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Global Health Security Global Health Security and Roles of Citiesand Roles of Cities

Dr Shigeru OmiDr Shigeru Omi

Regional DirectorRegional Director

World Health OrganizationWorld Health Organization

Western Pacific Regional OfficeWestern Pacific Regional Office

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History of disease and civilizationHistory of disease and civilizationPeriodPeriod EventEvent DiseaseDisease PlacePlace

PrehistoryPrehistory Human beings lived as Human beings lived as hunters and gatherers of foodhunters and gatherers of foodNo major communicable No major communicable diseasesdiseases

11stst WaveWave(5000 (5000 ––2500 years ago)2500 years ago)

HunterHunter--gatherers gatherers ‘‘settledsettled’’ into into agrarian villagesagrarian villages

Smallpox, measles, Smallpox, measles, chickenpox,tuberculosis chickenpox,tuberculosis Sumeria, EgyptSumeria, Egypt

22ndnd WaveWave(2500(2500--700 years ago)700 years ago)

Contact between different Contact between different civilizations (through trade civilizations (through trade and travel )and travel )

Smallpox, measles Smallpox, measles From Europe to Asia via the From Europe to Asia via the Silk RoadSilk Road

““Black DeathBlack Death”” /bubonic /bubonic plagueplague

Started in Europe in the 6Started in Europe in the 6ththcenturycentury

33rdrd WaveWave(700 years ago and (700 years ago and onwards)onwards)

TransTrans--oceanic movement of oceanic movement of seafarersseafarers

Smallpox, measles, Smallpox, measles, influenza, typhusinfluenza, typhus

To America from Europe To America from Europe (destroyed 90% of the (destroyed 90% of the population)population)

SyphilisSyphilis To Europe from AmericaTo Europe from America

Malaria, yellow fever Malaria, yellow fever To Europe from AfricaTo Europe from Africa

44thth Wave Wave ?? ?? ?? ??(McMicheal, A.J., Human frontiers, environments and diseasesCambridge University Press, 2001)

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1. Globalization1. Globalization The flow of people, goods and The flow of people, goods and information is unprecedentedinformation is unprecedented

2. Urbanization2. Urbanization TThere are more than 20 megacities here are more than 20 megacities today today

3. Consumerism3. Consumerism Consumption has become an end Consumption has become an end in itselfin itself

4. Demographic changes 4. Demographic changes Society is ageing Society is ageing

Characteristics of civilization todayCharacteristics of civilization today

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Emergence of new infectious diseasesEmergence of new infectious diseases

•• Most are zoonosesMost are zoonoses

•• Globally, an Globally, an average of one new average of one new infectious disease infectious disease has emerged each has emerged each year.year.

HIV 1 1983HIV 2 1985Enterocytozoon Bieneusi 1985Human Herpesvirus 6 (HHV 6) 1986Hepatitis C virus 1989Hepatitis E virus 1990Guanarito Virus 1991Barmah Forest Virus 1992Bartonella henselae 1992Sin Nombre Hantavirus 1993Cyclospora cayatenensis 1994Sabia Virus 1994Hendra Virus 1994Human Herpesvirus 8 1994Lyssavirus (in Australia) 1996Nipah Virus 1996New Variant CJD 1996Influenza A(H5N1) 1997West Nile Virus (in US) 1999SARS CoV 2003Monkeypox (in US) 2003

55

WHO has verified more than 1800 events between January 2001 and Dec 2007

66

Current concern about Current concern about potential influenza potential influenza

pandemicpandemic

7777

88

The way in which people live The way in which people live with and handle poultry in Asiawith and handle poultry in Asia

99

1010

1111

Influenza pandemics in 20th centuryInfluenza pandemics in 20th century

A(H1N1) A(H2N2) A(H3N2)

1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”

40-50 million deaths 1-4 million deaths 1-4 million deaths

1212

H5N1 viruses H5N1 viruses eevolve rapidlyvolve rapidly

Distinct geneDistinct genettic ic groups have been groups have been identifed.identifed.Different clades and Different clades and subclades have subclades have been circulating in been circulating in different parts of the different parts of the worldworld

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1.1. Outbreak of H5N1 in migratory birds Outbreak of H5N1 in migratory birds in Qinghai province, Chinain Qinghai province, China

Over 6,000 migratory birds died in May and June 2005 in Qinghai Lake. This event was unprecedented –significant mortality in wild birds is very unusual

Naqu, TibetNaqu, Tibet

YushuYushu GuolouGuolou

2.2. Optimum temperature of growthOptimum temperature of growth

Serious Condition of H1N1Serious Condition of H1N1

出典：PLoS Pathog. 2007 October; 3(10): e133.

