Epidemic...

is a type of

{emergency, crisis, disaster, threat, disease, shock, factor, challenge, event, issue, effect, outbreak, calamity, problem, cyclical, cause, risk}

affects

{people, regions, countries, animals, health systems, production systems}

can be triggered or spread by

{organisms, environmental conditions, population movements, poor infrastructure}

can cause

{deaths, suffering, fear, stigma, socioeconomic impact, vulnerability...}

can be managed by actions such as

prevention {treatment, WASH, vaccination, hygiene promotion...}

forecasting {surveillance, risk analysis, risk assessment...}

preparedness {social mobilisation, surveillance, community education...}

detection {early detection, laboratory testing, alert reporting, tracing...}

response {case management, epidemiology, containment, risk management...}

What are the consequences of epidemics?

These are causes of epidemics or causes of the spread of epidemics. They are not necessarily collective causes of all types of epidemics, although those related to pathogens and infrastructure/living conditions seem to be behind any of them, especially poor hygiene and sanitation.

Most documents highlighting the causes of epidemics are European and North American General documents and Activity reports produced by IGOs, NGOs and RC.

Pathogens are only mentioned in Activity reports and Strategy documents, whereas climate conditions, population movements and poor nutrition are mainly covered in General documents.

Most documents highlighting the consequences of epidemics are European and North American General documents and Activity reports produced by IGOs, NGOs and NGO_Feds, which means that IGOs and NGOs are equally concerned about both causes and consequences but RC is tends to be more concerned about causes and NGO_Feds about consequences.

Most frequent consequences are deaths and weak health systems. Generally speaking, NGOs show more concern about personal consequences (stigma, fear, suffering) and NGO_Fed about socio-economic impact.

It should be noted that the following are both causes and consequences of epidemics: displacement, diseases, weak health services, vulnerability, poverty, food insecurity.

Among the collocates referring to countries and regions where epidemics take place, Africa, Liberia, Sierra Leone, Guinea and Haiti stand out. Other than countries, prisons are also a common place for epidemics to spread.

Mosf frequent types of epidemics include cholera, AIDS/HIV, Ebola and malaria and the most common adjectives accompanying epidemic is global, showing the general concern about pandemics.

Similar related terms (e.g. parent concepts, siblings, synonyms) are disaster, disease, outbreak, flood, war, crisis, conflict, earthquake, pandemic.

Among the collocates referring to countries and regions where epidemics take place, Africa, China, America, Taiwan, Asia and Korea stand out. Other less frequent collocates include Europe, Italy, Brazil, India, Iran, Japan, UK, Nigeria, Canada, Liberia and Mexico, showing a wider scope as compared to the HE corpus.

Most frequent types of epidemics include SARS, influenza, Ebola, AIDS/HIV, MERS and COVID-19. One of the most common adjectives is also global, but also future, recent and major.

Similar related terms are pandemic, outbreak, disease, disaster, influenza and case.

Common collocates in all three text types are: epidemic types (Ebola, AIDS/HIV, cholera, malaria, tuberculosis, measles), near-synonyms (disease, outbreak, pandemic) and phases of epidemic management (control, surveillance, response, spread). Pandemic is proportionally more frequent in the Strategy corpus as compared to the General documents and Activity reports.

Regarding their differences, General documents focus on other epidemic types (meningitis, SARS, dengue and obesity) and verbs related to what epidemics do (impact, generalize, concentrate), whereas Activity reports focuses also on meningitis, obsesity and dengue but also on verbs related to response (tackle, combat, contain, fight). Strategy documents do not focus on other epidemics but on epidemic management, although with less "active" verbs and more nominalizations (WASH, preparedness, prevention, end, mitigate).

This graphic presents unique and shared collocations based on three organisation types. Unique collocations allow to discover what a particular organisation type says about epidemic. Shared collocations allow to discover matching elements.

Common collocates in IGOs, NGOs and NGO_Feds are similar to common collocates to all three text types (types, synonyms and management). Comparing differences, IGOs show more collocates related to epidemic types (SARS, Marburg, dengue, polio, hepatitis, influenza) or their impact/origin-related attributes (deadly, waterborne, devastating), whereas NGOs focus on attributes (devastating, deadly, lethal) but especially impact (rage, break, hit) and reponse-related verbs (contain, prevent, reverse). NGO_Feds share collocate types with IGOs and NGOs, since they focus on epidemic types (dengue, hepatitis, yellow fever, tuberculosis) and impact and response-related verbs (sweep, rage, devastate, declare, curb, tackle, contain, respond).

• Current fast spread and quick change of stage: national epidemic - cross border epidemic - pandemic "public health emergencies of international concern" (PHEICs).

• Newly emerging diseases appear at an unprecedented rate

• Problems in early detection:

  1. Bad surveillance systems provide bad quality data

  2. Traditional paper-based surveillance systems are not adequate in emergencies

• Data gap issue: people devastated by an epidemic might not be accounted for due to omissions related to crises that fall outside of definitions, parameters and indicators

• Reluctancy of health authorities to declare epidemics, mainly due to the additional burden this imposes on a health system

• Unadequate current stocks of vaccines and anti-viral medications

• Fragile inmune systems due to self-medication

• Availability of donor support has been reduced

• Governments contingency plans are rare or not sufficiently funded

• Poor preparedness due to limited preparedness capacity and investment

• Lack of political commitment to implementation of IHR and public health security

• Underreporting of outbreaks

• Poor coordination and collaboration at the national/international level

• Lack of leadership and coordination for epidemic prevention, preparedness and effective response (among countries and/or agencies)

• Command-and-control structure of health systems is ill-adapted

• Disruption in drug supplies

• Poor clinical management

• Lack of integral/international/cross-sectoral approaches to evolving epidemics:

  1. HIV/AIDS continues to be framed as a medical issue, and despite the multidimensional and widespread consequences of the epidemic, responsibility for AIDS continues to fall to provincial and national health departments

  2. At the outset of the epidemic HIV was mainly considered a public health issue, now it is increasingly seen as a fundamental challenge to broader human development (vicious circle of AIDS and poverty)

  3. HIV requires a longer-term reaction than the usual response to emergencies; there are no short-term solutions to underlying causes of vulnerability such as discrimination against marginalized groups and gender inequality

  4. The term ' epidemic ' may acquire different meanings according to the timeframe in which it is considered

• Vulnerability to acute public health events

• Lack of political will

• Gap in global research and development

• Vicious cycle of suboptimal preparedness, inadequate responses, and increased vulnerability to other emergencies.

