Geography

Where are the areas more vulnerable to Monkey Pox (MPox)?
Why is MPox deadly?
How does the outbreak of disease affect tourism?
What are the measures taken to contain the spread?

According to a report by the World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and World Bank Group, more than half of all stunted children, almost half of all overweight children and more than two-thirds of all wasted children live in Asia.

Stunted children are usually physically too short for their age. 

 Flooding in Pakistan

Updated 9 Oct 2022Updated 11 Oct

There seems to be a decline of dengue fever in SE Asia, except Singapore and Vietnam as reported from Jan to June in 2021 as compared to 2020.

What cause the decline in segue fever?

Why do you think there is an increase in the report of dengue fever in Vietnam and Singapore?

https://www.channelnewsasia.com/news/asia/dengue-fever-plummet-southeast-asia-2021-covid-19-lockdown-15047544

How can we manage the spread of Dengue Fever?

Since 2016, NEA has been conducting phased field studies to evaluate the use of male Wolbachia-Aedes mosquitoes to suppress the urban Aedes aegypti mosquito – the primary vector of dengue, chikungunya and Zika viruses in Singapore.

https://www.channelnewsasia.com/news/dengue-wolbachia-mosquitoes-tampines-yishun-12941006?cid=h3_referral_inarticlelinks_24082018_cna

How does COVID-19 contribute to higher number of Dengue cases?

Dengue cases remain high in Singapore as high as 2700 reported in 2021.

The NEA  expects an increasing number of dengue cases due to the accelerated breeding cycle and maturation of the Aedes aegypti mosquito vectors - meaning it takes less time for the mosquito to become a biting adult in warmer months - as well as the shorter incubation period of the dengue virus, which is the time needed for the mosquito to pick up the disease and pass it on. This period is around 8 to 12 days when the temperature is 25 to 28 deg C.

Since the Covid-19 phase two (heightened alert) measures kicked in on May 16, the NEA said that more people staying in and working from home could mean more " biting opportunities" for the day-biting Aedes aegypti mosquito, and potentially higher risk of dengue transmission.

https://www.straitstimes.com/singapore/rise-in-spore-dengue-cases-expected-as-mosquito-population-grows-by-30-per-cent

Watch the video below on how the spread of dengue fever is managed in Singapore, especially in 2020 when reported case was high.

How is the spread of COVID-19 managed in Singapore?

The need for more to be vaccinated, the implementation of quarantine order, stay home notice, trace together and conduct of swab tests. 

Are these sufficient to manage the spread?

What other measures are put in to manage the spread of disease?

Stay Safe. Strong together.

https://ppvbc.github.io 

Touch each spot on the map and the name of place, date, time visited by cases will be shown.

Look at the bar graph below. Why is the spread greater in the highlighted countries?

Why is the data presented in cases per million per week and not total cases per week?

 World Health Organization (WHO) launched an initiative to help eradicate Malaria in 25 more countries by 2025.

Where are the countries most affected by Malaria found in?

Why are children more vulnerable to Malaria?

What has been done to managed Malaria?

How has WHO helped countries eradicate Malaria?

https://www.channelnewsasia.com/news/asia/who-eyes-malaria-eradication-in-25-countries-by-2025-14667486

Causes of Malaria

Seasonal Malaria Chemoprevention (SMC) is the administration of treatment doses of longer-acting antimalarial medications at monthly intervals in areas of exclusively seasonal transmission. Watch the video below on how it is carried out in Mali and Senegal.

 The map shows the number of deaths from COVID-19 as at 16 April 2021.

Where are the countries which have near or more than half a million deaths from the pandemic? 

You can also observe than countries with near or more than 100,000 deaths are concentrated in Europe and South America. 

India seemed to be the only one in Asia with very high death rate from COVID-19. Why do you think  the high death toll is higher in India?

What are the factors which affected the spread of the disease? Are the factors similar to those in the textbook for infectious disease such as Malaria? 

How effective are the measures carried out to contain the spread?

Source: https://www.channelnewsasia.com/news/world/covid-19-death-toll-3-million-india-cases-surge-14640336

 Watch the video below on how poor nutrition results in stunting in Indonesia.

What cause stunting in children?

Realising its negative impact on the country’s economic growth, the Indonesian government has set a goal to reduce the stunting rate to 14 per cent by 2024. 

How does high rate of stunting affect the economy?

Diarrhea is the leading cause of child mortality in the country.

Why does diarrhea lead to high child mortality?

https://www.channelnewsasia.com/news/asia/indonesia-goal-reduce-stunting-malnutrition-children-poverty-14159428

A powerful graphic by the New York Times on the deaths as a results of the COVID-19 Pandemic in the US. Every dot represents a life lost and almost half a million lives have been lost from 24 April 2020 to 20 Feb 2021. The greater intensity as shown by number of dots (loss of lives) is in Jan 2021.

Health of forest can affect the health of human civilisation.

With deforestation, many of the animals are forced out of the forest into marginal habitats which are in closer and more frequent contact with people, 

More than two-thirds of zoonotic diseases are known to come from wild animals. 

Deforestation also contribute to climate change and increases the risk of disease emergence by pushing animals and the vectors (e.g. insects) that can transmit viruses into new regions that have not encountered those pathogens previously.

https://www.channelnewsasia.com/news/asia/covid-19-why-saving-our-forests-can-help-stop-next-pandemic-12688524

The number of visitors to Singapore plummeted to a historic low of 748 in April, which is a near 100 per cent drop from the 1.6 million tourists that came in the same month last year 2019 since the ban on short-term visitors was put in place on 24 March 2020.
https://www.straitstimes.com/singapore/visitor-arrivals-to-singapore-hit-historic-low-in-april?utm_medium=Social&utm_campaign=STFB&utm_source=Facebook#Echobox=1591281992

Border restriction to control the spread of COVID-19 has impacted on the tourist industry worldwide, this is especially so for business travellers and international conferencing with the rise of virtual online alternatives. 




