Financial influence on global risks of zoonotic emerging and re-emerging diseases: an integrative analysis.

BACKGROUND: Emerging and re-emerging infectious diseases (EIDs), such as Ebola virus disease and highly pathogenic influenza, are serious threats to human health and wellbeing worldwide. The financial sector has an important, yet often ignored, influence as owners and investors in industries that are associated with anthropogenic land-use changes in ecosystems linked to increased EIDs risks. We aimed to analyse financial influence associated with EIDs risks that are affected by anthropogenic land-use changes. We also aimed to provide empirical assessments of such influence to help guide engagements by governments, private organisations, and non-governmental organisations with the financial sector to advance a planetary health agenda. METHODS: For this integrative analysis, we identified regions in the world where there was evidence of a connection between EIDs and anthropogenic land-use changes between Nov 9, 1999, and Oct 25, 2021, through a targeted literature review of academic literature and grey literature to identify evidence of drivers of anthropogenic land-use change and their association with commodity production in these regions. We only included publications in English that showed a connection between deforestation and the production of one or more commodities. Publications merely describing spatial or temporal land-use change dynamics (eg, a reduction of forest or an increase of palm-oil plantations) were excluded. As we were assessing financial influence on corporate activities through ownership specifically, we focused our analysis on publicly listed companies. Equity data and data about ownership structure were extracted from Orbis, a company information database. We assessed financial influence by identifying financial entities with the largest equity ownership, descriptively mapping transboundary connections between investors and publicly listed companies. FINDINGS: 227 public and private companies operating in five economic sectors (ie, production of palm oil, pulp and wood products, cocoa, soybeans, and beef) between Dec 15, 2020, and March 8, 2021, were identified. Of these 227, 99 (44%) were publicly listed companies, with 2310 unique shareholders. These publicly listed companies operated in six geographical regions, resulting in nine case-study regions. 54 (55%) companies with complete geographical information were included in the countries network. Four financial entities (ie, Dimensional, Vanguard, BlackRock, and Norway's sovereign wealth fund) each had ownership in 39 companies or more in three of the case-study regions (ie, north America, east Asia, and Europe). Four large US-based asset managers (ie, Vanguard, BlackRock, T Rowe Price, and State Street) were the largest owners of publicly listed companies in terms of total equity size, with ownership amounts for these four entities ranging from US$8 billion to $21 billion. The specific patterns of cross-national ownership depended on the region of interest; for example, financial influence on EIDs risks that was associated with commodity production in southeast and east Asia came from not only global asset managers but also Malaysian, Chinese, Japanese, and Korean financial entities. India, Brazil, the USA, Mexico, and Argentina were the countries towards which investments were most directed. INTERPRETATION: Although commodity supply chains and financial markets are highly globalised, a small number of investors and countries could be viewed as disproportionally influential in sectors that increase EIDs risks. Such financial influence could be used to develop and implement effective policies to reduce ecological degradation and mitigate EIDs risks and their effects on population health. FUNDING: Formas and Networks of Financial Rupture-how cascading changes in the climate and ecosystems could impact on the financial sector.

Lumpy skin disease, an emerging transboundary viral disease: A review.

Lumpy skin disease is an emerging bovine viral disease, which is endemic in most African countries and some Middle East ones, and the elevated risk of the spread of disease into the rest of Asia and Europe should be considered. The recent rapid spread of disease in currently disease-free countries indicates the importance of understanding the limitations and routes of distribution. The causative agent, Capripoxvirus, can also induce sheeppox and goatpox. The economic significance of these diseases is of great concern, given that they threaten international trade and could be used as economic bioterrorism agents. The distribution of capripoxviruses seems to be expanding due to limited access to effective vaccines and poverty within farming communities. This is largely due to the economic effects of the Covid-19 pandemic and the imposition of crippling sanctions in endemic regions, as well as an increase in the legal and illegal trade of live animals and animal products, and also global climate change. The present review is designed to provide existing information on the various aspects of the disease such as its clinicopathology, transmission, epidemiology, diagnosis, prevention and control measures, and the potential role of wildlife in the further spread of disease.

