ROLES OF MULTI-COUNTRY NETWORKING IN PREVENTION AND CONTROL OF EMERGING AND RE-EMERGING INFECTIONS

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The emergence of new and the re-emergence of old infectious diseases reverses our previous belief that communicable diseases have been brought under human control. The development of antibiotic-resistant bacterial and fungal infections and the apparent lack of vaccines for many infectious diseases remind us of how vulnerable we are. Infections with SARS coronavirus, Nipah virus, and, more recently, H5N1 influenza virus in humans are just a few reality checks and more are expected. The problems of these emerging and re-emerging infections (ERI) give us several warnings. First, there are a number of pathogens, most of which are viral, that pose potential risks to human health and we know quite little about them. Second, many of these ERI are zoonotic. Effective control of zoonoses needs involvement and collaboration from the non-health sector. Third, since these ERI can easily spread across geopolitical boundaries, countries with a good public health infrastructure are not risk-free and should not be complacent. Surveillance and response efforts cannot be limited within one national boundary. Fourth, aside from the fundamental tools in disease control that we have, e.g. basic sanitation, personal hygiene, isolation and quarantine, and the newly-revised International Health Regulations, we have little other choices, e.g. drugs and vaccines. This limitation suggests that we could eventually be defenseless. Fifth, recent occurrences of certain ERI in some countries have demonstrated that damages caused in non-health terms, e.g. economic losses, can be significant. As a consequence, ERI may be dealt with as an economic problem while the human and health dimensions are ignored. There are a number of guiding principles that we may have to adopt. First, no country can or is allowed to fight ERI alone, no matter how well-developed its economic condition and public health infrastructure. However, it should be noted that ERI is a national health security problem and that national sovereignty must be recognized when addressing the ERI issues. Second, ERI problems need a lot of non-health partners, e.g. business and agriculture. Third, we need to improve our capacity to do surveillance and to respond. Surveillance without response is pointless. Fourth, we need specific tools to help tackle ERI. Networking is a mechanism through which countries can work together to fight ERI. A number of forums exist to address the problems of ERI, e.g. meetings of WHO and other UN agencies including FAO⁄OIE, ASEAN+3, and ACMECS. In addition, several bilateral frameworks are in place to address ERI. However, it is important to note the particular nature of ERI and follow the above-mentioned guiding principles to avoid failure.

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