Why does outbreak of disease affect tourism?
What are the other events which result in fluctuations in tourism?
Which event do you think has the most impact on tourism?

https://www.channelnewsasia.com/news/singapore/economic-cost-covid-19-singapore-business-closures-12791360

Geographical update of the spread of COVID-19 coronavirus which started in Wuhan, China.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Another real time update map


When was the first case of 2019 novel coronavirus (detected in Singapore?
Where are the areas affected?
Who are affected by the virus?
How does the virus affect the health of the people?
What is the difference between a epidemic and a pandemic?
https://www.wonderwall.sg/health/outbreak-endemic-epidemic-pandemic-whats-the-difference/








https://www.channelnewsasia.com/news/topics/wuhan-virus?cid=cna-sghome_wuhan_virus_outbreak_mobile_22012020_cna

https://www.google.com/amp/s/amp.cnn.com/cnn/asia/live-news/coronavirus-outbreak-hnk-intl-01-26-20/index.html

Advisories from various government sectors in Singapore
https://www.moh.gov.sg/2019-ncov-wuhan/advisories-for-various-sectors

More from ST interactive https://www.straitstimes.com/multimedia/graphics/2020/01/wuhan-virus-what-we-know/index.html?shell

The good from the outbreak.

Something good from the coronavirus outbreak.
1. Less pollution and reduction of carbon emission as some cities lockdown.

https://www.google.com/amp/s/www.sciencealert.com/here-s-what-covid-19-is-doing-to-our-pollution-levels

https://www.smart-energy.com/industry-sectors/business-finance-regulation/carbon-emissions-impacted-by-covid-19/


https://www.nature.com/articles/d41586-020-00758-2

More than 1,000 people have now died of Ebola in the Democratic Republic of Congo.

Challenges faced by the humanitarian groups in fighting the outbreak are the political situation and the resistance within communities to preventative measures, care facilities and safe burials. The long-standing presence of various rebel groups in Ituri and North Kivu has made it difficult for health workers to access tho 12000 people who might have come into contact with Ebola.

Tens of thousands of people were uprooted by the resurgence of violence in the east of the country. Among them, some 7,000 displaced people are housed in a primary school where the only water source is a nearby river and there are not enough toilets. Thus the risk of disease spread is high.

In the conflict-ridden country as a whole, more than 13 million people need humanitarian aid. More than five million have had to flee their homes, and Uganda is already home to more than 1.2 million refugees.

Https://sg.news.yahoo.com/more-1-000-dead-d-r-congo-ebola-020957162.html

Why does political situations affect the spread of disease?
What are the other factors affecting spread of disease?
How does international organisations help in mitigating the impacts of the spread of disease?
Where are the areas prone to the spread of disease?

Nepal reported its first case of dengue fever 14 years ago. Now, dengue patients can be found even in the Kathmandu Valley, nearly 1,400m above sea level. The disease has spread as a result of climate change, which has created warmer, more hospitable environments for the Aedes mosquito to breed and bite. There is also fear of the spread of Zika disease via mosquitoes.
Source:
https://www.straitstimes.com/asia/south-asia/a-modern-plague

Click on the link below for interactive on how climate change increase dengue cases in Singapore.
https://graphics.straitstimes.com/STI/STIMEDIA/Interactives/2018/11/warm-mosquito/index.html




Where are the areas affected by the spread of insect-borne diseases due to climate change?
Why does climate change affect the spread of insect-borne diseases?
What are the major causes of climate change?
How can climate change be mitigated?

Read the article on the large-scale Vaccine against Malaria @ 
http://www.straitstimes.com/world/africa/first-large-scale-malaria-vaccine-trials-for-africa

Read the following articles on the spread of MERS and how it affected South Korea: 
http://www.scmp.com/news/asia/article/1821231/tourists-and-their-money-skipping-south-korea-mers-crisis-persists

Indicators used to measure health
Infant mortality rate (IMR) - Number of infants that die before reaching the age of one year old per 1000 live births in a year. DCs have a lower IMR than LDCs because of better standards of living (SOL). Such better standards of living include access to good healthcare, clean drinking water and a hygienic environment
Life expectancy rate - Average number of years from the time of birth that a person can expect to live. DCs have a lower life expectancy than LDCs because of better standards of living (SOL)
Such better standards of living include access to nutritious food and proper hygiene and sanitation

These indicators help us to compare the state of health of people in the world.
Using a variety of indicators provides a better idea of how a population is faring over specific time periods.

http://www.prb.org/publications/datasheets/2014/2014-world-population-data-sheet/data-sheet.aspx
http://mashable.com/2014/05/19/life-expectancy-global/#F.yd_Dr8mkqO

How and why does the health of people differ between DCs and LDCs?

