While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a (...) case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

Human encroachment on the habitats of wild animals and the dense living conditions of farmed animals increase spill-over risk of emerging infectious diseases from animals to humans (such as COVID-19). In this article, we defend two claims: First, we argue that in order to limit the risk of emerging infectious disease outbreaks in the future, a One Health approach is needed, which focuses on human, animal, and environmental health. Second, we claim that One Health should not solely be grounded (...) in collaborations between veterinary, medical, and environmental scientists, but should also involve more dialogue with animal and environmental ethicists. Such an interdisciplinary approach would result in epidemiology-driven measures that are ethically legitimate. (shrink)

This paper explores differences in national responses to foodborne disease outbreaks, addressing both the sources of policy divergence and their implications for public health and coordinated emergency response. It presents findings from a comparative study of two multi-state E. coli outbreaks, one in the United States and one in Germany, demonstrating important differences in how risk managers understood and responded to each nation’s first major outbreak associated with fresh produce. Drawing on a qualitative analysis of 36 semi-structured interviews (...) with key stakeholders and hundreds of archival documents, this paper traces how social constructions of the E. coli risk interacted with organizational dynamics among state and industry actors to produce divergent policy outcomes: the U.S. outbreak was understood primarily as an agricultural problem that led to an industry-led agricultural solution, whereas the German outbreak was understood as a human disease problem that did not result in a substantial policy response once the acute health crisis passed. The paper concludes by discussing how these policy processes generate partial solutions to foodborne contamination that expose modern societies to systemic vulnerabilities. (shrink)

Human and animal interests are often in conflict. In many situations, however, it is unclear how to evaluate and weigh competing human and animal interests, as the satisfaction of the interests of one group often inevitably occurs at the expense of those of the other group. Human-animal conflicts of this kind give rise to ethical questions. If animals count morally for their own sake, then we must ask in which cases the satisfaction or frustration of the interests of humans and (...) animals in conflict situations is justified or unjustified from an ethical perspective. In this article, we argue that limited aggregation accounts represent a promising means for resolving interspecies conflicts. The reason for this is that they can appropriately consider the qualitative relevance of interests, their relative importance to each other, and the number of individuals affected. For our argument, we start from the premise that animals count morally for their own sake, albeit to a lesser extent than humans. That is, we accept the view that animals may be used, for example, as a source of food or in animal research. However, as we will show, many basic interests of animals are sufficiently similar to human interests and can thus be compared to them. Hence, they ought to be aggregated in cases of conflict with human interests. We illustrate our account and its practical implications with the real-world example of a human-animal conflict during the outbreak of a zoonotic disease among farmed animals. We conclude that, in many cases, animal interests ought to be given more importance than they currently receive, which includes distributing the burdens and risks of farming practices more fairly. (shrink)

Guideline 20 of the updated International Ethics Guidelines for Health‐related Research Involving Humans (2016) by the Council for International Organizations of Medical Sciences (CIOMS) provides guidance on research in disasters and disease outbreaks against the background of the need to generate knowledge quickly, overcome practical impediments to implementing such research, and the need to maintain public trust. The guideline recommends that research ethics committees could pre‐screen study protocols to expedite ethical reviews in a situation of crisis, that pre‐arrangements be (...) made regarding data sharing and biomedical sample sharing, and that sponsors and research ethics committees seek to minimize risk to researchers conducting research during a disaster. This paper critiques these recommendations against the background of the findings of a survey of public health officials and chairs of research ethics committees in the Caribbean during 2016, which sought to determine the best template for the expeditious ethical review of research proposals in emergency and epidemic situations in the Caribbean, and whose findings can serve as a model for other low‐ and middle‐income countries. (shrink)

This article argues that outbreak preparedness and response should implement a ‘family presence’ policy for infected patients in isolation that includes the option of physical visits and care within the isolation facility under some conditions. While such a ‘physical family presence’ policy could increase infections during an outbreak and may raise moral dilemmas, we argue that it is ethically justified based on the least infringement principle and the need to minimize the harms and burdens of isolation as a (...) restrictive measure. Categorical prohibition of PFP during the course of an outbreak or epidemic is likely to result in unnecessary harms to patients and families, and violate values such as the moral commitments of families to care for each other. Supporting the option of PFP under particular circumstances, on the other hand, will least infringe these moral considerations. An additional reason for a family presence policy is that it may facilitate voluntary cooperation with isolation and other restrictive measures. We provide an analysis of these considerations for supporting modes of family presence during an outbreak emergency, before defending the riskier option of PFP in the isolation facility from plausible objections and concerns. (shrink)

The global public health threat posed by infectious disease is well recognised. The obligation to treat whilst exposed to risk, and its limits, is debated with each novel serious and communicable pathogen. Within national jurisdictions, different responses are forthcoming. Some, like France in 2009, give government the power to require healthcare staff to work, and even to requisition staff, including retired professionals. Others rely on notions of solidarity and professional duty, with scope for individual discretion. Our research with staff (...) in the West Midlands in 2008/2009– including non-professionals – suggested a strong correlation between feeling a duty to work and willingness to work during a pandemic. This was more influential than removing other barriers to working. Medical military personnel can already be ordered into risky situations. Our research in 2015/16 with those who worked in the Ebola treatment unit in Sierra Leone suggested that their concerns about risk were complex: the perceived magnitude of the risk was only one factor, even though tolerance was high. The type of risk and circumstances requiring that risk to be taken were also influential.Against this background, it will be argued, with caveats, that:military medical personnel should be willing to accept greater risk than civilian medical staff;and that to maintain national health services during a communicable disease emergency:civilian medical staff ought to accept greater risks than they currently appear willing to tolerate;conscription – from civilian or military populations – is permissible, even though it may elevate personal risk. (shrink)

