 4442, New Zealand.



The global burden of infectious diseases and the increased attention to natural, accidental, and deliberate biological threats has resulted in significant investment in infectious disease research. Translating the results of these studies to inform prevention, detection, and response efforts often can be challenging, especially if prior relationships and communications have not been established with decision-makers. Whatever scientific information is shared with decision-makers before, during, and after public health emergencies is highly dependent on the individuals or organizations who are communicating with policy-makers. This article briefly describes the landscape of stakeholders involved in information-sharing before and during emergencies. We identify critical gaps in translation of scientific expertise and results, and biosafety and biosecurity measures to public health policy and practice with a focus on One Health and zoonotic diseases. Finally, we conclude by exploring ways of improving communication and funding, both of which help to address the identified gaps. By leveraging existing scientific information (from both the natural and social sciences) in the public health decision-making process, large-scale outbreaks may be averted even in low-income countries.

KEYWORDS: Ebola virus; One Health; emerging infectious diseases; zoonoses

PMID: 30974815 DOI: 10.3390/tropicalmed4020060

Keywords: Global Health; Infectious Diseases; Emerging Diseases; Pandemic Preparedness.


The #challenge of #antimicrobial #resistance: What #economics can contribute (Science, abstract)

[Source: Science, full page: (LINK). Abstract, edited.]

The challenge of antimicrobial resistance: What economics can contribute

Laurence S. J. Roope1,2,3, Richard D. Smith4,*, Koen B. Pouwels5,6, James Buchanan1,2, Lucy Abel3,7, Peter Eibich8, Christopher C. Butler2,7, Pui San Tan7,9, A. Sarah Walker2,3,10, Julie V. Robotham2,5, Sarah Wordsworth1,2,3

1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK. 2 The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK. 3 NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK. 4 University of Exeter Medical School, St Luke’s Campus, Exeter, UK. 5 Modelling and Economics Unit, National Infection Service, Public Health England, London, UK. 6 Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands. 7 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 8 Max Planck Institute for Demographic Research, Rostock, Germany. 9 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 10 Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.

*Corresponding author. Email:

Science  05 Apr 2019: Vol. 364, Issue 6435, eaau4679 / DOI: 10.1126/science.aau4679


Incentivizing restraint in drug use

The accelerating tide of antimicrobial resistance (AMR) is a major worldwide policy concern. Like climate change, the incentives for individual decision-makers do not take into account the costs to society at large. AMR represents an impending “tragedy of the commons,” and there is an immediate need for collective action to prevent future harm. Roope et al. review the issues associated with AMR from an economics perspective and draw parallels with climate change. A major stumbling block for both challenges is to build consensus about the best way forward when faced with many uncertainties and inequities.

Science, this issue p. eaau4679


Structured Abstract


Antimicrobial resistance (AMR) is increasing, driven by widespread antibiotic use. The wide availability of effective antibiotics is under threat, jeopardizing modern health care. Forecasts of the economic costs are similar to those of a 2°C rise in global average surface temperature, above preindustrial levels. AMR is becoming an urgent priority for policy-makers, and pressure is mounting to secure international commitments to tackle the problem.


Estimating the value of interventions to reduce antibiotic use requires predictions of future levels of antibiotic resistance. However, modeling the trajectory of antibiotic resistance, and how marginal changes in antibiotic consumption contribute to resistance, is complex. The challenge of estimating the resulting impact on health and the economy is similarly daunting. As with the cost of climate change, estimates of total AMR costs are fraught with uncertainty and may be far too low. Much of the uncertainty arises from the complexity of estimating the cost of changes in overall resistance levels. This cost depends on various factors: which drug and pathogen are involved, the mechanism of antibiotic resistance, the prevalence of that pathogen, the types of infections it causes and their level of transmissibility, the health burden of those infections, and whether alternative treatments are available.

Effective new antibiotics are urgently needed. However, without government intervention, R&D for antibiotics is rarely profitable, and most major pharmaceutical companies have left the field. New ways are needed to make antibiotic development profitable, decoupling profits from volumes sold.


Analogies can be drawn between climate change and AMR, both of which have been described as a global “tragedy of the commons.” There is some consensus that we should treat carbon emissions reduction as an insurance policy against the possibility of a catastrophic climate outcome—and avoid waiting for a definitive optimum-abatement policy. A similar paradigm shift is needed to incentivize both the introduction and valuation of interventions to reduce antibiotic use and R&D of new antibiotics.

Rather than taxing the price and letting the market dictate the quantity of antibiotics supplied, an alternative may be to establish a regulatory body that issues prescribers tradable permits and to allow the market to determine the price. Such an approach could create a predictable revenue stream through more-foreseeable licensing fees for important antibiotics by decoupling the return on investment from the volume used. Approaches such as this could incentivize industry to develop new antibiotics for which there would otherwise be too small a market to provide a sufficient return on investment.

Reducing inappropriate antibiotic use while expanding essential access is a difficult challenge, especially in low- and middle-income countries. However, policy-makers and philanthropists are alert to the importance of AMR and increasingly are making substantial research funds available, with much of these funds devoted to the social sciences. We need economists, across many different fields, to engage with this pressing global problem.



As antibiotic consumption grows, bacteria are becoming increasingly resistant to treatment. Antibiotic resistance undermines much of modern health care, which relies on access to effective antibiotics to prevent and treat infections associated with routine medical procedures. The resulting challenges have much in common with those posed by climate change, which economists have responded to with research that has informed and shaped public policy. Drawing on economic concepts such as externalities and the principal–agent relationship, we suggest how economics can help to solve the challenges arising from increasing resistance to antibiotics. We discuss solutions to the key economic issues, from incentivizing the development of effective new antibiotics to improving antibiotic stewardship through financial mechanisms and regulation.

This is an article distributed under the terms of the Science Journals Default License.

Keywords: Antibotics; Drugs; Resistance; Global Health; Economics.