Social factors
Diet -Lack of consumption of nutrients and poor diet can result in malnutrition in LDCs
Excessive consumption of nutrients which are eventually stored as body fats can result in obesity in DCs
Lifestyle choices -Healthy lifestyle like exercise reduces the risk of many diseases including heart diseases, diabetes and depression. Smoking is a bigger health problem in LDCs than in DCs
For example, 80% of the world’s 1 billion smokers are from LDCs
Education - People who are educated are more likely to be informed on how to lead a healthy lifestyle. Generally earn higher incomes that give them greater access to quality medical treatment, food and living conditions. 
When women are more informed of nutrition and health care, IMR tends to be lower as they are able to care and provide for their children more effectively. For example, according to the Indian Council of Medical Research, between 1981 and 2005 in India, IMR among children born to mothers without formal schooling has been consistently higher than those born to mothers with education
People in DCs are more likely to stay longer in school and complete their education compared to people in the LDCs because:
a) Education is compulsory in DCs
b) DCs have more resources and more highly skilled labour to invest in education
c) More people are living in poverty in LDCs thus they are more likely to drop out of school as it is not affordable for the family

Economic factors
Poverty and affluence -Poverty limits the purchasing power that people have to afford basic healthcare. People are also more likely to be exposed to health risks because of poor quality housing and insufficient nutrition
About 1.2 billion people remain below the extreme poverty line with an income of US$1.25 or less a day
About 2.4 billion people live on less than US$2 (median) a day
Poverty also exists in DCs due to the high standard of living (SOL)
Low socio-economic status (SES) brought about by poor education, lack of amenities, unemployment and job insecurity contribute to poor health
Children are more prone to nutrition-related diseases such as kwashiorkor and are also rarely given vaccination against the disease
Affluence provides people with greater access to food and better quality health services, increasing their resistance to diseases and improving their ability to deal with diseases (like adopt healthy diets and consult well-trained health care professionals)

Investment in health care and access to health services- Investment in healthcare can come from governments or private sectors (businesses or individuals)
The amount and quality of health care people can obtain depend on how accessible, available and affordable the healthcare is
Accessibility: how near or far are medical services from their homes
Availability: sufficient capacity to meet the needs of the people (enough hospitals, clinics, staff, medicine and equipment
Affordable: cost affordable to the people
Doctor-patient ratio: number of doctors to a given population
Patient-bed ratio: number of hospital beds to a given population
They reflect the amount of investment in health care by a country

Environmental factors - Living conditions
Communities or populations that experience poor living conditions are often found in slums
Slums are characterized by poorly secured structures, poor ventilation and overcrowding thus result in poor health and contribute to the spread of diseases
Access to safe drinking water Lack of access to safe drinking water can cause the spread of waterborne diseases like cholera
Providing safe drinking water for a large population requires time and large investments
Proper sanitation Human waste may contain harmful microorganisms that can cause diseases and be spread to a population
Sanitation controls and manages these waste to keep harmful microorganisms from spreading in a population  
Presence or absence of sanitation can influence the health of a population
For example: poor sanitation may result from the dumping or leakage of sewage into water bodies and lead to the spread of waterborne diseases


Which diseases cause more deaths in DCs and LDCs?
Two main groups of diseases:

• Infectious diseases
• Degenerative diseases

Infectious diseases
Diseases that are communicable or contagious, and are transmitted by a pathogen like bacteria, viruses, parasites and fungi through vectors from one person to another (cause a higher proportion of death in LDCs)
Examples: Dengue fever, Lower respiratory infections, Diarrhoeal diseases, HIV/AIDS and Malaria
Commonly associated with poverty, poor diet and limited healthcare, thus occur at a higher rate in LDCs than in DCs

Degenerative diseases
Leading causes of death tend to shift from infectious to degenerative diseases as countries develop 
Although infectious diseases are less common in DCs, individual cases of infectious diseases such as pneumonia and bronchitis still occur in DCs
Health conditions that are characterized by a gradual breakdown of physiological function like tissues or organs (cause a higher proportion of death in DCs)
Examples: Coronary heart disease, Stroke, Chronic obstructive lung disease, Cancer of the trachea, bronchus and lung and Alzheimer’s disease
Commonly associated with lifestyle choices, eating habits, bodily wear and tear or genetic causes
Leading causes of death due to people in DCs having longer lives
As countries develop, the diets of people change with rising affluence. For example increasing consumption of meat and other non-staple food which could lead to heart disease and obesity
According to the World Health Organisation (WHO), cancer accounted for 7.6 million deaths worldwide and 13% of all deaths in 2008
High-income countries had more than double the rate of all cancers combined compared to low-income countries

What influences the spread and impacts of infectious diseases?

Major disease outbreaks in the past
10 000 BC to 1979: Smallpox
700 BC to 1963: Measles
165 to 190 AD: Antonine Plague and Black Death
1918 to 1919 : Spanish Flu
1959 to present: HIV/AID
2003: SARS
2009: H1N1

Incidence rate Prevalence rate
The number of new cases of a disease in a particular population over a specified time period The total number of existing cases of a disease in a particular population
For example, Low incidence rate of 4 diagnosed cases of tuberculosis per 1000 people in 2011 For example, Global prevalence rate of tuberculosis in 2008 was 164 cases per 100 000 people

Scale at which diseases occur
Endemic
• Disease that is constantly present at low levels in a particular population or region
• For example, the present of dengue in Singapore 
Epidemic
• Occurs when an infectious disease spreads rapidly to many people
• Number of new cases in a given period, or the incidence rate, is greater than what is expected
• For example, cholera which broke out in Haiti after an earthquake in Haiti occurred in 2010
Pandemic
• Disease spreads across a large area, such as the entire country, continent or the whole world
• For example, Spanish flu broke out in 1918 during WWI and army troops brought the disease from USA to Europe  and to Russia, India, China and continent of Africa
• Another example, SARS was spread from Asia in 2003 to countries in North America and Europe