The aim of the present paper is to explore whether seasonal outbreaks of infectious diseases may be linked to changes in host microbiomes. This is a very important issue, because one way to have more control over seasonal outbreaks is to understand the factors that underlie them. In this paper, I will evaluate the relevance of the microbiome as one of such factors. The paper is based on two pillars of reasoning. Firstly, on the idea that microbiomes play an important (...) role in their hosts’ defence against infectious diseases. Secondly, on the idea that microbiomes are not stable, but change seasonally. These two ideas are combined in order to argue that seasonal changes in a given microbiome may influence the functionality of the host's immune system and consequently make it easier for infectious agents to infect the host at certain times of year. I will argue that, while this is only a theoretical possibility, certain studies may back up such claims. Furthermore, I will show that this does not necessarily contradict other hypotheses aimed at explaining seasonal outbreaks; in fact, it may even enhance them. (shrink)

In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case‐by‐case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, (...) harm mitigation, exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case‐by‐case exemptions for individual patients. We propose a process for ethical decision‐making that provides a shared language and structure to decrease the risks and burdens of decision‐making when clinicians or managers are considering requests for exemptions. (shrink)

Immunization plays a crucial role in global health security, preventing public health emergencies of international concern and protecting individuals from infectious disease outbreaks, yet these critical public health benefits are dependent on immunization law. Where public health law has become central to preventing, detecting, and responding to infectious disease, public health law reform is seen as necessary to implement the Global Health Security Agenda. This article examines national immunization laws as a basis to implement the GHSA and promote (...) the public's health, analyzing the scope and content of these laws to prevent infectious disease across Sub-Saharan Africa. Undertaking policy surveillance of national immunization laws in 20 Sub-Saharan African countries, this study: developed a legal framework to map the legal attributes relevant to immunization; created an assessment tool to determine the presence of these attributes under national immunization law; and applied this assessment tool to code national legal landscapes. An analysis of these coded laws highlights legal attributes that govern vaccine requirements, supply chains, vaccine administration standards, and medicines quality and manufacturer liability. Based upon this international policy surveillance, it will be crucial to undertake legal epidemiology research across countries, examining the influence of immunization law on vaccination rates and disease outbreaks. (shrink)

Laws and policies are vital tools in preventing outbreaks and limiting the further spread of disease, but they can vary in content and implementation. This manuscript provides insight into challenges in responding to recent vaccine-preventable disease outbreaks by examining legislative changes in California, policy changes on certain university campuses, and the laws implicated in a measles outbreak in Minnesota.

Older adults prefer positive over negative information in a lab setting, compared to young adults. The extent to which OA avoid negative events or information relevant for their health and safety is not clear. We first investigated age differences in preferences for fear-enhancing vs. fear-reducing news articles during the Ebola Outbreak of 2014. We were able to collect data from 15 YA and 13 OA during this acute health event. Compared to YA, OA were more likely to read the (...) fear-enhancing article, select hand-sanitizer over lip balm, and reported greater fear of Ebola. We further investigated our research question during the COVID-19 pandemic with 164 YA and 171 OA. Participants responded to an online survey about the COVID-19 pandemic across 13 days during the initial peak of the pandemic in the United States. Both YA and OA preferred to read positive over negative news about the coronavirus, but OA were even more likely than YA to prefer the positive news article. No age differences in the fear of contraction were found, but OA engaged in more health-protective behaviors compared to YA. Although OA may not always report greater fear than YA or seek out negative information related to a health concern, they still engage in protective health behaviors. Thus, although positivity effects were observed in attention and emotional reports, OA still modified their behaviors more than YA, suggesting that positivity effects did not hamper OA ability to respond to a health crisis. (shrink)

Thresholds for disease extinction provide essential information for the prevention and control of diseases. In this paper, a stochastic epidemic model, a continuous-time Markov chain, for the transmission dynamics of West Nile virus in birds is developed based on the assumptions of its analogous deterministic model. The branching process is applied to derive the extinction threshold for the stochastic model and conditions for disease extinction or persistence. The probability of disease extinction computed from the branching process is (...) shown to be in good agreement with the probability approximated from numerical simulations. The disease dynamics of both models are compared to ascertain the effect of demographic stochasticity on West Nile virus dynamics. Analytical and numerical results show differences in model predictions and asymptotic dynamics between stochastic and deterministic models that are crucial for the prevention of disease outbreaks. It is found that there is a high probability of disease extinction if the disease emerges from exposed mosquitoes unlike if it emerges from infectious mosquitoes and birds. Finite-time to disease extinction is estimated using sample paths and it is shown that the epidemic duration is shortest if the disease is introduced by exposed mosquitoes. (shrink)

Since the outbreak of coronavirus disease 2019 in China, people have been exposed to a flood of media news related to the pandemic every day. Studies have shown that media news about public crisis events have a significant impact on individuals' depression. However, how and when the duration of attention to pandemic news predicts depression still remains an open question. This study established a moderated mediating model to investigate the relationship between the duration of attention to pandemic news (...) and depression, the mediating effect of risk perception, and the moderating effect of future time perspective on the relationship. In early February 2020, 701 individuals from 29 provinces, autonomous regions, and municipalities across China were asked to self-report their duration of attention to pandemic news, level of depression, risk perception, and future time perspective during the COVID-19 outbreak. Results show that there is a significant positive correlation between the duration of attention to news on COVID-19 and depression; risk perception mediates the association between the duration of attention to pandemic news and depression; and future time perspective plays a moderating role between risk perception and depression. The findings of the present study provide theoretical implications and practically throw some light on alleviating the public's depression during pandemic periods. We highlight that the individual's hope for a better future, focusing on positive news, and time perspective balance during an epidemic disease are also beneficial to promoting positive emotion and reducing depression. (shrink)

