Epidemics Management Essay ⋆ Essays on Controversial Topics ⋆ EssayEmpire

The standard biomedical definition of epidemic is the sudden spread of a disease among a number of people in excess of normal expectancy. Unlike most social problems, infectious disease epidemics are grave social problems not only because of the possible deadly nature of the disease but also because of the element of surprise and the social context of contamination. For most communities affected by an infectious disease epidemic, the outbreak is unexpected. The mode of contamination tends be a simple daily life activity involving social relations and practices that are innocuous under normal circumstances but that must be halted once the link with the disease becomes evident (e.g., preparing, buying, and selling food; collecting, storing, and drinking water; sharing garments or eating utensils; or engaging in close social and physical contact). The disruption of normal social and economic activities in the affected communities is one of the major consequences of epidemics that transform what begins as one person’s illness episode into a large-scale social problem or crisis.

Thus the management of epidemics as a crisis is a problem of governance. Generally, governance refers to the management of the affairs of the collective to ensure safety, fairness, and equality of opportunity for all its individual members. Seen from the perspective of crisis management, unforeseen epidemics are real-time tests of the effectiveness of a country’s governance in a time of crisis, and foreseen epidemics testify to the country’s level of preparedness. Either way, the political leaders’ style of governance becomes a definitive factor in the country’s efforts to prevent or contain the epidemic. Consequently, the political and health authorities in the country or region affected by an epidemic are major stakeholders as they are naturally expected to find a solution and implement the measures necessary to deal with the crisis.

The world’s experiences with bubonic plague, cholera, typhoid, yellow fever, and countless other infectious disease epidemics of the ancient past have been amplified by encounters with recent epidemics such as HIV/AIDS, SARS (severe acute respiratory syndrome), and the threat of human transmission of the H5N1 virus, commonly known as “avian influenza” or “bird flu.” It is a sign of the times that, compared with past generations, although the world might still be caught unaware by an epidemic in the 21st century, economically advanced countries today are in a better position to manage epidemics. Still, the ability to manage epidemics varies widely across countries depending on the nature of the disease, economic resources, technical expertise, and the overall level of preparedness, among other things.

The accumulated knowledge and experiences with past epidemics highlight three important areas of attention in their management: the scientific and bio-medical efforts to develop an effective cure and vaccine against the infectious disease; the types of people affected by the disease; and the leadership actions and decision making that affect the level of success in managing the crisis. The biomedical and scientific efforts to find cures and vaccines are beyond the scope of this entry. The objects of attention here are the other two areas: people and the decision-making process.

Concerning the types of people involved, four types of stakeholders are crucial in the management of epidemics: the group or community directly affected by the outbreak, including infected persons, their families, and immediate social networks both formal and informal; the larger population at risk of infection; the medical and other health care personnel; and the political authorities, including policymakers, health authorities, and all levels of policy implementation personnel. The active cooperation of these important stakeholders is necessary to deal successfully with the epidemic. Medical sociology and social policy studies show that the cooperation of these groups tends to fluctuate due to the influence of many factors, but more significantly with the level of trust citizens have in their national leaders.

Regarding actions and decision-making processes, the management of epidemics requires two kinds of knowledge: (1) knowledge on the nature of the virus or bacteria involved and its clinical features, and (2) knowledge on the population affected. Historical records show that lack of both types of knowledge was among the reasons for the failure of communities and nations waging war against a succession of many epidemics such as bubonic plague in the 14th century; typhus, scurvy, and dysentery in the 16th and 17th centuries; and pulmonary tuberculosis for most of the 19th century.

Today we have HIV/AIDS, SARS, and avian influenza (“bird flu”), among other major infectious diseases. Managing these epidemics means preventing and controlling the infectious disease outbreaks, and this is a race against time. The ability of viruses to evolve and move across species represents an ever-increasing danger in a time of considerable population movements through global travel, immigration, and forced exodus propelled by large-scale natural and human-caused disasters. As a result, scientists around the world are scrutinizing the microcosm of viruses and bacteria with an increasing sense of urgency and intensity. Yet, while scientific advances are crucial, they are insufficient. The battle against infectious disease epidemics must be fought simultaneously outside the laboratory on a wider, social front involving the attitudes and actions of ordinary individuals and groups. People’s image of a disease influences their attitudes toward illness and may even become part of the community’s folklore. Research by medical sociologists and other social scientists indicates that the successful management of epidemics involves knowledge of factors such as cultural values, beliefs, and practices; socioeconomic and demographic features of the population; the public image of the infectious disease; and the political will to intervene. Cultural norms on disease causation, diagnosis, and treatment (including social stigma, privacy issues, and ability to obtain prompt and affordable medical care) are very important. These norms and beliefs influence people’s behavior and the level of success in preventing and containing an infectious disease epidemic.

A final point deserves specific mention. Given the dual nature of epidemics as both biomedical and social problems and given the two types of knowledge (biomedical and social) required for their prevention and management, it is clear that effective governance of epidemics can be attained only by close and dynamic collaboration between biomedical and social science experts on the one hand and leaders and the public on the other hand.

Bibliography:

Quah, Stella R., ed. 2007. Crisis Preparedness: Asia and the Global Governance of Epidemics. Stanford, CA: Shorenstein Asia-Pacific Research Centre and the Brookings Institution.
Quah, Stella R. 2007. “Public Image and Governance of Epidemics: Comparing HIV/AIDS and SARS.” Health Policy 80:253-72.
Rosenberg, Charles E. 1992. Explaining Epidemics and Other Studies in the History of Medicine. Cambridge, England: Cambridge University Press.
Wills, Christopher. 1996. Plagues:. Their Origin, History and Future. London: HarperCollins.
World Health Organization. 2006. SARS: How a Global Epidemic Was Stopped. Geneva: World Health Organization.

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