• Seasonal epidemic viruses (human to human transmission) replicatemost efficiently at 33℃.

• H5N1 replicates most efficiently at37 ℃.

• A recent study points out thatsome H5N1 viruses now canreplicate at 33℃

1414

0

5

10

15

20

2503

-Nov

Dec

04-J

anFe

bM

ar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

05-J

anFe

bM

ar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

06-J

anFe

bM

ar Apr

May

June July

Aug

Sep

Oct

Nov

Dec

07-J

anFe

bM

ar Apr

May Jun

July

Aug

Sep

Oct

Nov

Dec

08-J

anFe

bM

ar Apr

May

Date of onset

No.

of c

ases

0

10

20

30

40

50

60

70

80

90

100

CFR

(%)

Viet Nam (N=105)* Thailand (N=25) Cambodia (N=7) Indonesia (N=120)*China (N=30) Azerbaijan (N=5)* Egypt (N=32)* Turkey (N=11)*Iraq (N=2)* Nigeria (N=0)* Pakistan (N=3) Myanmar (N=1)Djibouti (N=1) Lao PDR (N=2) Bangladesh(N=1) CFR Trend**

Human Avian Influenza A (H5N1) Cases by Onset Human Avian Influenza A (H5N1) Cases by Onset Date and Country (n=347) (as of 19 June 2008)Date and Country (n=347) (as of 19 June 2008)

As of 19 June 2008, total of 385 cases were reported officially to WHO* Cases missing onset date are excluded:

1 Viet Nam, 13 Indonesia, 3 Azerbaijan, 18 Egypt, 1 Turkey, 1 Iraq, 1 Nigeria ** CFR Trend: computed based on cumulative dead & total

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Spread of 1918 Pandemic in USASpread of 1918 Pandemic in USA

Spread of 1918 Influenza Pandemic in USA

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Strategy: Pandemic PreparednessStrategy: Pandemic Preparedness

NonNon--Medical Medical interventionsinterventions

MedicalMedicalIntervenInterven--

tionstions

Security Security Food & water supplyFood & water supplyPower supplyPower supplyTransportation Transportation TelecommunicationTelecommunicationOther essential servicesOther essential services

Personal hygienePersonal hygieneTravel restrictionTravel restrictionQuarantine Quarantine Social distancing Social distancing Risk Communication Risk Communication

Antiviral drugsAntiviral drugsVaccines, etcVaccines, etcMedical care, PPEMedical care, PPE

Social ServicesSocial Services(keep a society running)

Public Health Measures

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1918 Death Rates: Philadelphia v St. Louis

0

2000

4000

6000

8000

10000

12000

14000

16000

1918

-09-14

1918

-09-21

1918

-09-28

1918

-10-05

1918

-10-12

1918

-10-19

1918

-10-26

1918

-11-02

1918

-11-09

1918

-11-16

1918

-11-23

1918

-11-30

1918

-12-07

1918

-12-14

1918

-12-21

1918

-12-28

Date

Dea

ths

Rat

es /

100,

000

Popu

latio

n (A

nnua

l Bas

is)

PhiladelphiaSt. Louis

Weekly mortality data provided by Marc Lipsitch

1818

TimeTime Check !Check !

1919

2. Increasing burden of 2. Increasing burden of noncommunicable diseasenoncommunicable disease

0

2

4

6

8

10

12

2000 2010 2020 2030

Year

Pro

ject

ed g

loba

l dea

ths

(mill

ions

)

Malaria

Cancers

HIV/AIDS

Road traffic accidents

TB

IHD

Stroke

Other infectious

2020

AFR EMR EURSEAR WPR AMR

Noncommunicableconditions

InjuriesInjuries

25

50

75%

Heavy burden of NCD compared Heavy burden of NCD compared to other conditionsto other conditions

DALY = Disability-Adjusted Life YearSource: World Health Report, 1999

Communicable diseases, maternal and perinatal conditions and nutritional deficiencies

2121

Causes of chronic diseasesCauses of chronic diseases

2222

Outcome of risk reductionOutcome of risk reduction

HealthyHealthy diet, regular physical activity diet, regular physical activity and avoidance of tobaccoand avoidance of tobacco

Could avoidCould avoid 80% of CVD, 80% of CVD, DDM M and 40% of cancersand 40% of cancers..