Infectious disease outbreaks in residential care are complex to manage and difficult to control. Research in this setting that includes individuals who lack capacity must conform to national legislation. We report here on our study that is investigating outbreaks of scabies, an itchy skin infection, in the residential care setting in the southeast of England. There appears to be a gap in legislative advice regarding the inclusion of people who lack capacity in research that takes place during time-limited acute (...) scenarios such as outbreaks. We received inconsistent advice from experts regarding, in particular, the role of nominated consultees. There is a potential inequality for vulnerable populations who cannot themselves provide informed consent in terms of their access to participation in a range of health-related research. (shrink)

This study investigates the effect of inclusive leadership on innovation performance with a mediating role of employee innovation behavior and the moderating role of psychological empowerment. Supervisors and employees of Saudi manufacturing firms are the participants of this study. This study used a quantitative research technique with a cross-sectional approach and a self-administrative survey questionnaire to collect the data. The data were analyzed by using the Smart PLS 3 software. The results depict that inclusive leadership has a significant positive impact (...) on the firm’s innovation performance. Employees’ innovation behavior has a significant mediating effect on the association of inclusive leadership and innovation performance. Findings revealed that PE has an important moderating role in the association of inclusive leadership and innovation performance. The findings of this study contribute to the body of knowledge by finding that inclusive leadership has a significant effect on the firm’s innovative performance and PE is crucial to enhance innovation performance. (shrink)

The interaction of humans, cholera bacteria, the zooplankton host of the bacterium , and the environment in the case of cholera can be employed to make reasonable predictions about this climate-driven disease. The issues are truly international and represent those that comprise a global scientific enterprise and encompass many other infectious diseases.

Surveillance is essential for communicable disease prevention and control. Traditional notification of demographic and clinical information, about individuals with selected infectious diseases, allows appropriate public health action and is protected by public health and privacy legislation, but is slow and insensitive. Big data–based electronic surveillance, by commercial bodies and government agencies, which draws on a plethora of internet- and mobile device–based sources, has been widely accepted, if not universally welcomed. Similar anonymous digital sources also contain syndromic information, which can (...) be analysed, using customised algorithms, to rapidly predict infectious disease outbreaks, but the data are nonspecific and predictions sometimes misleading. However, public health authorities could use these online sources, in combination with de-identified personal health data, to provide more accurate and earlier warning of infectious disease events—including exotic or emerging infections—even before the cause is confirmed, and allow more timely public health intervention. Achieving optimal benefits would require access to selected data from personal electronic health and laboratory records and the potential to re-identify individuals found to be involved in outbreaks, to ensure appropriate care and infection control. Despite existing widespread digital surveillance and major potential community benefits of extending its use to communicable disease control, there is considerable public disquiet about allowing public health authorities access to personal health data. Informed public discussion, greater transparency and an ethical framework will be essential to build public trust in the use of new technology for communicable disease control. (shrink)

Research represents an essential component of the response to infectious disease outbreaks and to other public health emergencies, whether they are localised, of international concern, or global. Research conducted in such contexts also comes with particular ethics challenges, the awareness of which has significantly grown following the Ebola outbreak in West Africa, the Zika outbreak in Latin America and the COVID-19 pandemic. These challenges include the need for implementing meaningful community engagement with the researched communities, not just (...) to build unidirectional trust towards the research team, but to achieve a genuine and mutually respectful partnership before, during and after the research. Here, we describe the real-life experience of 10 well-established research clinics in Nairobi, where a successful experience of community engagement linking prevention and care to research was interrupted during the COVID19 pandemic. We contrast this experience with the concept and processes of community engagement as described in selected scientific manuscripts and guidelines, to formulate some conclusions and recommendations. We contend that more action is needed, from research ethics committees and other key-research stakeholders, to align policies and practices with ethics guidance and with evidence-based recommendations from the academic literature, to achieve meaningful community engagement during emergency research, irrespective of the scale and location of an outbreak or public health crisis. Failure to do so, will aggravate the (postcolonial) asymmetries of power in global health and local systems. (shrink)

Ensuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, researchers and other concerned stakeholders also have to carefully balance time and resources allocated to immediate treatment and control activities, with an approach that integrates research as part of the outbreak response. Under such (...) circumstances, research “ethics preparedness” constitutes an important foundation for an effective response to infectious disease outbreaks and other health emergencies. A two-day workshop was convened in March 2018 by the World Health Organisation Global Health Ethics Team and the African coaLition for Epidemic Research, Response and Training, with representatives of National Ethics Committees, to identify practical processes and procedures related to ethics review preparedness. The workshop considered five areas where work might be undertaken to facilitate rapid and sound ethics review: preparing national ethics committees for outbreak response; pre-review of protocols; multi-country review; coordination between national ethics committees and other key stakeholders; data and benefit sharing; and export of samples to third countries. In this paper, we present the recommendations that resulted from the workshop. In particular, the participants recommended that Ethics Committees would develop a formal national standard operating procedure for emergency response ethical review; that there is a need to clarify the terminology and expectations of pre-review of generic protocols and agree upon specific terminology; that there is a need to explore mechanisms for multi-country emergency ethical consultation, and to establish procedures for communication between national ethics committees and other oversight bodies and public health authorities. In addition, it was suggested that ethics committees should request from researchers, at a minimum, a preliminary data sharing and sample sharing plan that outlines the benefit to the population from which data and samples are to be drawn. This should be followed in due time by a full plan. It is hoped that the national ethics committees, supported by the WHO, relevant collaborative research consortia and external funding agencies, will work towards bringing these recommendations into practice, for supporting the conduct of effective research during outbreaks. (shrink)