Consequences of Pathogen Lists: Why Some Diseases May Continue to Plague Us.

The current strategy used by many funding agencies for determining how money is spent on research to help prevent infectious disease outbreaks is based on pathogen-specific priority lists. Listing disease threats provides focus for business and research planning conducive to specific goals of developing a drug, or a vaccine, or other particular product. But, this singular type of focus has consequences. This perspective explores the consequences of lists, and describes how parallel programming independent of disease lists that address what we need to do to prevent and mitigate emerging disease risks may provide benefits out of reach of a singular focus on what products we need to have.

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review.

BACKGROUND: The emergence and re-emergence of vector-borne and other infectious diseases of poverty pose a threat to the health of populations living in urban and low-income settings. A detailed understanding of intervention strategies, including effectiveness of past outbreak containment, is necessary to improve future practices. The objective was to determine what is known about the effectiveness of containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings and identify research gaps and implications for public health practice. MAIN BODY: We conducted a scoping review and systematically searched peer-reviewed and grey literature published between 2000 and 2016. Different data extraction tools were used for data coding and extraction, and data on implementation process and transferability were extracted from all studies. A quality assessment was conducted for each included study. We screened 205 full-text articles and reports for a total of 31 articles included in the review. The quality of the studies was generally low to moderate. The largest body of evidence concerned control activities for Ebola virus and dengue fever. The majority of interventions (87%) relied on multiple types of measures, which were grouped into four categories: 1) healthcare provision; 2) epidemiological investigation and/or surveillance; 3) environmental or sanitary interventions; and 4) community-based interventions. The quality of the majority of studies (90%) was poor or moderate, and one-third of the studies did not provide a clear description of the outcomes and of the procedures and/or tools used for the intervention. CONCLUSIONS: Our results highlight the difficulty of establishing causation when assessing the effect of containment measures. Studies that extend beyond solely reporting on effectiveness and take into account the complexity of real-world settings are urgently needed. We recommend the allocation of research efforts to the evaluation of the implementation processes of interventions as well as their comprehensive and systematic description using validated checklists.

Economic cost of lumpy skin disease outbreaks in three Balkan countries: Albania, Bulgaria and the Former Yugoslav Republic of Macedonia (2016-2017).

Lumpy skin disease (LSD) is an emerging viral disease that was detected for the first time in the Balkan Peninsula in Greece in 2015. In April 2016, there was a reoccurrence in Greece and the spread of the disease for the first time into Bulgaria, the Former Yugoslav Republic of Macedonia, Serbia, Kosovo, Albania and Montenegro. The veterinary services of the countries responded with different strategies to control the disease, mostly based on mass vaccination campaigns and diverse stamping out approaches. During 2017, the epidemic was mostly controlled except for outbreaks reported in Albania, Greece and the Former Yugoslav Republic of Macedonia. The study aims to quantify the cost of disease and control measures in three selected Balkan countries, that is, Albania, Bulgaria and the Former Yugoslav Republic of Macedonia, which were differently affected by the disease, had different animal production structures and implemented different control strategies. The total cost for the three countries was 20.9 million Euro (EUR 20.9 m), mostly incurred in 2016 (EUR 16.6 m), when the disease was spreading throughout the Balkan region. In 2017 (data until October), the cost was EUR 4.0 m, mainly due to vaccination costs. Bulgaria was the country with the highest total cost at EUR 8.6 m, followed by the Former Yugoslav Republic of Macedonia (EUR 6.7 m) and Albania (EUR 5.3 m). According to our data, the average cost per affected herd in 2016 was EUR 869, EUR 6,994 and EUR 3,071 in Albania, Bulgaria and the Former Yugoslav Republic of Macedonia, respectively. The cost per animal in the affected herds was EUR 539, 147 and 258, respectively. The results from this study are useful to understand the cost of LSD outbreaks in the region, which might contribute to improve the surveillance and control of the disease.

The Threat and Response to Infectious Diseases (Revised).

