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Towards Effective Emerging Infectious Diseases

Surveillance: Evidence from Egypt (NAMRU-3), Kenya


(USAMRU-K), Peru (NMRCD), and the US-Mexican
Border (EWIDS)
DTRA-ASCO Visit
FY11 Proposal Presentations
Sophal Ear, Ph.D.
8 July 2010
Disclaimer: Material contained herein is made available for the purpose of peer review and discussion and
does not necessarily reflect the views of the Department of the Navy or the Department of Defense.
Indonesia, Cambodia, and Mexico Update:
1
st
draft of Cambodia-Indonesia paper (April)
Mexico Research Trip (June)
Key Issues Identified by Interview
Subjects by Country
Cambodia Indonesia
Issue Respondents
emphasizing issue
(percent)*
Issue Respondents
emphasizing issue
(percent)
Low salaries 5 of 12 (42%) Poor host-donor
relationship
13 of 26 (50%)
Donor dependence
pathologies
5 of 12 (42%) Differing host and donor
priorities
8 of 26 (31%)
Poor staff management/HR 4 of 12 (33%) Low salaries 7 of 26 (27%)
Patronage networks 4 of 12 (33%) Decline in the MoH
quality
6 of 26 (23%)
No compensation for
culling
4 of 12 (33%) NAMRU-2 is
misunderstood
6 of 26 (23%)
Differing host and donor
priorities
3 of 12 (25%) Poor compensation for
culling
4 of 26 (15%)
Local levels dont see
reporting translated into
response
4 of 26 (15%)
* By proportion of interview subjects
By proportion of interview sessions
Difference in calculation due to prevalence of group interviews in Indonesia
Puzzle/Research Question
Focus:
Effective surveillance of
EIDs via understanding of
the political / economic /
cultural factors inherent to
each country.
How do we accomplish
this?
Having looked at
Cambodia, Indonesia,
Mexico, and the US
(1976), add case studies of
Egypt, Kenya, Peru, and
US-Mexican border (both
successes and failures).
Early
Warning
Infectious
Disease
Surveillance
Outcome: Insight into the political,
economic, and cultural challenges to
effective surveillance of EIDs
Questions:
What infrastructure is necessary to conduct
effective (timely, cost-effective) disease
surveillance?
What would it take to actualize effective
surveillance in developing countries?
What challenges to effective EID surveillance
would we find in developing countries?
What can be done to mitigate or overcome
these challenges?
Why should we care?
No report or
no surveillance?
Why?
US-Mexican border is 1,969 miles and the most frequently crossed international border in
the world, with about 250 million people crossings per year. Early warning of EIDs is crucial.
Myriad problems exist in the political economy of pandemic preparedness:
Poor to non-existent surveillance in the developing world
Poor diagnostic laboratory capability in the developing world
Disincentive to report (bad publicity, bad for business => Cambodia)
Viral sovereignty (=> Indonesia)
Why and how is this
important to US
national security?
This study specifically touches upon
two areas: U.S. national security and its
safety via interaction with developing
countries.
The methods and lessons from my case
studies tie back to U.S. national interest
and security.
Cross-Border Issues
Transnational Threats
UNCLASSIFIED
UNCLASSIFIED
Anticipating
Threats &
Opportunities
Strategic
Vision
Over-The-
Horizon
Proliferation
Track II Strategic
Dialogues on Threat
Reduction
Countering
WMD
Proliferation
Strategic
Foundations
21
st
Century
Deterrence
Countering
WMD
Terrorism
Sustaining
Communities
of Interest
Preparing the
Next
Generation
How will this help DTRA-ASCO meet its
objectives?
Priorities
(Referenced
DTRA/ASCO
Priorities) Ties into
goals outlined in
President Obamas
National Strategy for
Countering
Biological Threats
(proactive
confrontation of
WMD threats at their
source and as far
from American
borders as possible)
Development of
analytical tools to
detect and actively
confront the full
spectrum of WMD
threats
Sustaining communities of interest,
specifically referring to developing
countries whose health have the potential
to affect U.S. homeland security.
Preparing the next generation (U.S. and
global policy makers) to have a body of
knowledge that analyzes and understands
the infrastructures underlying the political
economy of successful and unsuccessful
national programs for EID surveillance.
Politics Trumps
Science
Scientists too
frequently see the
surveillance of EIDs as
a technical problem of
science, pure and
simple. The reality,
however, is that on
the ground, even the
most advanced
technology cannot
trump politics.
Namru-2 Jakarta is
shutting down. I have
been very sad. Not only
because I am losing my
job, but more than that,
Indonesia will loss [sic]
an established laboratory
research coz [sic] of
political reasons
--Senior Indonesian
scientist
E-mail
11 April 2010
Scientists should be on
tap, but not on top.
Churchill
By which he meant scientists have
a duty to inform politics, but they
have no special insights beyond
that, and must allow politicians to
formulate policy based on social,
economic and ethical principles.*
Barriers to effective preparedness
span not only the technical and
scientific, but cultural, political,
and economic realms.
* http://www.newscientist.com/blogs/thesword/2010/05/time-for-scientists-to-go-into.html
Objective:
To produce three more
case studies that would
be part of a third
installment of a collection
of policy reports studying
the necessary
components of an
effective EID surveillance
system.
Deliverables:
Set of policy reports on
Egypt, Kenya, Peru, and
US-Mexican border
Refereed journal articles
Book chapters (even a
book)
Established Record of
Productivity on Political
Economy of Avian
Flu Research in 2009/10:
Stanford Working Paper
University of Sussex/ESRC
Working Paper
Book chapter
Worlds Poultry Science
Journal article