2323

0

5

10

15

20

25

30

1993-1997 1998-2002

?Death rate Per 100,000

2424

Suicide Death rate

Per 100,000

0

5

10

15

20

25

30

1993-1997 1998-2002

2525

Lack of connectedness

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DENGUE CASES & TEMPERATURE, SINGAPORE, 1989 - 2006

9441733 2179

2878

946 12392008

31284300

5258

1355673

2372

39454788

9459

14209

3126

26.9

27.6

27.427.3

27.4

27.6 27.627.5

28.3 28.3

27.7

27.527.6

28.1

27.76 27.8

28.2

27.5

0

2000

4000

6000

8000

10000

12000

14000

16000

89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

YEAR

NO. O

F CA

SES

26

26.5

27

27.5

28

28.5

DEG

. CEL

CIUS

CasesTemperatureLinear (Temperature)

(e-w k 10)

Dengue cases 1989Dengue cases 1989--20062006

2727

2828

History of disease and civilizationHistory of disease and civilizationPeriodPeriod EventEvent DiseaseDisease PlacePlace

PrehistoryPrehistory Human beings lived as Human beings lived as hunters and gatherers of foodhunters and gatherers of foodNo major communicable No major communicable diseasesdiseases

11stst WaveWave HunterHunter--gatherers gatherers ‘‘settledsettled’’ into into agrarian villagesagrarian villagesSmallpox, measles, Smallpox, measles, chickenpox,tuberculosis chickenpox,tuberculosis Sumeria, EgyptSumeria, Egypt

22ndnd WaveWave Contact between different Contact between different civilizationscivilizationsSmallpox, measles Smallpox, measles fromfrom Europe to AsiEurope to Asiaa

““Black DeathBlack Death”” Europe in the 6Europe in the 6thth centurycentury

33rdrd WaveWave TransTrans--oceanic movement of oceanic movement of seafarersseafarers

Smallpox, measles,Smallpox, measles, etcetc To America from EuropeTo America from Europe

SyphilisSyphilis To Europe from AmericaTo Europe from America

Malaria, yellow fever Malaria, yellow fever To Europe from AfricaTo Europe from Africa

44thth Wave Wave

GlobalizationGlobalizationUrbanizationUrbanizationConsumerismConsumerismDemographic Demographic changeschanges

Noncommunicable Noncommunicable diseasesdiseasescommunicable communicable diseasesdiseasesIncreasing Increasing environmental health environmental health risksrisks

All over the All over the worldworld

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To what extent are human beings To what extent are human beings responsible for diseases?responsible for diseases?

PastPast NowNow

％％

００

100100

Industrial Industrial RevolutionRevolution

3030

Key message:Key message:

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１．１．Be innovative in technology and Be innovative in technology and policy development; and policy development; and live responsibly with nature live responsibly with nature Change the ways in which humans coChange the ways in which humans co--exist with other exist with other speciesspecies

Proactively identify, report and contain threats to public Proactively identify, report and contain threats to public health securityhealth security

Maintain a healthy lifestyleMaintain a healthy lifestyle

Build supportive environments conducive to healthBuild supportive environments conducive to health

Promote policies which enable us to use cleaner and Promote policies which enable us to use cleaner and greener technologiesgreener technologies

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２．２．Be agents for change by establishing Be agents for change by establishing ““newnew”” connectedness in societyconnectedness in society

Build up a “common forum” which includes representatives of civil society, the older persons, scholars, NGOs, private companies and public organizations and capitalize on the decentralization movement and higher education of citizens to influence local and national conditions.

Discuss issues based on longDiscuss issues based on long--term visionterm vision

Take up various issues which are being neglected by Take up various issues which are being neglected by existing institutions/mechanismsexisting institutions/mechanisms

Share the sense of social responsibilityShare the sense of social responsibility

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