In 2016, following pandemic influenza threats and the 2014–2016 Ebola virus disease outbreaks, the WHO developed a guidance document for managing ethical issues in infectious disease outbreaks. In this article, we analyse some ethical issues that have had a predominant role in decision making in response to the current COVID-19 pandemic but were absent or not addressed in the same ways in the 2016 guidance document. A pandemic results in a health crisis and social and political crises both (...) nationally and globally. The ethical implications of these global effects should be properly identified so that appropriate actions can be taken globally and not just in national isolation. Our analysis, which is a starting point to test the broader relevance of the 2016 WHO document that remains the only available guidance document applicable globally, concludes that the WHO guidance should be updated to provide reasoned and thoughtful comprehensive ethics advice for the sound management of the current and future pandemics. (shrink)

Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. -/- We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived (...) risk of infection—holding fixed other considerations such as vaccine confidence and convenience. (shrink)

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth, have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their (...) experience of developing PTG.Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.Results: We found resilience to have a significant impact on PTG. Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development. (shrink)

As the recent Ebola outbreak demonstrates, visibility is central to the shaping of political, medical, and socioeconomic decisions. The symposium in this issue of the Journal of Bioethical Inquiry explores the uneasy relationship between the necessity of making diseases visible, the mechanisms of legal and visual censorship, and the overall ethics of viewing and spectatorship, including the effects of media visibility on the perception of particular “marked” bodies. Scholarship across the disciplines of communication, anthropology, gender studies, and visual studies, (...) as well as a photographer’s visual essay and memorial reflection, throw light on various strategies of visualization and legitimation and link these to broader socioeconomic concerns. Questions of the ethics of spectatorship, such as how to evoke empathy in the representation of individuals’ suffering without perpetuating social and economic inequalities, are explored in individual, national, and global contexts, demonstrating how disease visibility intersects with a complex nexus of health, sexuality, and global/national politics. A sensible management of visibility—an “ecology of the visible”—can be productive of more viable ways of individual and collective engagement with those who suffer. (shrink)

The study aimed to understand how coping strategies in general and humor-based coping strategies in particular modulate the perception of pandemic-related stress in a sample of Italian healthcare workers during the coronavirus disease outbreak in Italy. A total of 625 healthcare workers anonymously and voluntarily completed a 10-min questionnaire, which included psychometrically valid measurements preceded by a set of questions aimed at determining workers’ exposure to COVID-19. The Perceived Stress Scale was used to measure healthcare workers’ stress levels, (...) and the Brief COPE Scale and Coping Humor Scale were used to assess participants’ avoidant or approach coping style and verify the degree to which they relied on humor to cope with stress. The results show that levels of perceived stress were higher in healthcare workers who were more exposed to COVID-19 in comparison to less-exposed workers; participants who reported a higher use of avoidant coping strategies perceived the situation as more stressful than those who used them less; and healthcare workers who reported higher use of humor-based coping strategies perceived the situation as less stressful in comparison with those who reported less use of coping humor. Such findings expanded other research studies by including coping humor as a potential factor to mitigate the perceived stress related to COVID-19. The paper concludes with a discussion of implications for future research and limitations of the study. (shrink)

Seasonal outbreaks have several different periods that occur primarily during winter in temperate regions, while influenza may occur throughout the year in tropical regions, triggering outbreaks more irregularly. Similarly, dengue occurs in the star of the rainy season in early May and reaches its peak in late June. Dengue and flu brought an impact on various countries in the years 2017–2019 and streaming Twitter data reveals the status of dengue and flu outbreaks in the most affected regions. This research work (...) presents that Social Media Analysis can be used as a detector of the epidemic outbreak and to understand the sentiment of social media users regarding various diseases. Providing awareness about seasonal outbreaks through SMA is an effective approach for researchers and healthcare responders to detect the early outbreaks. The proposed model aims to find the sentiment about the disease in tweets, and the seasonal outbreaks-related tweets are classified into two classes as disease positive and disease negative. This work proposes a machine-learning-based approach to detect dengue and flu outbreaks in social media platform Twitter, using four machine learning algorithms: Random Forest, K-Nearest Neighbor, Support Vector Machine, and Decision Tree, with the help of Term Frequency and Inverse Document Frequency. For experimental analysis, two datasets are analyzed individually. The experimental results show that the RF classifier has outperformed the comparison models in terms of improved accuracy, precision, recall, F1-measure, and Receiver Operating Characteristic curve. The proposed work offers favorable performance with total precision, accuracy, recall, and F1-measure ranging from 84% to 88% for conventional machine learning techniques. (shrink)

The highly contagious 2019 novel coronavirus disease (COVID-19) outbreak has not only impacted health systems, economies, and governments, it has also rapidly grown into a global health crisis, which is now threatening the lives of millions of people globally. While, on one hand, medical institutions are critically attempting to find a cure, on the other hand, governments have introduced striking measures and policies to curtail the rapid spread of the disease. Although COVID-19 has achieved pandemic status and (...) is predominantly viewed as a biomedical issue, it is argued that it should also be treated as a psychological crisis. This paper also reviews the literature to examine and comment on the detrimental effects of isolation, which has been enforced as one of the primary preventative measures to manage the spread of COVID-19. This paper further outlines key recommendations that should be addressed across different levels to buffer against the known adverse effects of isolation, which is especially relevant for the current COVID-19 situation, where a large proportion of the global population is isolated, confined, and/or quarantined. (shrink)

