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ANTC68H3 Chapter Notes -Onchocerciasis, Cold Chain, Market System

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Week # 10: Surveillance, Eradication and Control: Successes and Failures William Foege
6 lessons that require examination on disease eradication and control
1st lesson is the absolute importance of problem definition we need to invest even more
o no substitute for knowledge
o think from the viewpoint of pathogenic agent
o be willing to do heroic things which will change from disease to disease but DO
o surveillance can be set up in a small amount of time but you should not rely on
this mode ALL THE TIME
o constant feedback necessary to tailor solutions to unique problems you come
across to have an effective measure put in place
Another part of the problem definition is the lesson learned wit the Epidemic Intelligence
Service program in the US
o Response to biological warfare
o Now we know a lot about polio, measles, hepatitis and diseae control problems in
the US
o Created a national network which has strengthened the public health system
There needs to be an urgent need of global colations, networks and partnerships
o WHO helped us combat polio, smallpox and guinea worm
o Don’t rely on WHO leadership, these diseases became priorities from colatiions
who put it on the world agenda
A useful approach to disease eradication or control is to change the question
Fourth, primacy of prevention which the primacy of vaccines
o Vaccine is of permanent value
o Need to get away from needles, syringes, towards oral, nebulizers,
o Get rid of cold chain and have a heat-stable vaccine
Fifth, there are some generic barriers
o Market system is a barrier to disease eradication and control
o Political will how to translate what we know into political action
o Social will Rotarians and Polio mobilize people!
Sixth the problem of leadership specifically the US leadership
o Smallpox, Polio, Onchocerciasis have been success stories
o However, the US has lost crediablitiy in terms of international health leadership
because we don’t pay our due to the WHO and we are seen as the world’s biggest
exporters of death and disease because of arms and tobacco
Some steps to better action
o Exploring ways of combining the marketplace and disease control needs
o We need a generic surveillance plan that can work for most and be modified as
per our needs
Traditional surveillance of antibiotic sensitivity
o Rapid diagnostic techniques
o Better Modelling techniques
o Inventory of all the systems we have now and ask how we can fill the gaps
o We need a global equivalent of Epidemic Investigation System program
o We need to exert pressure on our own political system to again have US
leadership in international health
The US should aim to restore its credibility as a leader in the global effort to plan a
rational health future
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