Extent and spread of Malaria in the world and in Asia
• Malaria: vector-borne diseases (transmitted from person to person via living organisms)
• By far the most serious vector-borne disease in the world – 200 million people infected every year
• Spread through expansion diffusion (infectious disease spreads outwards from its source)
• Endemic disease because consistently occur in an area or community
• 2012 World Malaria Report reported 655 000 malaria deaths and 90% occurred on the African continent
• Malaria mortality rate high in Africa due to long life span of mosquito species
• Prefer to bite humans over animals
• Also present in India, Indonesia and Myanmar as Endemic disease
• Incidence of malaria infections sometimes increases greatly after disasters for example, when Indonesia was hit by a tsunami in 2004
• Pool of stagnant water left behind by the tsunami and heavy rains provided mosquitoes with suitable breeding conditions
• According to WHO, about 600 000 children under the age of five die from malaria each year in Sub-Saharan Africa

http://www.team2017.org/malaria/index.html


Factors contributing to the spread of malaria

Socio-economic factors
Overcrowded living conditions
• In such conditions, people tend to share the same spaces and use the same items
• Interact with each other more often and more closely
• Thus diseases spread quickly and easily 
• For example, the housing for refugees and migrant workers is often overcrowded and unhygienic and these conditions made it easy for Anopheles mosquitoes to spread from one person to another

Lack of proper sanitation
• Waste water not disposed properly may form stagnant pools of water, which is favourable as a breeding ground for mosquitoes

Limited provision of and access to healthcare
• Shortage of doctors, the lack of health services in rural areas and the cost of malaria treatment can contribute to the spread of malaria
• United Nations Development Programme (UNDP) states that there is a critical shortage of doctors in India (6 doctors for every 10 000 people and India only spends 4% of the GDP on healthcare)
• Medication in medical centres is usually far from people’s homes in the rural areas and thus there is delay in treatment and this contributes to higher chances of people spreading the disease
• Treatment is unaffordable in rural areas where malaria is prevalent thus those who cannot afford resort to cheaper but ineffective treatment 
Environmental factors Poor drainage and stagnant water • Poor drainage of water creates conditions favourable for the growth of mosquito populations
• For example, in the state of Rajasthan, India, water from 8000 kilometres of canals in the Great Indian Thar Desert leaks into many places, creating swamps which formed breeding ground for Anopheles mosquitoes

Effect of climate
• Monsoons create favourable conditions for mosquitoes to breed by bringing large amounts of rainfall
• Heavy rain form pools of water often due to blocked storm water drains caused by accumulations of debris
• These pools of water provide ideal and secure breeding grounds for mosquitoes
• Post-monsoon period poses more risk for malaria to spread
• When flooded areas dry up, they leave pools of stagnant water which causes epidemics of malaria to take place in areas such as Pakistan in 2006 and 2009

Role of climate in the spread of malaria
Temperature
Temperatures ranging from 22°C to 30°C increase the lifespan of female mosquitoes
Higher temperatures shorten the development time of the parasites in the mosquitoes host
As a result, mosquitoes become active and infectious sooner
Aquatic life cycle of mosquitoes will be reduced from 20 days to 7 days when temperature increases causing malaria to spread more easily Pools of stagnant water allows mosquitoes to breed and infect more people

Precipitation
Habitats may be removed when rainfall is too high since the stagnant water will be washed away by the rain Relative humidity ranges from 50% to 60% is needed for the survival and activity of mosquitoes

Relative humidity
Higher humidity level leads to mosquitoes having a longer lifespan, and are able to infect more people



Impacts of Malaria

Socio-demographic impact
Death rate
• World Health Organisation estimated that in 2010, of the 216 million cases of malaria, between 537 000 to 907 000 people have died from malaria

Infant mortality rate
• High infant mortality rate could be as high as 140 out of every 1000 children born alive in Nigeria
• Infant mortality due to low birth weight caused by malaria infection during pregnancy can range between 75 000 to 200 000 
Economic impact Burden of malaria on households
• Economic burden of malaria includes increased medical expenses
• In the Republic of Ghana, West Africa, the economic burden can be as high as 34% of a household’s income 

Cost of health care
• Funds has to be set aside for the provision of health care to address the disease
• Funds used for costs such as building maintenance and investments in hospitals and clinics, purchase of medication and insecticide-treated nets can account for as much as 40% of public health spending for some countries 

Loss of productivity
• People are not able to work due to their poor health, resulting in poor productivity
• Poor productivity produced less goods and service for export, thus results in slower economic growth
• For example, areas endemic to malaria like Africa has slowed down their economic growth by 1.3% each year


Extent and spread of HIV/AIDS in the world and in Asia
• Human Immunodeficiency Virus (HIV): virus that attack the immune system by destroying white blood cells that are critical to fighting infections
• Will lead to Acquired Immune Deficiency Syndrome (AIDS), which is a severe loss in the body’s cellular immunity
• Transmitted from person to person through blood or bodily fluids (sexual contact, sharing of infected needle, blood infusion and pregnant mother to baby)
• Spread through expansion diffusion (infectious disease spreads outwards from its source) and relocation diffusion (disease spreads to new areas outside its current geographical range, whilst still present in the location of origin)
• Spread from Africa to North America and Europe in the 1970s
• Epidemic occurred in the mid-1980s, especially in Sub-Saharan Africa through expansion diffusion
• WHO estimated 34 million people worldwide were living with HIV/AIDS in 2011 and 1.8 million people have died due to HIV/AIDS in 2010
• United Nations Joint Programme on HIV/AIDS (UNAIDS) estimated that more than 310 000 people in Botswana in Sub-Saharan Africa wereHIV-positive in 2010 

Table showing a global view of HIV infection in 2008: 33.4 million people living with HIV
http://www.who.int/hiv/data/global_data/en/