Neglected diseases are severe conditions that mainly affect the world's poorest people. Those suffering from neglected diseases are mostly suffering from tropical infections that have failed to receive priority in pharmaceutical research and development programs, as well as in public health policies aimed at improving availability and access to preventive, diagnostic and curative medicine. The World Health Organization has issued a number of documents directing attention to the plight affecting one third of the world's population, assisted by active support from (...) private organizations, notably the Bill and Melissa Gates Foundation, but the overall situation remains dismal. In the wake of major socioeconomic processes including globalization, steadily growing economic disparity, healthcare inequality, the instability created by rogue states and terrorism, as well as massive migration, and epidemic outbreaks, the features of neglected diseases have been changing. Neglected populations affected by tropical diseases are suffering increasingly from non-infectious degenerative conditions and disabilities due to untreated chronic maladies. Pockets of poverty and neglect can also be detected in high-income countries, contributing to the emergence of new diseases and the reemergence of infections believed to be disappearing such as tuberculosis and the measles. Included in the issues of neglect are rare diseases, mostly of genetic origin, affecting a small number of patients that suffer from multiple life-shortening functional impairment and organ defects. Effective medicines are extremely expensive, allegedly because research and development of appropriate drugs is resources and time consuming, requiring exorbitant prices to recoup investment from a small number of consumers. Bioethics has been tardy in addressing the suffering and destitution of neglected and rare diseases. Convinced that permanently repeated denunciations blunt the sensitivity towards suffering, whereas statistics are bloodless and unable to elicit commitment, this book attempts to explore a different strategy. In an upstream approach, bioethics needs to engage in ethnographic fieldwork that confronts and shares the context in which people suffer, vividly presenting what epidemiological research has blunted into statistical data. Additionally, a downstream approach is suggested, requiring bioethics to vigorously and openly denounce unethical biomedical and pharmaceutical research, misdeeds in registration and marketing of drugs, and misalignment of policies with the unmet healthcare needs of the destitute. More than being critical observers, bioethicists ought to shed lurking conflicts of interests and seek active participation in planning research and public healthcare practices aimed at improving the lives of medically neglected populations. (shrink)

Vietnam, with a geographical proximity and a high volume of trade with China, was the first country to record an outbreak of the new Coronavirus disease (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-CoV-2. While the country was expected to have a high risk of transmission, as of April 4, 2020—in comparison to attempts to contain the disease around the world—responses from Vietnam are being seen as prompt and effective in protecting the interests (...) of its citizens, with 239 confirmed cases and no fatalities. This study analyzes the situation in terms of Vietnam’s policy response, social media and science journalism. A self-made web crawl engine was used to scan and collect official media news related to COVID-19 between the beginning of January and April 4, yielding a comprehensive dataset of 14,952 news items. The findings shed light on how Vietnam—despite being under-resourced—has demonstrated political readiness to combat the emerging pandemic since the earliest days. Timely communication on any developments of the outbreak from the government and the media, combined with up-to-date research on the new virus by the Vietnamese science community, have altogether provided reliable sources of information. By emphasizing the need for immediate and genuine cooperation between government, civil society and private individuals, the case study offers valuable lessons for other nations concerning not only the concurrent fight against the COVID-19 pandemic but also the overall responses to a public health crisis. (shrink)

A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases (EIDs) in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary (...) approaches to EID decision-making—which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice. (shrink)

BackgroundPsychological resilience may reduce the impact of psychological distress to some extent. We aimed to investigate the mental health status of the public during the outbreak of coronavirus disease 2019 and explore the level and related factors of anxiety and depression.MethodsFrom February 8 to March 9, 2020, 3,180 public completed the Zung’s Self-Rating Anxiety Scale for anxiety, Zung’s Self-Rating Depression Scale for depression, the Connor–Davidson resilience scale for psychological resilience, and the Simplified Coping Style Questionnaire for the attitudes (...) and coping styles.ResultsThe number of people with depressive symptoms was 1,303. The number of people with anxiety symptoms was 1,184. The depressed group and anxiety group had less education, more unmarried and younger age, as well as had significant different in SDS total score, SAS total score, CD-RISC total score, and SCSQ score. The binary logistic regression showed that female, strength, and the subscales of active coping style in SCSQ remained protective factors and passive coping style and higher SAS score were risk factors for depression. Optimism in CD-RISC was a protective factor, and passive coping styles and higher SDS score were risk factors for anxiety.LimitationsThis study adopted a cross-sectional design and used self-report questionnaires.ConclusionThe mental health of the public, especially females, the younger and less educational populations, and unmarried individuals, should be given more attention. Individuals with high level of mental resilience and active coping styles would have lower levels of anxiety and depression during the outbreak of COVID-19. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has had profound effects on all aspects of society. Families were among those directly impacted by the first measures imposed by health authorities worldwide to contain the spread of the Sars-CoV-2 virus, where social distancing and mandatory quarantine were the main approaches implemented. Notably, little is yet known about how social distancing during COVID-19 has altered families' daily routines, particularly regarding music-related behaviors. The aim of this study was 2-fold: (i) to explore changes (...) in families' daily routine and caregivers' levels of well-being and stress during the COVID-19 outbreak in Brazil and (ii) to investigate whether musical behaviors of caregivers and the children under their care (aged from 3 to 6 years old) changed during social distancing. One hundred and eighty-eight caregivers residing in Brazil participated in an online cross-sectional study conducted between July and August 2020. Our findings suggest significant changes in families' dynamics during the COVID-19 outbreak, with parents (especially mothers) spending more time on childcare and a substantial decrease in caregiver's well-being. Regarding music-related behaviors, our results revealed considerable changes in caregivers' and children's musical activities at home during social distancing, including an increase in child-only musical behaviors and shared caregiver-child activities. Moreover, sociodemographic factors such as caregiver background and well-being as well as the child's disability status significantly influenced musical engagement at home during social distancing. This study captured some features of the home musical environment of middle-class families in Brazil in the first stages of social distancing restrictions during the pandemic and caregivers' role in providing an environment where musical experiences are nurtured. Further research is needed to better understand aspects such as the long-term impact of the changes of musical behaviors at home on musical parenting and families' well-being. (shrink)

