Sundas Rifquat 11/04/2020

Sadia Chowdhury 

Maria Bolanos

ENG21003: Final Research Project

The Adverse Effect of Globalization on Infectious Disease Emergence

Abstract: From ancient origins to currently TB infecting 2 billion people worldwide, Tuberculosis (TB) has survived untiringly over the course of history. According to The Global Tuberculosis Report of 2020 by WHO, around 10.4 million TB new cases are reported each year and almost one-third of the world’s population are carriers (Mac and Izzo 1). Opportunistic infections such as TB and HIV can join forces to minimize lifespan. People, who had developed a TB-HIV coinfection, have a higher risk for progressing to TB disease. The Human Immunodeficiency Virus (HIV) is a worldwide ongoing serious issue which reported 1.7 million new cases in 2018 (CDC 18). Since HIV patients have a compromised immune system, they must be extra cautious to prevent a Covid-19 infection. The world remains vigilant due to the evolving Covid-19 outbreak. According to the Corona Virus Resource Center, around 47,000,000 cases and 1,200,000 deaths have been reported worldwide for Covid-19 (CSSE). The TB, HIV, and Covid-19 is past-present-future sample scenarios of the effects of globalizing forces on the emergence, dispersion, and circulation of infectious diseases. No one can escape from the growing global threat of an infectious disease outbreak. Nowadays, a disease carrier or vector can be undercover as an enthusiastic traveler/tourist or a simple mosquito. Back in the day, globalization emerged as a limitless ground for people to travel around the world and to exchange goods freely between countries. Unfortunately, not only people kept moving, pathogens were able to rich global rides on airplanes and products. Then, the outgrowing trade, economic development, and cultural exchange encouraged the spread of infectious disease. The constant fear for the emergence and rapid global dispersion of infectious disease demands for a global health community collaboration. Outstanding teamwork between government and health care institutions is essential to address a worldwide threat of an infectious disease.

Introduction 

In a fast-growing world, there are rapidly spreading diseases, infections, and viruses that are life-threatening to humans. Specifically, Tuberculosis (TB), the Human Immunodeficiency Virus (HIV), and Covid-19 have reportedly shown as some of the most deadly and contagious diseases worldwide. Each year there are over billions of cases of these diseases/outbreaks. TB and HIV have been ongoing for many years, however, mutation of Covid-19 has also drastically increased the risks of the health of many causing a pandemic for the world (Crisan-Dabija & Grigorescu 2). These infectious diseases are particularly contagious because there are higher possibilities of it spreading through any kind of human contact. Globalization is one of the leading causes of the rising cases of these diseases. While globalization includes pros, it has more cons that are harmful in the long run. The process of trading goods and international businesses has shown to be the main cause of the spread of such deadly infectious diseases. For instance, airports can be one of the biggest examples because it is a place full of people from around the world and the spread of such diseases are mostly initiated through traveling from one country to another. Even if an individual is affected, they may or may not show severe symptoms, however, they are most likely to pass it on to whoever they come in contact with and the next affected person can have a severe condition than the carrier themselves. To cure or prevent such infectious diseases can take years of research and effort for the scientific and medicine world, however, the spread of it can more or less be prevented to help decrease the number of cases each year. It is really important for humans globally to be responsible for their health and safety by following guidelines to take precautions. Therefore, it is also necessary for the government and health care management to propose effective changes to globalization in order to protect their citizens. Such ongoing disease can be hard to bring to control for nations which is why it requires its citizens, government, and health care management to cooperate with one another. There are many actions to implement towards making globalization less harmful through processes such as sterilization to help stop the spread and decrease infections.

Methods

A massive immigration wave from underdeveloped countries triggered the reemergence of multidrug-resistant TB. Over time, people have moved in and out of different countries or territories to improve their quality of life, including new jobs and education opportunities. Also, political and social conflicts are major factors to drive people away from their home-land. Tourism is just a small percentage within the network of international travels and open borders within countries. Refugees, one of the most vulnerable communities, have the lowest economic resources and health standards. Due to a low life-quality, refugees have become a principal sponsor for the spread of infectious disease. The constant movement of the working class has helped to transmit infectious disease overseas and over generations. As the economic gaps increase over time, the wealthy making more money by the minute while the working class has a meal per day,  greater numbers of people either are forcibly displaced or leave their homes by choice in search of a better life. 