Factors contributing to the spread of HIV/AIDS

Social factors

Social stigma
• Commonly associated with HIV/AIDS
• HIV/AIDS patients face various forms of discrimination
• Due to prejudice against people with HIV/AIDS and ignorance about how the disease is transmitted, early intervention was hindered in both DCs and LDCs during the 1980s which contributed to the spread of the disease

Education
• Many people are not aware of how the disease can be transmitted and this could be due to the lack of education
• Cultural practices that keep girls from knowing about sex and sexuality until marriage
• For example, sexuality awareness education is not conducted in schools in Nigeria and this ignorance could propagate the spread of HIV/AIDS among the people

Lifestyle choices
• Drug injection or sharing needles or refusal to use condoms may increase one’s risk of being infected with HIV/AIDS, contributing to the spread of HV/AIDS
• Drug and alcohol intoxication affect judgement and can lead to unsafe sexual practices, which put people at risk for getting HIV or transmitting it to someone else
Lapses in medical practices • Mistakes, corruption and negligence associated with medical practices contribute to the spread of HIV/AIDS
• According to WHO, about 5% to 10% of HIV infections were transmitted by blood transfusion tainted with HIV/AIDS
• For example, in USA, 130 000 patients were potentially exposed to HIV between 2001 and 2011 because contaminated containers and syringes were used in blood transfusions 
Economic factors

Vice trades
• In China, women move from villages to cities in search of work have limited access to education and job training
• They were only able to find jobs with low pay and no job security
• Thus they often resort to commercial sex and this causes them to be more vulnerable to HIV/AIDS

Mobility
• Men who move to cities or mining areas in search of work often leave behind their families
• Thus they may get involved in risk-taking behaviours and put themselves at risk of being infected with HIV
• Development of modern transportation has helped to carry HIV rapidly across the globe at a shorter period of time and reach more people
• Tourists often take risks like drinking more and engaged in unprotected sex, thus tourism industry contributes to the spread of HIV/AIDS 
• For example, 206 people in Queensland, Australia were diagnosed with HIV when they travelled to Papua New Guinea, a country with high HIV/AIDS prevalence


Impacts of HIV/AIDS
Socio-demographic impact
Life expectancy and Infant mortality rate
• Increases the number of deaths and reduces life expectancy, population size and population growth
• For example, large number of death occur mostly in LDCs where HIV/AIDS is prevalent such as Botswana, Kenya and Uganda
• The difference in life expectancies are almost 6 years lower than what would have been in the absence of the disease
• HIV/AIDS also caused an increase in IMR
Orphan crisis • Large numbers of children lose their parents due to HIV/AIDS
• Almost 17 million orphans due to HIV/AIDS
• Carers of the orphans are plagued by deeper poverty due to the medical costs and living expenses incurred when the orphans stay with them
• Orphans with carers are vulnerable to forced labour into sex industry and to recruit as child soldiers
• Often stigmatized by society through association with HIV/AIDS
• Limits access to basic necessities and more likely to suffer from malnutrition and illnesses
Economic impact

Health care expenditure
• Expensive cost for individuals and countries
• High health care expenditures by governments for treating complications from HIV/AIDS
• Antiretroviral drugs used to treat HIV/AIDS can be expensive
• For example in Singapore, a combination of such drugs can cost from US$160 to US$1200 per month
• The drugs will have to be taken daily for the patient’s entire life and such high cost is borne by NGOs or by the governments in some LDCs
• Government could have use the funds to channel to other forms of developments in the country
• For example, government of South Africa spent US$1.2 billion in 2010 in health care expenditure for HIV/AIDS patients
• This large amount of money could have been spent on other public services such as roads, public transport systems, schools and sanitation in the country 

Slower economic growth
• Businesses are unlikely to invest in places without adequate infrastructure, no skilled labour and a population with poor health
• HIV/AIDS causes high death rates which shrinks workforce 
• Illnesses also cause people to be weak to work for long hours, resulting in reduced labour productivity
• Lack of funds to build an effective education system results in lower skilled workforce
• This deters foreign investments and hindered economic growth
• For example, Uganda experienced slow economic growth due to HIV/AIDS
• Economic growth slowed by 1.2% each year



How can we manage the current and future spread of infectious diseases?

What are the challenges in managing the spread of infectious diseases?
Public health experts believed that infectious diseases could be eradicated within a relatively short time, for example, small pox was declared eradicated in 1979 

Challenges in managing the spread:
Emerging and re-emerging infectious diseases
Diseases spreading globally
Pathogens are microorganisms which can cause infectious diseases

Emerging diseases: appear for the 1st time

Example: SARS
Began spreading from Guangdong Province in China in November 2002
Spread of SARS was contained in July 2003 with 8422 cases and 914 deaths
Slow response to early cases and the difficulty of identifying SARS had led to the outbreak of the pandemic
Re-emerging diseases: may have existed previously but are rapidly increasing

Example: Dengue fever
Vector-borne disease commonly found in the tropical and subtropical zones
Re-emerging in the USA and WHO reported in 2010 with 1.6million cases in dengue fever
Spread to new areas like Europe (France and Croatia) in 2010
1800 cases in the Madeira Islands of Portugal in 2012 Due to the efficiency of modern transportation and communications

Also made it easier for diseases to spread
Example: SARS February 2003:
Spread from Guangdong Province, China to Hong Kong, then to Canada, Singapore and Vietnam
With more travellers, higher likelihood that one of them may be a carrier of disease
This greatly increases the risk of infectious diseases outbreaks and pandemics

http://www.niaid.nih.gov/about/whoweare/planningpriorities/strategicplan/Pages/emerge.aspx

Why is there a re-emergence of Malaria?