This paper is about an avian influenza outbreak in South Africa’s commercial ostrich industry. The outbreak was managed according to international best practice and led to the destruction of 30,000 ostriches in two of South Africa’s provinces. However, the industry has a long history of managing low pathogenic avian influenza outbreaks in a different way. We use the 2004 outbreak and earlier approaches to managing disease to shed light on recent debates on how we might live (...) differently with livestock diseases. The paper is based on in-depth interviews with farmers, veterinarians, scientists and agriculture officials. (shrink)

Cognitive biases play an important role in creating and perpetuating problems that lead to foodborne illness outbreaks. By using insights from behavioral ethics, we argue that sometimes people engage in unethical behavior that increases the likelihood of foodborne illness outbreaks without necessarily intending to or being consciously aware of it. We demonstrate these insights in an analysis of the 2011 Listeriosis outbreak in the U.S. from the consumption of contaminated cantaloupes. We then provide policy implications that can improve our (...) understanding of other kinds of disease outbreaks and epidemics. (shrink)

This article outlines aconceptual framework for examining recentoutbreaks of E. coli O157:H7 infectionassociated with the consumption of beef in theUnited States. We argue that beef produced inthis country is generally safer frombacteriological contamination than in the past.Paradoxically, increasing intensification andconcentration in the meat subsector since theearly 1980s has (a) altered agro-food ecology,including characteristics of foodborne bacteriaand human physiology; (b) created conditionsfavorable for the rapid amplification of lowconcentrations of pathogens; and (c) reducedthe beef industry's flexibility to introducechanges necessary to preclude and/or (...) controlthe rapid spread of pathogens in meat and meatproducts. As a result, beef industry currentlyis capable of producing large quantities ofbacteriologically safe meat whilesimultaneously becoming more vulnerable to foodcontaminations that can be fatal in some cases.The limitations and effectiveness of a newregulatory regime, the HACCP (Hazard Analysisand Critical Control Points) system as well asother efforts to decontaminate the beef supplyare discussed. (shrink)

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive (...) and symptomatic; negative; and untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

Ever since the outbreak of the coronavirus disease, people have been flooded with vast amounts of information related to the virus and its social consequences. This paper draws on social amplification theory and the extended parallel process model and assesses the following: how two amplification stations—news media and peoples’ personal networks—influence the risk-related perceptions of people and how these risk-related perceptions impact people’s health-protective behaviors. This study surveyed 1,946 participants. The results indicate that peoples’ exposure to news media (...) significantly and positively predicted both perceived efficacy and perceived threat. It also shows that peoples’ exposure to risk-related information through their personal networks negatively predicted their perceived efficacy, but it positively predicted their perceived threat. The mediating effect of fear was examined, and the result was contradictory to the EPPM. In short, this study reveals the underlying mechanism of individuals’ exposure to risk information, processing, and precautionary measures. (shrink)

Fairchild, Center for the History and Ethics of Public Health in the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health Abstract Surveillance is a cornerstone of public health. It permits us to recognize disease outbreaks, to track the incidence and prevalence of threats to public health, and to monitor the effectiveness of our interventions. But surveillance also challenges our understandings of the significance and role of privacy in a liberal democracy. In this paper we trace (...) the century-long history of public health surveillance in the United States situating that history in the context of the broad social, political, and ideological forces that have shaped our conceptions of privacy. Although we focus here on the United States, the debates over privacy that unfolded in the 1960s were repeated in many European nations. The themes we explore here, then, provide a framework for examining the relationship between privacy and public health in other contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

Prior to the outbreak of the coronavirus disease 2019 pandemic, the churches in Nigeria contended with Bokoharam insurgency which mainly affected the churches in Northern Nigeria. However, COVID-19 affected various churches in all the nooks and crannies of the country. It brought about obvious changes in numerous practices of churches in Nigeria. Long-standing traditions of churches such as solemnisation of Holy Matrimony, Holy Communion, baptism, prayer and sharing of peace have been modified or suspended. Whilst this article appreciates (...) the efforts of the federal and state governments, it investigates the implications of COVID-19 outbreak on traditional religious practices of churches in Nigeria. It also examines the responses of churches towards controlling the pandemic. The phenomenological method is used to analyse the data collected from both primary and secondary sources. Findings from this work indicate that COVID-19 outbreak is a challenge to the purpose of the institution 'church'.CONTRIBUTION: The article investigated and examined the changes which churches made in their doctrine and liturgy with respect to the outbreak of COVID-19 in Nigeria. It discovered that many traditions of the church have been modified or suspended as a way of curtailing the spread of the virus. (shrink)