Mycobacterium tuberculosis (MT), the source of TB, has been a permanent challenge over the course of human history due to its social implications. The disease is present through the entire life-span of a patient and creates tubercles in different parts of the body. From ancient origins to currently infecting 2 billion people worldwide, MT has survived over 70,000 years (Mac and Izzo 1). The first historical records of TB originated three million years ago. When an early form of MT infected early hominids in East Africa (Brosch 3684). Also, Egyptian mummies revealed historical evidence for TB through skeletal deformities typical of tuberculosis (Morse 524). According to Hippocrates, from ancient Greece, TB was considered a fatal disease highly affecting young adults. According to archaeological findings, TB spread over Europe due to the decline of the Roman Empire. In the 18th century in Western Europe, TB had a mortality rate of 900 deaths per year. During the industrial revolution, the emergence of harmful social conditions, such as extremely unhealthy work settings, poorly ventilated and overcrowded housing, low-quality sanitation, and malnutrition, were directly associated with TB. In 1838, most of the English working-class men died of TB, while the upper class was excluded from the fatal statistics. Moreover, the TB epidemic wave expanded all over Europe and North America showing shocking statistics of one TB case for every four deaths (Barberis 9).

According to Dr. Fanning from the Division of Infectious Disease of Alberta University, 95% of the 8 million TB cases, reported annually in the US, arose from underdeveloped territories. Unfortunately, only 0.5 out of 5 million patients receive curative directly observed therapy. Commonly, new TB cases emerge as reactivation in the people estimated to have been infected with M. tuberculosis. The US Center for Disease Control and Prevention announced that 56% of TB cases occur in foreign-born persons. The records of US immigration flow showed an annual entrance of approximately 60,000 refugees. Refugees are required to undergo a pre-immigration screening for TB. In December 2003, the US Department of State announced a refugee resettlement program for around 16,000 Hmong refugees from a temporary camp for displaced persons in Thailand. In 2005, approximately 10,000 refugees had immigrated to the United States. Initial reports, after health assessments of newly arrived refugees, identified 37 TB cases, 4 of which were Multidrug-Resistant TB (Oeltmann 1715). TB is a critical health concern due to its complex immunological response, chronic progression, and the need for long-term treatment. In addition, the emergence of multi-drug resistant forms and the current TB-HIV epidemic represent a permanent challenge over the course of human history. Over the centuries, TB has constantly developed a high mortality rate. Nowadays, TB is responsible for 1.4 million deaths, among infectious diseases after the human immunodeficiency virus (Klaucke 2002).

As the travel speed for current passengers is constantly increasing due to technological innovations, the incubation time for infectious diseases remains constant. It could be a matter of weeks for a local outbreak to turn into a worldwide pandemic. The remarkable amount of people moving around the world has improved and expanded the horizons of human travel. Thirty years ago there were only about 200 million international tourist arrivals annually, compared with an expected 900 million or more by 2010. The global spread of HIV/AIDS is only one example of the impact of this tremendous human mobility on infectious disease (Klaucke 2002). According to “Origins of HIV and the AIDS pandemic,” HIV originated in the Democratic Republic of Congo around 1920 when the virus crossed species from chimpanzees to humans. Also, demographic data indicated that pandemic HIV emerged through the expansion of African populations such as Leopoldville. Later on, the rivers, which were mainly used for commerce and travel, became the bridge between the chimpanzee reservoir of HIV and Leopoldville.  In 1980, HIV spread over North America, South America, Europe, Africa, Australia, and around  300,000 people were potentially infected. The United Nations HIV Financial Board presented through statistical research that underdeveloped countries experience the greatest HIV/AIDS mortality, with the highest rates recorded in young adults in Africa (Sharp and Beatrice 2011).

The following case study explored how globalization transforms particular social contexts and activities related to HIV. “The Global Transformations of Transactional Sex in Mbekweni Township South Africa” study involved the analysis of economic globalization and transactional sex practices in South Africa. The research defined “transactional sex” as the exchange of gifts for sex, excluding prostitution. The overall findings demonstrated that participation in transactional sex was multidimensional and it connected to the processes of globalization through economic and cultural perspectives. Also, the research indicated a strong connection between female aspirations for a modern lifestyle in line with popular images of global modernity and rationalization to satisfy the material basis for obtaining this image even at an increased risk for HIV infection through transactional sex. According to “Globalization and Its Enemies” by Daniel Cohen, “globalization is only a fleeting image… what we too often ignore is how strong this image is, how pregnant with promises yet to be fulfilled.” The Mbekweni study showed evidence to suggest that motivations for young women’s involvement in transactional sex is not confined entirely to matters of survival but include women’s pursuit of material goods for pleasure and vanity as a perceived open-door to modernity. The Mbekweni study labeled the search of money and material goods as a matter of greater importance and the fears of HIV infection as a matter of not much relevance (Brown and Labonté 29). Even though HIV treatment has considerably reduced the percentage of disease-related deaths. There is uncertainty about the possibility of curative treatments and an effective vaccine. Also, access to HIV therapy is not a universal resource. Unfortunately, HIV will continue as a significant public health issue through future generations. 

