Global Public Health Threats

4. Which new health threats have emerged in recent years?

• 4.1 How did Anthrax letters reveal a new bioterrorist risk?
• 4.2 How vulnerable are we to emerging diseases such as SARS?
• 4.3 How can the transport and dumping of wastes endanger public health?
• 4.4 What is the role of the media in our perception of health risks?

A number of new health threats have emerged since the year 2000, partly due to the great changes that the world has experienced in recent times. These threats include bioterrorism, the emergence of new diseases and the large-scale dumping of waste as an element of global trade.

This text is a summary of: WHO, World Health Report 2007 – A safer future: global public health security in the 21^st century (2007),
Chapter 3: New health threats in the 21^st century, p.35 

4.1 How did Anthrax letters reveal a new bioterrorist risk?

For years, the United States and other industrialized countries had lived with the fear of an attack involving biological weapons, which a number of countries held in stock. The United States Government was so concerned about potential anthrax attacks that in 1990, during the first Gulf War, more than 100 000 soldiers and in 1998, a programme was started to vaccinate all military personnel. From 1997 on, there were frequent hoaxes and alerts when suspect powders were sent to abortion clinics, government offices and other facilities. By 2001, most American state governments and authorities of large cities had begun to develop plans to deal with bioterrorism.

In September 2001, within the United States, four letters sent by mail were found to contain anthrax, 22 people were infected and five of them died. The attack caused massive disruptions of the postal services in many countries around the world and had huge economic, public health and security consequences. Emergency drugs were given to the 32 000 people who could potentially have been exposed and about 3.75 million antimicrobial tablets were distributed. Public health laboratories had to test a vast number of samples and if the country had not been so well prepared, such a large-scale testing would have overwhelmed the nation’s facilities. After the attack, the United States invested millions of dollars to prevent the distribution of hazardous substances through mail.

The anthrax attack showed that bioterrorism has the potential to cause not only death and disability, but also huge social and economic disruption at international levels. In addition to anthrax, other microorganisms could be used as biological weapons. Perhaps the most devastating of these would be an attack involving smallpox, a disease that is often deadly and has no specific cure. An outbreak of smallpox would spread uncontrollably because, since its eradication, people have no longer been vaccinated against it.

This text is a summary of: WHO, World Health Report 2007 – A safer future: global public health security in the 21^st century (2007),
Chapter 3: New health threats in the 21^st century, "The anthrax letters", p.35-37 

4.2 How vulnerable are we to emerging diseases such as SARS?

SARS (Severe Acute Respiratory Syndrome) is a new, pneumonia-like disease which represents a threat to public health and economic security of international scale. It is deadly, killing around 10% of those infected, especially hospital staff. It is passed on directly from person to person, it survives anywhere on Earth, and the infection is difficult to diagnose initially.

The ways in which nations and people interact globally have made us more vulnerable to diseases such as SARS, which can spread easily along the routes of international travel, placing every city with an international airport at risk. This is a serious problem in a world where airlines carried an estimated 2.1 billion passengers in 2006, where financial markets and businesses are intricately linked, and where information is instantly accessible.

The 2003 epidemic of SARS in Asia could potentially have become a global pandemic resulting in the death of millions. However, infections were limited to 8422 people, 11% of which died. The actual number of SARS cases was relatively small but the epidemic provoked a high degree of public anxiety. The fear of transmission caused foreign tourists to choose other destinations. Travel to affected areas in Asia was brought to a virtual standstill and this drained billions of dollars from economies across entire regions. The local population felt safer avoiding restaurants and other public places, and people spent less on non-essential items. As a result, the estimated cost of the epidemic to Asian countries was approximately US$ 20 billion in terms of GDP, which breaks down to over US$ 2 million per person infected.

Thanks to strong leadership and coordinated international public health action, the 2003 epidemic did not become a pandemic and its spread was stopped in approximately three months. If the outbreak lasted over a year and affected the entire world, as had been predicted, the long-term consequences in terms of job loss and bankruptcy would have continued to produce hardship for many years. If a larger proportion of the world’s population had been infected, the global economy could have shut down. The spread of SARS was halted in about three months after it was first recognized as an international threat. In a world still struggling to cope with HIV/AIDS, if SARS had become permanently established the consequences for global public health security would have been disastrous.

The SARS outbreak brought to light the risk posed by emerging diseases and also highlighted the fact that they represent a worldwide threat. Even the wealthiest countries, with the best standards of living and healthcare, are not automatically protected from either the arrival of a new disease on their territory or the subsequent disruption this can cause.

This text is a summary of: WHO, World Health Report 2007 – A safer future: global public health security in the 21^st century (2007),
Chapter 3: New health threats in the 21^st century, "SARS: vulnerability revealed", p.37-40 

4.3 How can the transport and dumping of wastes endanger public health?

The global movement of products, particularly the international movement and disposal of hazardous waste, has serious health consequences.

In August 2006, over 500 tons of chemical waste were unloaded from a cargo ship and illegally dumped by trucks at different sites around Abidjan in Côte d’Ivoire. Exposure to the waste caused nose and throat irritation, breathing difficulties, headaches, nausea and vomiting. In the most severe cases people had trouble breathing, were dehydrated and suffered from nose and intestinal bleeding. One month after the dumping, 69 people had been admitted to hospital and eight deaths were attributed to the event. More deaths are suspected to have occurred due to the worsening of pre-existing medical conditions such as asthma, respiratory conditions or cardiovascular disease.

This incident had important public health, social and economic consequences:

• It occurred in a climate of social unrest and political instability that intensified when people demonstrated in the streets and caused violent incidents on a daily basis.
• Because of the growing anxiety, tens of thousands of people arrived at medical centres with either health complaints or fears about the future consequences of exposure to the chemicals. This stretched the public health system to its limit and left it unable to provide the medical care required by the population
• In addition, there was increasing local and international concern about potential water and food contamination. Some rubbish dumps that were contaminated had to be closed, and domestic garbage began piling up in different areas of the city that had to be closed for security reasons. Neighbouring countries were concerned that rivers and the sea would be polluted and they remained on the alert

The situation called for governmental intervention at the highest level as well as the support of national and international organizations.

This incident shows how globalization has made the movement and disposal of hazardous wastes more dangerous.

This text is a summary of: WHO, World Health Report 2007 – A safer future: global public health security in the 21^st century (2007),
Chapter 3: New health threats in the 21^st century, "Dumping of toxic chemicals", p.40-43 

4.4 What is the role of the media in our perception of health risks?

The mass media have a powerful influence on people’s perception of risks, whether from a new epidemic disease, deliberate attacks or natural catastrophes. The Internet, television, radio, newspapers and magazines are the most influential sources of everyday information on risks to health.

In covering health issues, the media often use government press releases, scientists and international scientific journals as a source of information that they then present to the public in lay terms. At the same time, they also need to reflect the concerns of the general public.

Mass communication can either increase levels of anxiety or provide reassurance at times of public health crises. Authorities such as governments may use the mass media to reassure the public. However, they need to strike a balance between saying too much, which could cause an overreaction; and saying too little, which could make them appear complacent or may spark the media to search for information elsewhere and create or heighten a sense of anxiety.

This text is a summary of: WHO, World Health Report 2007 – A safer future: global public health security in the 21^st century (2007),
Chapter 3: New health threats in the 21^st century, "Box 3.2 The role of the mass media in risk perceprions", p.41