The threat from microorganisms is complex, and the approaches for reducing the challenges the world is facing are also multifaceted, but a combination approach including several simple steps can make a difference and reduce morbidity and mortality and the economic cost of fighting infectious diseases. This paper discusses the continually evolving infectious disease landscape, contributing factors in the rise of the threat, reasons for optimism, and the policies, technologies, actions, and institutions that might be harnessed to further reduce the dangers introduced by pathogens. It builds upon and updates the work of other authors that have recognized the dangers of emerging and re-emerging pathogens and have explored and documented potential solutions.

Vaccinia Virus Natural Infections in Brazil: The Good, the Bad, and the Ugly.

The orthopoxviruses (OPV) comprise several emerging viruses with great importance to human and veterinary medicine, including vaccinia virus (VACV), which causes outbreaks of bovine vaccinia (BV) in South America. Historically, VACV is the most comprehensively studied virus, however, its origin and natural hosts remain unknown. VACV was the primary component of the smallpox vaccine, largely used during the smallpox eradication campaign. After smallpox was declared eradicated, the vaccination that conferred immunity to OPV was discontinued, favoring a new contingent of susceptible individuals to OPV. VACV infections occur naturally after direct contact with infected dairy cattle, in recently vaccinated individuals, or through alternative routes of exposure. In Brazil, VACV outbreaks are frequently reported in rural areas, affecting mainly farm animals and humans. Recent studies have shown the role of wildlife in the VACV transmission chain, exploring the role of wild rodents as reservoirs that facilitate VACV spread throughout rural areas. Furthermore, VACV circulation in urban environments and the significance of this with respect to public health, have also been explored. In this review, we discuss the history, epidemiological, ecological and clinical aspects of natural VACV infections in Brazil, also highlighting alternative routes of VACV transmission, the factors involved in susceptibility to infection, and the natural history of the disease in humans and animals, and the potential for dissemination to urban environments.

West Africa 2013 Ebola: From Virus Outbreak to Humanitarian Crisis.

The 2013 outbreak of Ebola virus disease (EVD) in West Africa constituted a major humanitarian crisis. The outbreak numbered over 28,500 cases, more than 10 times the number cumulatively registered from all previous EVD outbreaks combined, with at least 11,000 deaths, and resulted in billions of dollars of lost economic growth to an already impoverished region. The unprecedented scale of West Africa 2013 took the world by surprise and laid bare deficiencies in our response capacity to complex humanitarian disasters of highly infectious and lethal pathogens. However, the magnitude of West Africa 2013 also provided a unique opportunity and obligation to better understand not only the biology and epidemiology of EVD, but also the many scientific, economic, social, political, ethical, and logistical challenges in confronting emerging infectious diseases in the modern era.

Where to next with animal health in Latin America? The transition from endemic to disease-free status.

The Latin American and Caribbean region (LAC) is a leading global producer and exporter of animal products. Its livestock production systems are diverse, ranging from large-scale commercial enterprises to family farms. Countries in this region have sought to improve their animal health status through both public and private efforts. Despite significant advances in eradicating such diseases as foot and mouth disease and classical swine fever, other animal health challenges remain; constraining exports, causing negative economic impacts and threatening food security. Obtaining certification of disease-free status is only the first step towards gaining benefits from improvements in animal health. Increasing international trade means that countries must manage the sustainability of their disease-free status in conjunction with trade partners and must comply with additional food safety and animal welfare standards. This paper comments on the challenges created by this new scenario in relation to the epidemiology and economics of animal health, when seeking to improve decisionmaking for animal health management. The authors characterise the current LAC livestock landscape and animal health situation, describing transitions in disease control and the use of economics in improving animal health. They conclude with remarks on the challenges presented by decision-making, economic rationality, sources of benefits, distribution and incentives.