The global spread of capitalism and the free market is the main driving force behind globalization. The rapidly changing nature of a global marketplace and the economic-political decision-making powers spreading around the world have important implications during the emergence and control of the infectious disease. Global panic can originate from the lack of food safety programs within a public health system. Outbreaks of foodborne illness have revealed several flows in food safety regulation capabilities within the United States. The free exchange of food raises serious concerns about the global spread of antibiotic resistance associated with the consumption of antibiotic-fed food animals (Klaucke 2002).

In the present time, the world is experiencing a chaotic pandemic caused by SARS-CoV-2. The disease was primarily identified in China when a couple of patients were diagnosed with severe pneumonia of unknown source. Even though different pandemics have emerged through the course of human history, the Corona-virus pandemic has developed an outstanding capacity to take advantage of modern globalization allowing for the massive spread at an incredible speed. Covid-19 asymptomatic carriers, who are commonly unaware of their infection, are facilitating the spread of the disease. The current COVID-19 pandemic requires analysis within broader cultural, political, scientific, and geographic contexts. Epidemics are not solely a function of pathogens; they are also a function of how society is structured, how political power is wielded in the name of public health, how quantitative data is collected, how diseases are categorized and modeled, and how histories of the disease are narrated. Each of these activities has its own history (Charters 223).

 

Results

As the diseases were spreading worldwide, there were many actions that took place as a result to stop the spread of the diseases. According to “Authority, Autonomy, and the first London bills of Molarity ” gives a concise description of molarity which also allows to compare a molarity based on location and time. Many historians and the postcolonial theorist have studied the diseases and provided the data based on the events that were happening during the time. “They reflected subjective judgements as to what is counted and what to compare to” (Mckay). Some of the framework that have been happening to stop the spread of international health is to investigate and understand the disease and from there to carry on and to protect the humans from different ways. “Despite increased funding and dramatic changes many less people come to the agreement” saying that it will require more money and even new approaches to stop the virus. 

To stop the spread of diseases, one of the effective ways to protect human health as worldwide is Vaccine development. “The hallmark of an effective Vaccine is one that can be given to the young population and which will provide lifelong immunity against particular pathogens”(MacDonald). Typically, the T cells would be created for a specific antigen and then those T cells would reside in a tissue that would then protect the disease. “In the case of M.Tuberculosis infection the infection follows a more complex route” (MacDonald). This case has shown some of the infections are harsh to understand and come to the conclusion of understanding it.

Bacillus Calmette – Guerin (BCG) is the most widely used vaccine in the world.  This vaccine has been delivered to 3 billion people. “Despite its worldwide spread use, BCG delivers only minimal protection and has failed to reduce the disease burden of TB” (MacDonald). However, this vaccine provides useful defense against TB infection but is still the best vaccine in the world. The development of the against M. tuberculosis vaccine has been so hard to develop for the past centuries while being examined to see the infection and the immune responses. However, the effective vaccine is nowhere but the effective drugs are so expensive. As a worldwide speaker, there are some people who are able to afford and some or not. 

In response to the current pandemic as a result people were isolated. “The clinical data, laboratory data, and pulmonary involvement range of 52 patients after symptom onset. Body temperature, CRP level, and the range of pulmonary involvement after symptom onset were significantly different between the moderate group and the severe group (Z = −2.141; Z = 2.062; Z = -2.288, ).Patients with severe COVID-19 had higher body temperature and CRP level, and a wider range of pulmonary involvement after symptom onset. Moderate patients mainly used symptomatic support treatment, including antiviral, phlegm, improving immunity, strengthening nutrition, and oxygen therapy. On the basis of symptomatic treatment, severe patients should actively prevent and cure complications, treat basic diseases, prevent secondary infection, and provide timely organ function support”(Jun Shen). This shows how the result of the study cases were conducted and what ideas were used to study the virus and what were the outcomes. 