For at least the past 15 years, food safety stakeholders across all levels of government have recognized the critical role that state and local agencies play in our nation's food safety system. State and local agencies are the first responders to foodborne outbreaks and have primary responsibility for keeping their residents safe from foodborne disease through effective surveillance and rapid response to outbreaks. They also conduct the vast majority of food safety inspections across the nation's restaurants, grocery stores, and (...) other food service and food retail establishments.Recent efforts among industry and government officials alike have focused on creating a more integrated, prevention-oriented food safety system. The Food Safety Modernization Act, the first major overhaul of the nation's food safety laws since the 1930s, now mandates that most sectors of the food industry put preventive controls in place, changing the emphasis of what the FDA does from response to prevention. (shrink)

BackgroundNurses provide the majority of health-care services and face numerous health challenges during an epidemic. During the COVID-19 epidemic, nurses are subjected to physical, mental, and social disorders that impair their quality of life and hardiness. Therefore, it is important to be aware of the situation of nurses. The current study aimed to compare the compassion satisfaction, compassion fatigue and hardiness among nurses before and during the COVID-19 outbreak.Materials and MethodsThis cross-sectional study included 508 clinical nurses from one public (...) hospital in southern Iran. The subjects were recruited using census sampling methods in 2019–2020. Sampling was performed before and during the COVID-19 with a 1-year interval. Although, the study setting was the same before and during the COVID-19, questionnaires were completed by different nurses before and during the COVID-19. Demographic questionnaire, professional quality of life questionnaire and Occupational Hardiness Questionnaire were used to collect data.ResultsThe scores of compassion satisfaction, compassion fatigue and hardiness did not differ significantly during the COVID-19 compared with before the COVID-19. Before COVID-19, hardiness and work experience predicted 11% of the variance of compassion satisfaction, whereas during COVID-19, hardiness and gender predicted 26% of the variance of compassion satisfaction. Before COVID-19, hardiness and work experience predicted 3% of the variance of compassion fatigue, whereas during COVID-19, hardiness, type of employment and gender predicted 6% of the variance of compassion fatigue.ConclusionThe current study found that compassion satisfaction, compassion fatigue and hardiness did not change during the COVID-19 outbreak compared with before the COVID-19 outbreak. However, during the COVID-19, the hardiness was a significant predictor of compassion satisfaction and compassion fatigue. The study results showed that it was possible to increase the compassion satisfaction and reduce the compassion fatigue by strengthening the hardiness of nurses. However, these results need to be considered in future studies, especially in crises such as COVID-19 disease. (shrink)

BackgroundHow do the police officers perceive health risk, psychological distress, and work stress during the COVID-19 outbreak in China? This study explores the health risk perception, work stress, and psychological distress of police officers who worked at the front line to implement lockdown measures.Materials and MethodsWe conducted a large-scale field survey with police officers sample in the northwestern part of China from February 29 to March 7, 2020. Independent-sample T-test and ANOVA were used to analyze whether there are differences (...) in health risk perception, work stress, and psychological distress between different groups. The regression analysis was employed to figure out the factors that influence police officers’ psychological distress.ResultsResults showed a gender difference in perceiving work stress among police officers. Also, police officers with chronic disease perceived higher health risks, more psychological distress, and higher work stress. Additionally, police officers above 45 years old significantly perceived higher health risks than young officers did. It also revealed that working hours contribute to police officers’ health risk perception, psychological distress, and work stress. Finally, our results highlight that age, working hours, chronic disease, health risk perception, and work stress significantly contribute to police officers’ psychological distress.ConclusionOur research verifies that there is a gender difference in perceiving work stress among police officers. Police officers with ongoing medical issues and above 45 years old suffer more during the COVID-19 outbreak in China. Our research suggests that the government should pay more attention to their physical health and mental health. The heavy workload containing the COVID-19 extends police officers’ working hours, causing higher health risks, work stress, and psychological distress. This study contributes to the psychological distress literature and provides a way forward to other countries struggling to contain the COVID-19. (shrink)

The exponential accumulation, processing and accrual of big data in healthcare are only possible through an equally rapidly evolving field of big data analytics. The latter offers the capacity to rationalize, understand and use big data to serve many different purposes, from improved services modelling to prediction of treatment outcomes, to greater patient and disease stratification. In the area of infectious diseases, the application of big data analytics has introduced a number of changes in the information accumulation models. These (...) are discussed by comparing the traditional and new models of data accumulation. Big data analytics is fast becoming a crucial component for the modelling of transmission—aiding infection control measures and policies—emergency response analyses required during local or international outbreaks. However, the application of big data analytics in infectious diseases is coupled with a number of ethical impacts. Four key areas are discussed in this paper: automation and algorithmic reliance impacting freedom of choice, big data analytics complexity impacting informed consent, reliance on profiling impacting individual and group identities and justice/fair access and increased surveillance and population intervention capabilities impacting behavioural norms and practices. Furthermore, the extension of big data analytics to include information derived from personal devices, such as mobile phones and wearables as part of infectious disease frameworks in the near future and their potential ethical impacts are discussed. Considered together, the need for a constructive and transparent inclusion of ethical questioning in this rapidly evolving field becomes an increasing necessity in order to provide a moral foundation for the societal acceptance and responsible development of the technological advancement. (shrink)