Resistance to anti-malarial drugs
Increased due to the rise in the use of counterfeit or incomplete doses of anti-malarial drugs

Allows the surviving malaria parasites to build resistance to the drug

Example:
Migrant workers had surviving malarial parasites that were resistant to anti-malarial drugs in their bodies while working in Thailand

When they return to India, the existing malaria treatment in India became ineffective against the surviving parasites

As a result, more difficult to contain the spread of malaria in India

Air travel
Transport of vectors to new areas led to the re-emergence of Malaria in France
In Asia, an Anopheles mosquito infected by malaria enters the plane and bites the passenger
When the passenger reaches the destination country (Europe), the passenger is bitten by another Anopheles mosquito
This mosquito then acquires the malaria parasite and spreads the disease when it bites another person

Example:
In 1995, Malaria was reported in southern France
These cases occurred in areas non-endemic to malaria and amongst people who had not travelled nor received blood transfusions

Climate change
When the climate gets warmer, temperatures at higher altitudes increase
These places become favourable breeding sites for mosquitoes due to the increased temperatures

Example:
Average temperatures have increased in Central Highlands region in Kenya, allowing malaria to occur in areas of higher altitude
Resulted in an additional 4 million people at risk of malaria

Insecticide-resistant mosquitoes
DDT (chemical pesticide) was replaced by chemicals such as pyrethroids
Pyrethoids were ineffective against mosquitoes, which were able to build resistance to the chemicals in a short period of time

Example:
According to WHO, mosquito resistance to insecticides has been detected in 64 countries around the world

If the situation worsens, it could potentially place 120 000 children under the 5 years of age in Africa at risk of malaria

http://www.humanosphere.org/global-health/2013/08/dengue-fever-spreading-brazil/

What are the challenges in managing the spread of malaria?

Socio-economic challenges
Health care
Malaria parasites able to develop resistance to anti-malarial drugs
Resistance to drugs is caused by incompletely treating an infected person and thus some of the surviving parasites develop resistance to drugs
In 2009, resistance to anti-malarial drugs was observed along the Thai-Cambodia border

Human activities - Population movement
Difficult to monitor the movement of people and increasingly even more difficult because movement is in larger volume and scale due to better and cheaper transport link
Need border control in places such as Greater Mekong subregion in SEA to control the spread of malaria
Also need travel advisories to reduce travel to places where the risk of infection is very high 

Human activities -Forest clearance
Cleared land provides suitable habitat for mosquitoes to breed
Water less able to seep into the ground and accumulate on the surface of the ground
More pH neutral water found in forested areas is suitable for mosquito larvae to survive (Africa, Asia and Latin America)
Loss of biodiversity such as fish, birds and dragonflies allows mosquito populations to increase
Agriculture such as wet rice cultivation also provide a conducive environment for mosquitoes to breed

Environmental challenges
Climate
Changes in temperature and amount of rainfall affect the behavior and range of mosquitoes
Increased temperatures speed up the rate at which mosquitoes breed and mature
Increased rainfall also provides more pools of standing water for mosquitoes to breed
These suitable conditions lengthened the period for mosquitoes to breed and transmit malaria

Monsoons
Monsoons bring high rainfall and this helps to increase the number of malaria cases in India
Heavy rains create long-lasting pools of stagnant water for mosquitoes to breed
Malaria prevalence and rainfall in Chadiza District, Zambia (Africa)
http://www.tiempocyberclimate.org/newswatch/xp_feature091004.htm


What are the challenges in managing the spread of HIV/AIDS?

Social challenges
Difficulties in HIV detection No visible signs of the disease
Infected people may continue with their normal behavior, potentially infecting many others
Limited access to healthcare made people difficult  to obtain HIV testing
In Congo, only 35.2% of women with HIV knew they had HIV before the test
The rest who had HIV were unaware of their HIV status
 

Lifestyle choices
Difficulty in containing the spread of HIV/AIDS due to sexually active years at young age
Traditional culture such as practising polygamy in Zambia and Kenya makes it difficult to manage the spread of HIV/AIDS
Testing for HIV/AIDS before marriage is not practised in these countries  too, thus making it a challenge to manage the spread of malaria

Social stigma
Causes many people to stay away from being tested and receiving treatment , thus increasing the spread and making it difficult to contain the spread
Social stigma also causes people not to stay on track with their antiretroviral therapy
Health professionals may also discriminate against HIV infected patients as they think it is a waste of valuable resources to treat them
They will also get infected with HIV while treating these patients

Environmental challenges
Health care
Treatment is costly and unaffordable to many patients
Transport costs to the clinic and forgoing a day’s earning to a clinic are also unaffordable to many people
For example, in Botswana, long waiting time at clinics was a reason why patients stop visiting and taking medication

Population movement
Truck drivers work long hours and spend long hours away from their families
Thus they are more prone to risk-taking behavior such as seeking the company of commercial sex workers
The Kinshasa Highway, which links Uganda and Kenya, is also known as the AIDS Highway because of the high prevalence of HIV/AIDS among commercial sex workers along the road

The areas near the borders of South Africa, Zimbabwe and Botswana also experience high population movement and therefore high prevalence of HIV/AIDS
Number of people with access to antiretroviral therapy and the number of people dying from AIDS-related causes in low- and middle income countries, 2002–2010
http://www.medindia.net/health_statistics/international/various-diseases-and-resources-print.asp


What can individual, communities, governments and organisations do to manage the spread of infectious diseases?

