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Viral trade.

Laura Kahn's "Viral Trade and Global Public Health" (Issues, Winter 2004) raises important concerns about the age of our current international health regulatory structure in light of emerging infections. She correctly points out the need to modernize the regulations and argues for more global standardization of the legal framework. She argues that this is necessary if we are going to successfully control infectious threats in an environment of rapid change.

Reducing the threat of emerging infectious diseases will require a significant effort on a global scale, and improvements in public health law and regulations are an important step. In fact, the World Health Association is currently working with its member nations to update their international health regulations, which were last modified in 1981. When they are finally adopted, it is hoped that a more modern and effective regulatory structure will be in place. There is, however, a more pressing and important problem that must be addressed, otherwise current efforts to update these regulatory authorities will be ineffective. We need a strong public health infrastructure globally, nationally, and locally. It is our first line of defense to protect our populations from harm.

Public health infrastructure is generally defined as people, properly trained with the tools and resources necessary to improve the public's health. The global infrastructure for public health, like that in the United States, has been challenged for decades. In many parts of the world, basic infrastructure is at best tenuous. In an environment where we are one plane ride away from an infectious disaster, investing in an adequate infrastructure is an essential step. Although ensuring the adequacy of the legal authority to perform this work is one important component of an effective system, the capacity to quickly identify a emerging or reemerging infectious threat, track it, and contain its spread is the best defense against global disaster. In today's world, preventing the disease from becoming endemic must also be a goal. Effective and rapid communication and coordination like that which occurred during the severe acute respiratory syndrome (SARS) outbreak of 2003 provides an operational framework to ensure success.

Virulent organisms do not know the rules of trade, diplomacy, or law. Properly crafted regulations are a small part of the solution. An adequate public health infrastructure is the key.

GEORGES C. BENJAMIN

Executive Director

American Public Health Association

Washington, D.C.

georges.benjamin@apha.org

We have recently experienced several newly emerging viral infections around the world. Severe acute respiratory syndrome (SARS) claimed some 800 lives out of about 8,000 worldwide cases of SARS in the 2002-2003 outbreak. It is likely that people were infected with the SARS coronavirus, a causative agent of SARS, from exotic animals such as civet cats in Guangdong Province, China, at an early stage of the outbreak. The global outbreaks of SARS then occurred through human-to-human transmission.

In 1998-1999, there was an outbreak of mysterious encephalitis in Malaysia, claiming more than 100 lives. Nipah virus was identified as the causative agent. (Fortunately, no human-to-human transmission of Nipah virus has been reported.) We now know that the causative virus jumped from fruit bats, the true reservoirs, into a pig colony on a pig-breeding farm, resulting in an amplification of the virus in pigs. Then people with close contact with the farm contracted Nipah virus from the infected pigs. A transmission of monkeypox virus to prairie dogs in the United States from giant Gambian rats that were imported from West Africa as pets, a transmission of Marburg and Ebola viruses to nonhuman primates from still-unknown reservoirs, and a transmission of H5N1 influenza virus from migratory ducks to chicken colonies on farms were fundamental causes of outbreaks of these newly emerging viruses in humans.

All of these outbreaks have originated in developing countries. Deforestation, the destruction of nature, poor sanitary environments in animal colonies on farms, and high population density are associated not only with human economic activities but also with cultural, traditional, and recreational lifestyles. So many people depend on wood as an energy source. So many people hunt wild animals for food. These activities are considered to be fundamental origins of the emerging viral infections, so that these infections may be associated in part with problems of poverty.

In order to minimize the risk of the emergence of global viral infections in the future, there is no doubt that strict controls on animal trade and the establishment and enforcement of global health standards through incentives by the World Health Organization and World Trade Organization are needed. However, we also emphasize the importance of overcoming the so-called North-South problem, the economic disparity between developed and developing countries, as well. The process of combating the emerging viral infections is as difficult as the resolution process for the North-South problem.

MASAYUKI SAIJO

Masato Tashiro

National Institute of Infectious Diseases

Tokyo, Japan

mtashiro@nih.go.jp
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Title Annotation:Forum; global health standards need modernization in order to minimize risk of emerging viral infections
Author:BENJAMIN, GEORGES C.; SAIJO, MASAYUKI
Publication:Issues in Science and Technology
Date:Mar 22, 2004
Words:807
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