The current COVID-19 pandemic and the previous SARS/MERS outbreaks of 2003 and 2012 have resulted in a series of major global public health crises. We argue that in the interest of developing effective and safe vaccines and drugs and to better understand coronaviruses and associated disease mechenisms it is necessary to integrate the large and exponentially growing body of heterogeneous coronavirus data. Ontologies play an important role in standard-based knowledge and data representation, integration, sharing, and analysis. Accordingly, we initiated (...) the development of the community-based Coronavirus Infectious Disease Ontology in early 2020. -/- As an Open Biomedical Ontology (OBO) library ontology, CIDO is open source and interoperable with other existing OBO ontologies. CIDO is aligned with the Basic Formal Ontology and Viral Infectious Disease Ontology. CIDO has imported terms from over 30 OBO ontologies. For example, CIDO imports all SARS-CoV-2 protein terms from the Protein Ontology, COVID-19-related phenotype terms from the Human Phenotype Ontology, and over 100 COVID-19 terms for vaccines (both authorized and in clinical trial) from the Vaccine Ontology. CIDO systematically represents variants of SARS-CoV-2 viruses and over 300 amino acid substitutions therein, along with over 300 diagnostic kits and methods. CIDO also describes hundreds of host-coronavirus protein-protein interactions (PPIs) and the drugs that target proteins in these PPIs. CIDO has been used to model COVID-19 related phenomena in areas such as epidemiology. The scope of CIDO was evaluated by visual analysis supported by a summarization network method. CIDO has been used in various applications such as term standardization, inference, natural language processing (NLP) and clinical data integration. We have applied the amino acid variant knowledge present in CIDO to analyze differences between SARS-CoV-2 Delta and Omicron variants. CIDO's integrative host-coronavirus PPIs and drug-target knowledge has also been used to support drug repurposing for COVID-19 treatment. -/- CIDO represents entities and relations in the domain of coronavirus diseases with a special focus on COVID-19. It supports shared knowledge representation, data and metadata standardization and integration, and has been used in a range of applications. (shrink)

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities (...) in New South Wales, Australia to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health researchusing this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected. (shrink)

It is necessary to study the various dimensions of health and their affecting factors during the coronavirus disease-19 pandemic to identify the necessary interventions. The study aims to determine the relationship between spiritual health and happiness in medical students during the COVID-19 outbreak. In this analytical cross-sectional design study, 409 medical students were examined for the state of happiness and spiritual health and the relationship between them. Student information was collected through Web-based sampling by using standard tools from (...) 20 April to 20 June 2020. Medical students completed the demographic questionnaire as well as Oxford Happiness Questionnaire and Paloutzian and Ellison spiritual health questionnaire. The results showed that while the score of spiritual health and happiness was related to factors such as marriage, interest in a field of study, and socioeconomic status, the relationship between spiritual health and happiness was significant. This study showed that students’ happiness scores were not optimal during the COVID-19 pandemic. Due to the strong relationship between spiritual health and happiness scores, spiritual health promotion, in conjunction with other interventions, can be used to improve happiness in this group. (shrink)

The emotion of disgust is suggested to be an adaptation that evolved to keep us away from sources of infection. Therefore, individuals from populations with greater pathogen stress should have a greater disgust sensitivity. However, current evidence for a positive relationship between disgust sensitivity and the intensity of infectious diseases in the environment is limited. We tested whether disgust and contamination sensitivity changed in response to the COVID-19 pandemic. Disgust was assessed in 984 women in 2017 and 633 women in (...) 2020 by a set of photographs depicting sources of infection and Pathogen and Moral of Three-Domain Disgust Scale. Further, contamination sensitivity among participants in two waves was measured by Contamination Obsessions and Washing Compulsions Subscale of Padua Inventory. State anxiety was measured with the Polish adaptation of the State-Trait Anxiety Inventory only during the second wave of data collection. Women from the COVID-19 pandemic group assessed the photographs depicting sources of infection as more disgusting, scoring higher on Padua Inventory, but lower on Moral Disgust Domain as compared to women from before the pandemic. In addition, anxiety levels during pandemic positively correlated with scores from Pathogen Disgust Domain, Padua Inventory, and the ratings of the photographs. The participants of the study scored higher in state anxiety than the norms determined for the Polish population. Summarizing, we present evidence for differences in individual levels of disgust sensitivity in relation to pathogen stress, supporting the idea that disgust evolved to serve as protection from pathogens. (shrink)

During the course of the COVID-19 pandemic, a wide range of digital technologies and data analytics have been incorporated into pandemic response models globally, in the hope of better detecting, tracking, monitoring and containing outbreaks. This increased digital involvement in disease control has offered the prospect of heightened effectiveness in all of the above, but not without raising other concerns. This paper contributes to ongoing discussions of the digital transformation in disease control by proposing a materialist analysis of (...) how such control has become operative and what its effects may be, both now and in the future. Using Taiwan's digital pandemic response as a case study, the paper explores specific ways in which material processes and arrangements have shaped digital measures, as well as the actions that rendered such measures operable, with their ensuing consequences. This analysis illustrates the importance of historical, material and technological specificities and contingencies to our understanding of how digital disease control takes a particular shape. It also demonstrates how shifting regimes of practice continually reconfigure the ways in which digital disease control functions. The paper argues that paying greater attention to the materialities of digital disease control can provide a more nuanced understanding of the complex ways in which society may be protected or harmed by its use, possibly simultaneously. It is hoped that such increased attentiveness may inform more considered and careful preparation for subsequent pandemics. (shrink)

Pandemic plans recommend phases of response to an emergent infectious disease outbreak, and are primarily aimed at preventing and mitigating human-to-human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization. The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. (...) As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks. (shrink)