Assignment: Historical Epidemiological Events

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Week 1 discussion Discussion Part One Discuss one historical epidemiological event or accomplishment that has left an impact on healthcare as we know it. Clearly identify, describe, and define key points or people in the event or accomplishment. Discussion Part Two How might such an event have an impact on the goals and objectives of Healthy People 2020? Discussion Part Three Please provide a summary of the case or information you have discussed this week.

In response to the spread of Ebola virus disease in west Africa, global public health agencies have scrambled to organise teams to staunch the spiral of infections and have urged researchers in medical anthropology, disaster management, ethics, and other social science fields to formulate ideas for intervention as quickly as possible. The epidemic is by far the worst of the Ebola outbreaks on record that date back to 1976. Yet, it is only one of several deadly viral pathogens—such as yellow fever, dengue, and influenza—that have repeatedly scourged populations in west Africa. How do the past and present Ebola outbreaks compare with other viral epidemics? What efforts were made to contain previous outbreaks and how did these efforts fare? How did local populations respond to and interpret these interventions? How did they understand the causes of the outbreaks?

We do not have robust answers to all these questions. In part, this is because the subject area of historical epidemiology—on the cusp of the fields of the history of medicine and epidemiology—has been claimed by neither of these disciplines. Historians of medicine and public health have mostly paid scant attention to the historical study of viral disease control efforts and their epidemiological consequences. Most medical historians tend to focus their research efforts on the social history of disease in developed nations. Epidemiologists are deeply involved in the analysis of viral outbreaks, focusing principally on dynamic modelling. The twain rarely meet. One consequence is that physicians and public health specialists do not usually draw lessons from the historical record of disease control efforts. This can sometimes result in poor policy decisions.

The lack of integration of current health policy with the epidemiological past is not restricted to viral epidemics. Consider the case of malaria. In 2007, global health donors rushed to commit to a programme for the eradication of malaria. This commitment was not based upon an assessment of past experiences with malaria control and eradication. As a result, some experiences were repeated. Global donors deployed dichlorodiphenyltrichloroethane and other synthetic insecticides during the 21st century in west African regions where a similar array of insecticides had been deployed during the mid-20th century WHO-led Malaria Eradication Program. The synthetic insecticides once again produced resistance in the Anopheles mosquito vectors. The USA was the major funder for the Malaria Eradication Program, and after it reduced its contributions in the mid-1960s, the global campaign sputtered to a halt. A similarly eerie echo of the past is found in the financial vicissitudes that beset the contemporary global malaria campaign. The financial commitments pledged early in the 21st century are faltering largely because of the ongoing global economic recession that began in 2008. In the mid-20th century, the Malaria Eradication Program substantially reduced malaria mortality and morbidity, but in some areas, after the commitment to malaria control and eradication waned, malaria rebounded savagely. Echoing this experience, in the 21st century large successes have again been achieved in reducing the burden of malaria. But with declining resources, and without the creation of dedicated malaria control services in tropical Africa, it is possible that the experience of the vicious rebound of malaria, too, might be repeated in some places.

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