• Weak health systems and an insufficient public health infrastructure and health emergency management system

• Insecurity in countries affected by emergencies remains a major challenge in the delivery of health services, putting health partners and providers at risk

• Inability of affected countries to sustain an emergency response system over the time (obstacle to adequate monitoring and risk assessment)

• Local resistance to outbreak management teams

• Poor supervision of health staff and patient treatment's regimes

• Drastic improvement of surveillance systems

• Avoid epidemics through risk management instead of expensive emergency aid interventions

• Policy and intervention responses cannot be guided by simplistic stereotypes about populations at risk (HIV-related)

• The recurrent health emergencies in most of the African countries need considerable and sustainable efforts in terms of coordination, including information management, technical support and resource mobilization

• Improve infection control capacity

• Integrate security risk management in response approaches

• Worldwide action to enable response operations through a public-private parnership of UN agencies, the private sector, intergovernmental organisations and other sectors

• Stronger financing for response programmes

• Include pandemic preparedness into general emergency frameworks

• Based on global economic and security-related impact of epidemics, health issues should be an integral part of geopolitical analysis

• Improve political commitment

• Technical and programmatic innovations

• Greater vaccine production capacity

• AIDS prevention must be rights-based

• Control population movements

• Provide people with information

• Pre-disaster funding based on warning systems

• Increase commitment to the development of IHR

• Increase IHR compliance

• Strategic alliances (regional, national, international) for public health security

• Addressing public health emergencies should be part of the wider developmental agenda

• Integrated prevention and response plans

• Cross-sectoral approach:

  1. Governments need to address the drivers of the outbreaks (e.g. safe water and sanitation) while ensuring that the health response is both timely and comprehensive.

  2. Strengthen the interface between humanitarian and public health communities, including regional, national, local and community capacities

  3. Strong leadership and coordination from governments, nongovernmental organizations, the World Health Organization, the World Bank, and the private sector

  4. Add a human development perspective (e.g. focus on how virus are transmitted but also on underlying structural factors that render people and communities vulnerable)

  5. Build resilience rather than merely providing assistance

• Risk reduction measures (e.g. control of panzootica)

• Strengthen nations' capacity to prevent, detect, and respond

• A final question is one which will inevitably be addressed to donors: with the possibility of a malaria epidemic, will donors invest in stockpiles of antimalarials, spraying equipment, insecticide and additional health and logistical personnel? How accurate will systems have to be before donors invest in predictions?

• The question is: how can this [improve infection control capacity] best be done? Part of the answer relates to the background factors or causes that lead or contribute to epidemics and other acute health emergencies. These may be natural, environmental, industrial, human, accidental or deliberate.

• The influence of pharmaceutical firms on the WHO's new definition of pandemic: before it was necessary that the illness breaks out in several countries at once, but also that it has serious consequences, with a number of mortalities in excess of the usual averages. That aspect was erased from the new definition.

• Disasters should no longer be viewed as linear – with a discrete beginning, middle and end – but as long-term events requiring a different paradigm for responses: "Traditional humanitarian thinking focuses on the short-term, and is often aimed at returning affected populations to 'normality'."

• The role of foreign military engagement is questionable

• The key question is whether there has been any change [since IHR] in domestic preparedness and in the speed of response by the humanitarian sector.

• Reassessment of WHO's capacity and role in major disease outbreaks.

• Two of the key questions regarding the HIV-related responses needed in disasters are: where has the disaster occurred; and at what stage is the disaster? The first question is largely about HIV prevalence and the type of epidemic in the disaster area; the second is about what responses are appropriate and cost-effective at any given stage of the specific disaster (...). The question of 'when' revolves around the stage of disaster. It is also a question about 'who' since different organizations have their own special expertise and priorities, and the responsibilities of host governments also come into play.

• The "emerging diseases worldview":

  1. It is a convincing depiction of current health problems but at the same time a selective approach with questionable political implications

  2. It draws certain health problems and threats to be relevant and tends to neglect a range of equally important global public health concerns

  3. The understanding of global public health changed from being a humanitarian issue to being a domain of security

  4. Global disease surveillance is not always beneficial as it binds manpower and money into often redundant surveillance networks.

  5. High-income nations often become the beneficiaries of the early warning information and the scientific data produced through these surveillance systems while low- and middle-income countries lack the necessary basic health infrastructure

  6. The consequential securitization of global health is strongly biased towards the interests of western nations

  7. The implied orientation towards the discovery of a novel pathogen and the prioritization of surveillance, early warning and emergency responses is leading to the occlusion of underlying more structural factors driving disease emergence. Hunger and lack of clean water, a growing number of urban poor or the ongoing deterioration of national health systems are challenges that need to be re-centred on the global public health agenda against an emerging diseases worldview

• Health and well-being are not individual concerns: they are global issues... [they] are human rights; they are also public goods... like the road networks, clean air and clean water

• Debates of whether tackling the epidemic through treatment or through prevention is the best approach

• AIDS exceptionalism