La région Amérique latine et Caraïbes est l'une des principales régions productrices et exportatrices de produits d'origine animale dans le monde. Les systèmes de production du secteur de l'élevage y sont très diversifiés, depuis les petites exploitations familiales jusqu'aux élevages commerciaux à grande échelle. Les pays de la région ont cherché à améliorer la situation de la santé animale sur leur territoire en y consacrant les efforts de leur secteur public et privé. Malgré les avancées considérables réalisées dans l'éradication de maladies comme la fièvre aphteuse et la peste porcine classique, la santé animale est encore confrontée à des problèmes qui freinent les exportations et ont un impact économique négatif, tout en menaçant la sécurité de l'approvisionnement alimentaire. La reconnaissance officielle du statut indemne de maladie ne représente qu'une première étape dans le processus visant à générer des bénéfices grâce à une meilleure santé animale. L'intensification des échanges internationaux impose aux pays de s'assurer de la durabilité de leur statut indemne aux côtés de leurs partenaires commerciaux et de respecter de nouvelles normes relatives à la sécurité sanitaire des aliments et au bien-être animal. Les auteurs analysent les conséquences de ce scénario sur l'épidémiologie et l'économie de la santé animale ainsi que ses enjeux dans la recherche d'une meilleure prise de décisions dans la gestion de la santé animale. Ils définissent ensuite le paysage actuel de l'élevage et la situation de la santé animale en Amérique latine et dans les Caraïbes et décrivent les évolutions à l'oeuvre en matière de lutte contre les maladies animales et d'utilisation de l'économie dans l'amélioration de la santé animale. Ils concluent sur quelques remarques concernant les difficultés qui se présentent en matière de prise de décision, de rationalité économique, de sources de profit, de distribution et d'incitation.

La región de América Latina y el Caribe es uno de los principales productores y exportadores de productos animales del mundo. Sus sistemas de producción ganadera exhiben gran heterogeneidad, pues van desde las grandes empresas de dimensión industrial hasta las pequeñas explotaciones familiares. Apoyándose en la iniciativa tanto pública como privada, los países de la región vienen tratando de mejorar su situación zoosanitaria. Pese a los importantes progresos registrados en la erradicación de enfermedades como la fiebre aftosa o la peste porcina clásica, subsisten otros problemas de sanidad animal que restringen las exportaciones, lastran la economía y amenazan la seguridad alimentaria. La certificación de «ausencia de enfermedad¼ es solo el primer paso para beneficiarse de las mejoras conseguidas en el terreno de la sanidad animal. Habida cuenta de la intensificación del comercio internacional, los países deben gestionar la continuidad a largo plazo de su estatuto de «libres de enfermedad¼ conjuntamente con sus socios comerciales y, para ello, cumplir normas adicionales en material de inocuidad de los alimentos y bienestar animal. Los autores exponen las dificultades que se plantean en esta nueva coyuntura de la epidemiología y la economía de la sanidad animal a la hora de mejorar los procesos decisorios en materia de gestión zoosanitaria. Tras caracterizar el actual paisaje de la ganadería y la situación zoosanitaria en América Latina y el Caribe, describen la transición que se está operando en cuanto al control de enfermedades y al uso de la economía para mejorar la sanidad animal y concluyen con una serie de observaciones sobre los problemas que surgen en relación con la adopción de decisiones, la racionalidad económica, las fuentes de beneficios y las cuestiones ligadas a la distribución y los incentivos.

Economic assessment of an emerging disease: the case of Schmallenberg virus in France.

Schmallenberg virus (SBV) was first detected in 2011 in Germany and then in France in 2012. This study simulates the production of different ruminant systems in France and estimates, through partial budget analyses, the economic cost of SBV at the farm level, under two disease scenarios (a high-impact and low-impact scenario). A partial budget is used to evaluate the financial effect of incremental changes, and includes only resources or production that will be changed. In the high-impact scenario, the estimated impact of SBV ranged from €23 to €43 per cow per year and €19 to €37 per ewe per year. In the low-impact scenario, it was approximately half (for cows) or one-third (for ewes) of this amount. These financial impacts represent 0.6% to 63% of the gross margin, depending on the chosen scenario and the livestock system being considered. The impacts of SBV come mainly from: the extra costs from purchasing and raising replacement heifers and losses in milk production (dairy cows); the losses in calf or lamb production (beef systems and meat sheep); and the losses in milk production and from unsold replacement lambs (dairy sheep). The use of integrated production and economic models enabled the authors to estimate the cost of SBV and to tackle the problem of scarce data, which is a difficulty for most emerging diseases, by their very nature. It also allowed the authors to develop an accurate disease impact assessment for several production systems, over a short time span. Extrapolating from this economic assessment to predict the scenario in coming years depends on the immunity period of the disease and the length of the production cycles.