A) Individuals
• Take actions to help manage the spread of infectious diseases when they are aware of what these diseases are and the conditions which favour their spread
• For example, being more mindful about their hygiene when they are aware of the Hand, Foot and Mouth Disease (HFMD)
• Enable them to exercise social responsibility and take precautionary measures against infectious diseases
• For example, a spray, protective clothing or insecticide-treated nets can be used to reduce contact with mosquitoes and potential breeding sites could be identified and removed
• Obtaining up-to-date and timely vaccinations and following travel advisories could also make a person less likely to contract diseases

B) Communities
• Work together to introduce possible disease control strategies
• Decide when and where strategies will be implemented and by whom
• Engage health workers to train and monitor members
• Community-led programme makes people more receptive to advice or information on treatment
• Community-led strategies also empower residents to develop their own solutions based on knowledge of local conditions 

Strategy  
Sierra Leone
Community-Led Total Sanitation (CLTS)
To remove the practice of open defecation through awareness raising and affordable sanitation options
Community go from house to house digging toilets for each household that needs assistance
Implementation of CLTS gradually extended to the involvement of NGOs and district health management teams working together to help communities throughout the country

Successes
As of 2009, 754 communities had been involved in the project and the incidences of diarrhea due to improved sanitation had decreased

Limitations
CLTS works best in rural areas where population density is low and has proved less successful in urban areas
This is due to ongoing migration and lack of space for toilets

Managua, Nicaragua
Community-based mosquito control
Community conducts surveys to ascertain neighborhood residents’ existing understanding of dengue and their mosquito-control practices
Identified mosquito breeding sites and examined households for breeding sites

Successes
From 2004 to 2007, dengue infection in children declined by more than half
Households were 25% less likely to have breeding sites for mosquitoes

Limitations
Needs cooperation from the government to manage water and waste management issues
Government could help to monitor out-of-reach areas (sewers) on behalf of the community as these areas are not easily accessible to residents

Vellore, India
Geographic Information System (GIS) to monitor dengue outbreaks  
GIS is used to identify the location of infections and pin-point the start of outbreaks of dengue fever
Also used to locate potential mosquito breeding zones that may be targeted for control Volunteers from the community helped to collect data for the mapping of dengue fever outbreaks

Successes
Identifying and reducing mosquito breeding sites is the most effective long-term prevention measure
By identifying the locations of infections and pinpointing the start of outbreaks, GIS can be used to alert the public of an impending outbreak of dengue fever

Limitations
In some areas, street addresses are not available for mapping purposes
The relationship between pinpointing a disease and the potential environmental risk factor is difficult to prove
For example, working adults may spend much of their time outside their place of residence and be infected with the disease from elsewhere
Inaccurate data may thus be used in the mapping of the disease 


C) Governments
• Actively carrying out precautionary measures that aim to prevent outbreaks of diseases
• Use mitigation measures to try to reduce the occurrence of an epidemic

Implementing precautionary measures
   
Singapore
Providing vaccinations against H1N1
In 2009, Singapore began providing vaccinations for its population against the H1N1 influenza virus before it emerged in the country
More than 400 family clinics island-wide stocked with H1N1 vaccines to ensure that Singaporeans had ready access to medical assessment and prompt treatment for mild cases of H1N1

Successes
Singapore is in the process of developing its own vaccine for H1N1
In 2013, Singapore’s first H1N1 flu vaccine has reached the first phase of clinical trials

Limitations
Vaccinations take up to 2 weeks to take effect
Individuals may choose not to receive vaccinations and risk being infected with influenza virus
The waiting period for imported vaccines would take up to 3 months

Thailand
Thermal fogging
Thermal fogging is applied during malaria outbreaks and in uncontrolled transmission areas
In principle, it is applied once a week for 4 week consecutive weeks

Successes
Thermal fogging kills adult mosquitoes found outdoors

Limitations
Thermal fogging is expensive and must be carried out on a regular basis in order to be effective
The thick fog also causes reduced visibility and is a traffic hazard

Implementing mitigation measures

Singapore
Control measures during the SARS outbreak in 2003
Detecting and isolating infected people in a dedicated hospital
A dedicated private ambulance service was used to transport people suspected to be infected

Successes
Prevented and controlled spread within hospitals by closely monitoring the health of staff and by restricting visitors
Potential patients of the disease were subjected to home quarantine by law WHO medical officials praised Singapore’s handling of the outbreak and its prompt and open reporting of cases
They encouraged other countries to learn from Singapore’s handling of the SARS outbreak

WHO medical officials said stringent measures taken by Singapore has contained the spread of the disease

Limitations
Some patients displayed symptoms not commonly associated with SARS
Some patients did not show any signs of SARS until much later
As a result, these patients infected people they came in contact with
This made the detection and the disease harder to contain

Singapore
National Environment Agency (NEA)’s approach to vector control
NEA has the 5-pronged approach to vector control
NEA launched the ‘Do the Mozzie Wipeout’ on 28 April 2013 to prevent an outbreak of dengue fever
This campaign includes community outreach to raise awareness on prevention methods
‘Colour Coded Alert System’ which indicates the seriousness of the dengue situation through colour-coded banners
The colours indicate the corresponding preventive measures to take

Successes
WHO cited Singapore as a good role model in preventing and managing dengue cases and encouraged other countries to learn from Singapore
Number of cases with more serious dengue fever has decreased in recent years since the 2005 outbreak Most people are unaware or complacent about Aedes mosquitoes breeding at their place of residence and this posed difficulties in preventing the breeding of the mosquitoes

Limitations
Mosquitoes breed faster at higher temperatures
More people had been infected with Den-1, a new dominant virus
New virus can make a mosquito ready to spread the disease just 3 to 4 days after it bites an infected person, compared to the usual 7 days
Majority of the population has no immunity against the new virus

D) International organisations
• Include the World Health Organisation (WHO), the World Bank, United Nations Joint Programme on HIV/AIDS (UNAIDS) and other non-governmental organisations (NGOs)