Discussion

 

COVID-19 is spreading all over the world and there are still many cases all over the world. However, there are a number of people who have recovered from this disease. “In this study, the main clinical manifestations of COVID-19 patients were fever (98.08%) and dry cough (48.08%)” (Jun Shen). This study was conducted above the patient’s body temperature, CRP level and so on. Which has shown that their immune system was very active. “A retrospective analysis of the chest CT findings of 52 patients with COVID-19 at the last time of admission and the first follow-up after discharge found that 90.38% (47/52) of the clinically cured patients with COVID-19 had various degrees of pulmonary lesion dissipation” (Jun Shen). This result indicated that lesions of the moderate group were faster in the absorption stage and the time that was needed for the research was very short. “We believed that this might be related to a strong inherent immunity and a relatively milder lung disease in these patients. This study also showed that the range of pulmonary involvement after symptom onset in moderate patients is significantly smaller than that in severe patients, which supported our view” (Shen). There were limitations to these steps and studies that were being conducted. However, the study time was very short but the long recovery effects of the patients were unknown. Thus, there is much more to follow up with these sorts of research and conduct a stroger study cases. Clinically being cured COVID-19 patients had faster dissipation and short term recovery but the residual pulmonary lesions in serve patients were higher than the moderate patients which also requires further follow-up to conduct more study cases. To sum up, all the diseases need more further investigation to understand the outcomes of it in depth.

 

Bibliography

   Crisan-Dabija, Grigorescu. “Tuberculosis and COVID-19: Lessons from the Past Viral Outbreaks and Possible Future Outcomes.” Canadian Respiratory Journal 2020 (2020): 1–10. Web. 11 Nov. 2020.

 

   Charters, McKay. “The History of Science and Medicine in the Context of COVID‐19.” Centaurus 62.2 (2020): 223–233. Web. 11 Nov. 2020.

 

Klaucke D. “Globalization and Health: A Framework for Analysis and Action; Presentation at the Institute of Medicine Workshop on the Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and the Opportunities;” Washington, D.C.. Institute of Medicine Forum on Emerging Infections; Apr 17, 2002. Web. 11 Nov. 2020.

Mac Donald EM, Izzo AA. “Tuberculosis Vaccine Development — Its History and Future Directions.” Tuberculosis-expanding knowledge. Ribbon W, Ed, Chapter 6, IntechOpen, 8 July, 2015. Web. 11 Nov. 2020. doi: 10.5772/59658

Centers for Disease Control and Prevention. “Estimated HIV incidence and prevalence in the United States”, 2014–2018. HIV Surveillance Supplemental Report 2020;25(No. 1)Web. 11 Nov. 2020.

CSSE. “COVID-19 Map.” COVID-19 Dashboard by the Center for Systems Science and Engineering at Johns Hopkins University. Johns Hopkins U, 04 Nov. 2020. Web. 05 Nov. 2020.

Brosch, R et al. “A new evolutionary scenario for the Mycobacterium tuberculosis complex.” Proceedings of the National Academy of Sciences of the United States of America vol. 99,6 (2002): 3684-9. Web. 11 Nov. 2020. doi:10.1073/pnas.052548299

 

Morse, D et al. “Tuberculosis in Ancient Egypt.” The American review of respiratory disease vol. 90 (1964): 524-41. Web. 11 Nov. 2020. doi:10.1164/arrd.1964.90.4.524

 

Barberis, I et al. “The history of tuberculosis: from the first historical records to the isolation of Koch’s bacillus.” Journal of preventive medicine and hygiene vol. 58,1 (2017): E9-E12.Web. 11 Nov. 2020.

 

Oeltmann, John E et al. “Multidrug-resistant tuberculosis outbreak among US-bound Hmong refugees, Thailand, 2005.” Emerging infectious diseases vol. 14,11 (2008): 1715-21.Web. 11 Nov. 2020. doi:10.3201/eid1411.071629

 

Sharp, Paul M, and Beatrice H Hahn. “Origins of HIV and the AIDS pandemic.” Cold Spring Harbor perspectives in medicine vol. 1,1 (2011): a006841. Web. 11 Nov. 2020. doi:10.1101/cshperspect.a006841

 

Brown, G.W., Labonté, R. “Globalization and its methodological discontents: Contextualizing globalization through the study of HIV/AIDS.” Global Health 7, 29 (2011). Web. 11 Nov. 2020.