Le virus de Schmallenberg a été détecté pour la première fois en 2011 en Allemagne, puis en France en 2012. Les auteurs présentent une étude de simulation de plusieurs systèmes de production de ruminants en France, dont l'objectif était d'estimer, à partir d'analyses budgétaires partielles, les coûts économiques du virus de Schmallenberg à l'échelle des exploitations, sous deux scénarios différents (hypothèses d'un fort impact et d'un faible impact de la maladie, respectivement). Une analyse budgétaire partielle sert à évaluer les conséquences financières d'un changement graduel et ne prend en compte que les modifications effectives en termes de ressources et de production. Dans l'hypothèse d'un impact fort de la maladie, l'impact annuel estimé du virus de Schmallenberg variait de 23 à 43 euros par vache et de 19 à 37 euros par brebis. Dans l'hypothèse d'un impact faible, l'impact annuel était deux fois moindre chez les vaches et trois fois moindre chez les brebis que dans la première hypothèse. Ces impacts financiers représentent 0,6 % à 63 % de la marge brute en fonction du scénario choisi et du système de production. Les impacts du virus de Schmallenberg découlent principalement des coûts supplémentaires induits par l'achat et le maintien de génisses de remplacement et d'une baisse de la production de lait (vaches laitières), des pertes de veaux ou d'agneaux (bovins et ovins de boucherie), d'une baisse de la production de lait et du coût des agnelles de remplacement invendues (brebis laitières). L'utilisation de modèles intégrant les aspects économiques et les données de production a permis aux auteurs d'estimer le coût du virus de Schmallenberg malgré la pénurie de données, s'attaquant ainsi à une difficulté inhérente à la plupart des maladies émergentes. Cela leur a également permis d'effectuer une évaluation précise de l'impact sanitaire dans plusieurs systèmes de production, sur une durée courte. La possibilité d'extrapoler à partir de cette évaluation économique un scénario pour les années à venir dépend de la période d'immunité vis-à-vis de la maladie et de la durée des cycles de production.

El virus de Schmallenberg fue detectado por primera vez en 2011 en Alemania y ulteriormente en 2012 en Francia. Los autores describen un estudio en el que se simularon distintos sistemas de producción de rumiantes en Francia y se estimó, con análisis presupuestarios parciales, el coste económico que entrañaría para una explotación el virus de Schmallenberg en dos hipotéticas situaciones sanitarias (una situación con efectos profundos y otra con efectos leves). El análisis presupuestario parcial sirve para evaluar los efectos económicos de cambios graduales, e incluye únicamente aquellos recursos y aspectos de la producción que experimentarán cambios. En la hipótesis de efectos profundos, el impacto estimado de la infección por el virus de Schmallenberg oscilaba entre 23 y 43 euros anuales por vaca y entre 19 y 37 euros anuales por oveja hembra. La hipótesis de efectos leves deparaba importes de aproximadamente la mitad (en el caso de las vacas) o un tercio (en el de las ovejas). Este impacto económico representa del 0,6% al 63% del margen bruto, dependiendo de la hipótesis elegida y del sistema productivo de que se trate. Los efectos de la infección por el virus de Schmallenberg se concretan básicamente en: los costos suplementarios derivados de adquirir y criar vaquillas de sustitución y de obtener una menor producción de leche (vacas lecheras); las pérdidas de terneros o corderos (sistemas de bovino u ovino cárnicos); y los costos derivados de la menor producción de leche y de no vender las corderas de sustitución (ovejas lecheras). El uso de modelos que integran los factores productivos y económicos sirvió a los autores para estimar el costo del virus de Schmallenberg a pesar de la escasez de datos, que, por la propia naturaleza de las enfermedades emergentes, es una dificultad común a la mayoría de ellas. También les permitió evaluar con exactitud el impacto de la enfermedad en distintos sistemas productivos en un breve lapso de tiempo. La realización de extrapolaciones a partir de esta evaluación económica para pronosticar la situación en años venideros depende del periodo de inmunidad respecto de la enfermedad y de la duración de los ciclos productivos.