WHO
Directly Observed Treatment, short course (DOTS) (1993 to 2011)

The 5 components of DOTS are:
• Political commitment with increased and sustained financing
• Case detection through quality-assured biological science
• Standardised treatment with supervision and patient support
• An effective drug supply and management system
• A monitoring, evaluation and impact measurement system Total number of countries implementing DOTS increased since 1995 and was approaching 183 in 2004

Successes
Global treatment success rate under DOTS has been high since 1994, with 77% of the patients treated. 
Success rate has remained above 80% since 1998
In 2004, the target of an 85% success rate was achieved in 57 countries, and 2 WHO regions, such as Southeast Asia and West Pacific. Global target was not met by 2000 and the target year was deferred to 2005

3 obstacles to the implementation of DOTS:
Lack of laboratory skills and infrastructure to set up good laboratories, lack of funding and lack of qualified staff
Several factors affect the likelihood of treatment success such as severity of disease, HIV infection, drug resistance, malnutrition and the support provided to the patient to ensure that he or she completes the treatment.  

World Bank
Rolling Back Malaria: The Global Strategy and Booster Program (since 2005)

World Bank will mobilise financial and technical resources from within and outside institution, including public and private sectors, to provide items such as insecticide-treated bed nets and anti-malarial drugs; lower tax on such items; improve and maintain long term commitment to malaria control by government and civil society groups


Purpose of the Global Strategy and Booster Program is to translate the World Bank’s corporate commitment into a serious effort to close the gap between knowing and doing in malaria control 

Implementation of this program will increase the impact of World Bank support to reduce the burden of economic loss, impaired development, preventable illnesses and deaths due to malaria In 1997, the World Bank provided US$165 million in financing for the Enhanced Control Project (EMCP) and EMCP invested in 100 highest risk districts in 8 North Indian states

More than 300 000 village-based volunteers have been trained in malaria case management and anti-malarial drug were supplied to them

Almost 3 million insecticide-treated bed nets have been distributed

Local governments, community groups and NGOs have become actively involved in distribution of insecticide-treated bed nets and community awareness campaigns

Reported cases of malaria declined by:
93.9% for state of Maharashtra, 80.8% for the state of Gujarat and 40.6% for the state of Rajasthan
World bank has limited control over how its funds is used in health care once the finances have been provided to the country

In Ghana, despite an increased in health budget funded by the World Bank, malaria incidence is on the rise

UNAIDS
Getting to Zero 2011 to 2015 UNAIDS Strategy

UNAIDS brings together the resources to the UNAIDS Secretariat and 10 UN system organisations for coordinated and accountable effort to unite the world against AIDS

Vision of UNAIDS is:
‘Zero new HIV infections, Zero discrimination, Zero AIDS related deaths’.

UNAIDS goals:
• Sexual transmission of HIV reduced by half
• Universal access to antiretroviral therapy for people living with HIV who are eligible for treatment
• HIV-specific needs of women and girls are addressed in at least half of all national HIV responses
UNAIDS’ support helped to ensure the successful agreement between the Government of Kenya and the Global Fund for the implementation of its Round 10 grants 

Since 2009, Kenya has reduced new HIV infections among children by 44% but still reported 13 000 new infections among children
Stigma, discrimination, violence against women and girls and other HIV-related abuses of human rights remain widespread and continue to obstruct effective HIV responses

In Cameroon, 13% of people living with HIV/AIDS were denied access to health services due to their HIV status

Cooperation and execution of strategies from governments prove to be challenging 




E) Non-governmental organisations (NGOs)
• Perform a variety of services and humanitarian functions include bringing citizen concerns to governments, supporting and monitoring policies and encouraging political participation

  
International HIV/AIDS Alliance (IHAA)
HIV, Health and Rights: Sustaining Community Action Strategy (2013 to 2020)

IHAA is an innovative alliance of nationally based, independent, civil society organisations

Some of the ways in which the strategy responds to the HIV epidemic include:
• Increasing access to HIV and health programmes
• Supporting community-based organisations to be connected and supporting effective elements of health systems
• Advocating for HIV, health and human rights
Individual countries will take up more ownership in implementing the strategy

Measureable goals for the whole Alliance

Organisations that work with IHAA will use this strategy together with their own national plans to shape their future strategies Success depends on the will of governments to better target their resources and work with civil society in their HIV responses

Not all countries have the funds to implement the strategies

It depends on the goodwill of other countries or international organisations to provide funds for them
American Red Cross, United Nations Foundation, US Centres for Disease Control and Prevention (CDC), UNICEF and World Health Organisation (WHO)
Measles and Rubella Intiative (M&RI) since 2011 M&RI is a global partnership committed to ensuring no child dies from measles or is born with congenital rubella syndrome

Strategy is carried out through:
• Providing vaccination with 2 doses measles and rubella containing vaccines through routine immunization and campaigns
• Monitoring disease using effective surveillance and evaluating results to ensure progress
• Fast response to outbreaks and manage cases Since 2001, the initiative has supported 80 countries to deliver more than 1.1 billion doses of measles vaccine, helped to raise measles vaccination coverage to 84% globally, and reduced measles deaths by 71%

In the African region, deaths caused by measles decreased by an estimated 85% between 2000 to 2010
Many LDCs have limited funds to combat measles; hence they are not able to fully cooperate with the American Red Cross in the initiatives

In 2008 and 2009, there was an outbreak of the disease and increase in deaths caused by the disease in the African region

In some cases, measles vaccination campaigns were not carried out routinely every 2 to 4 years

This gap caused an outbreak of the disease in the African region in 2008