Economics for assisting policy-makers to take decisions about new and endemic diseases.

Animal health policy-makers are frequently faced with making decisions concerning the control and exclusion of diseases in livestock and wildlife populations. Economics is one of the tools they have to aid their decision-making. It can enable them to make objective decisions based on the expected costs and benefits of their policy. In addition, economics can help them determine both the distribution impact and the indirect impact of their decisions. However, economics is only one of many tools available to policy-makers, who also need to consider non-economic outcomes in their decision-making process. While there are sophisticated epidemic and economic (epinomic) models that are available to help evaluate complex problems, these models typically require extensive data and well-trained analysts to run and interpret their results. In addition, effective communication between analysts and policy-makers is important to ensure that results are clearly conveyed to the policy-makers. This may be facilitated by early and continued discussions between these two potentially disparate groups. If successfully performed and communicated, economic analyses may present valuable information to policy-makers, enabling them to not only better understand the economic implications of their policy, but also to communicate the policy to relevant stakeholders, further ensuring their likelihood of participating in the planned policy and hence increasing its likelihood of success.

Les responsables des politiques de santé animale sont souvent confrontés à la nécessité de prendre des décisions au sujet de la lutte à mener contre les maladies animales affectant les populations domestiques et sauvages ou de leur éradication. L'économie est l'un des outils d'aide à la décision à leur disposition. L'économie peut les aider à prendre des décisions objectives basées sur les coûts et les avantages attendus des politiques envisagées. Elle peut aussi les aider à déterminer l'impact de leurs décisions en termes de portée et d'effets indirects. Néanmoins, l'économie n'est qu'un des nombreux outils disponibles et les décideurs doivent également intégrer les résultats non économiques lors de leur processus décisionnel. Un certain nombre de modèles épidémiques et économiques (« épinomiques ¼) sophistiqués permettent d'évaluer des problèmes complexes ; ils nécessitent cependant un volume considérable de données ainsi que des analystes qualifiés pour les mettre en oeuvre et en interpréter les résultats. En outre, une communication efficace doit être mise en place entre les analystes et les décideurs afin de s'assurer que les résultats obtenus sont rapportés à ces derniers dans un langage clair. Ceci peut être facilité par des échanges précoces et permanents entre ces deux groupes potentiellement hétérogènes. Des analyses économiques bien réalisées et faisant l'objet d'une bonne communication fournissent aux décideurs des informations de qualité grâce auxquelles ils peuvent appréhender plus clairement les conséquences économiques de leurs politiques, mais aussi expliquer ces politiques aux principales parties prenantes, ce qui accroît la probabilité de les faire adhérer aux mesures planifiées et améliore d'autant les chances de succès.

Los planificadores de políticas zoosanitarias se ven con frecuencia en la tesitura de adoptar decisiones acerca del control y la exclusión de enfermedades en poblaciones de ganado o de animales salvajes. La economía es una de las herramientas en las que pueden apoyarse para ello, pues les ayuda a tomar decisiones objetivas basándose en los costos y beneficios previstos de determinada política. Además, la economía puede serles útil para determinar tanto el impacto distributivo como el impacto indirecto de sus decisiones. Sin embargo, la economía es solo una de las muchas herramientas de que disponen los planificadores, que en su proceso decisorio también deben tener en cuenta efectos de carácter no económico. Si bien para ayudarles a aprehender problemas complejos existen sofisticados modelos epidemiológicos y económicos (epinómicos), estos suelen requerir un gran número de datos, así como el concurso de analistas cualificados para aplicar los modelos e interpretar sus resultados. Asimismo, para que los resultados obtenidos por los analistas lleguen con claridad a los planificadores es importante que existan cauces eficaces de comunicación entre los primeros y los segundos, lo que puede verse facilitado si estos dos grupos, en potencia tan dispares, dialogan desde buen comienzo y de forma continua. Si se llevan a cabo y se comunican correctamente, los análisis económicos pueden ofrecer información útil a los planificadores, que les sirva no solo para aprehender mejor las consecuencias económicas de sus políticas, sino también para explicar determinada política a todos los interlocutores del sector, con lo cual estos serán más proclives a participar en dicha política y esta tendrá más probabilidades de éxito.

An economic evaluation of vector control in the age of a dengue vaccine.

INTRODUCTION: Dengue is a rapidly emerging vector-borne Neglected Tropical Disease, with a 30-fold increase in the number of cases reported since 1960. The economic cost of the illness is measured in the billions of dollars annually. Environmental change and unplanned urbanization are conspiring to raise the health and economic cost even further beyond the reach of health systems and households. The health-sector response has depended in large part on control of the Aedes aegypti and Ae. albopictus (mosquito) vectors. The cost-effectiveness of the first-ever dengue vaccine remains to be evaluated in the field. In this paper, we examine how it might affect the cost-effectiveness of sustained vector control. METHODS: We employ a dynamic Markov model of the effects of vector control on dengue in both vectors and humans over a 15-year period, in six countries: Brazil, Columbia, Malaysia, Mexico, the Philippines, and Thailand. We evaluate the cost (direct medical costs and control programme costs) and cost-effectiveness of sustained vector control, outbreak response and/or medical case management, in the presence of a (hypothetical) highly targeted and low cost immunization strategy using a (non-hypothetical) medium-efficacy vaccine. RESULTS: Sustained vector control using existing technologies would cost little more than outbreak response, given the associated costs of medical case management. If sustained use of existing or upcoming technologies (of similar price) reduce vector populations by 70-90%, the cost per disability-adjusted life year averted is 2013 US$ 679-1331 (best estimates) relative to no intervention. Sustained vector control could be highly cost-effective even with less effective technologies (50-70% reduction in vector populations) and in the presence of a highly targeted and low cost immunization strategy using a medium-efficacy vaccine. DISCUSSION: Economic evaluation of the first-ever dengue vaccine is ongoing. However, even under very optimistic assumptions about a highly targeted and low cost immunization strategy, our results suggest that sustained vector control will continue to play an important role in mitigating the impact of environmental change and urbanization on human health. If additional benefits for the control of other Aedes borne diseases, such as Chikungunya, yellow fever and Zika fever are taken into account, the investment case is even stronger. High-burden endemic countries should proceed to map populations to be covered by sustained vector control.

Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges.

Infectious diseases are a significant burden on public health and economic stability of societies all over the world. They have for centuries been among the leading causes of death and disability and presented growing challenges to health security and human progress. The threat posed by infectious diseases is further deepened by the continued emergence of new, unrecognized, and old infectious disease epidemics of global impact. Over the past three and half decades at least 30 new infectious agents affecting humans have emerged, most of which are zoonotic and their origins have been shown to correlate significantly with socioeconomic, environmental, and ecological factors. As these factors continue to increase, putting people in increased contact with the disease causing pathogens, there is concern that infectious diseases may continue to present a formidable challenge. Constant awareness and pursuance of effective strategies for controlling infectious diseases and disease emergence thus remain crucial. This review presents current updates on emerging and neglected infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with particular focus on WHO top priority emerging infectious diseases (EIDs) and neglected tropical infectious diseases.

To address emerging infections, we must invest in enduring systems: The kinetics and dynamics of health systems strengthening.

Clinical pharmacology uses foundational principles of pharmacokinetics (PK) and pharmacodynamics (PD) to address medication use spanning a continuum from molecules to the masses. In the realm of infectious diseases, PK/PD attributes are considered especially important, because subtherapeutic dosing of antibiotics has been associated with poorer clinical outcomes in patients and increased incidences of drug resistance in populations. In consideration of these PK/PD principles, we will describe the analogous relationship between health systems strengthening, including for educating healthcare providers about emerging infections, and the tenets of therapeutic drug monitoring.