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This introductory chapter discusses the rationale behind this book on how to deal with emerging infections. It considers why such a study is necessary. It details how the topics were chosen and why SARS is used as the example for the study.

In 1912, the MCA decided to stop production of the popular Gospel Art Calendar and establish a second community at Bullard, Texas. Never a financial success, the Bullard community would collapse in 1919. World War I, the influenza epidemic and chronic debt hindered the movement. In 1918, Duke Farson and his sons left the MCA organizing the rival Immanuel Church in Chicago. Remarkable revivals continued especially in the winter of 1919–1920 in Boscobel, Wisconsin. A Shortly before Harvey’s death in 1926, W. S. Hitchcock became president. Under Hitchcock leadership debt reduction replaced evangelism as the moment’s central emphasis. As the MCA retreated in North America dynamic young leaders strengthened and established missions in India, South Africa and Europe.

The influenza virus is perhaps the most intensely studied of human pathogens. Effective vaccines have been available for over fifty years, yet influenza continues to present a major threat to public health. Does this bode ill for the control of SARS should it return? This chapter relates several recent evolutionary studies that provide insight into the ability of influenza to infect humans repeatedly throughout their lives. It reviews some common misconceptions about influenza which, in retrospect, were not far-fetched but simply based on limited data. These lessons may be pertinent if we hope to come quickly to grips with emerging infections such as SARS or avian flu.

With outbreaks of infectious disease emerging from animal sources, we have learned to expect the unexpected. We were and are expecting a new influenza A pandemic, but no one predicted the emergence of an unknown coronavirus as a deadly human pathogen. Thanks to the preparedness of the international network of influenza researchers and laboratories, the cause of SARS was rapidly identified, but there is no complacency over the global or local management of the epidemic in terms of public health logistics. The human population was lucky that only a small proportion of infected persons proved to be highly infectious to others, and that they did not become so before they felt ill. These were the features that helped to make the outbreak containable. The next outbreak of another kind of virus may well be quite different.

Efforts to eliminate avian influenza are imbued with viral panic and are anchored to the 1918 influenza pandemic, SARS, and bioterrorism. The small number of human HPAI deaths has been given enormous significance but less attention is paid to impacts of containment policies on food security, nutrition, or subsistence among small-scale farmers. In Vietnam, the livelihoods of the rural poor are supplemented by household poultry. Government policies to eliminate backyard operations remove a hedge against economic security, undermine the symbolic and cultural importance of poultry, and rupture relationships between buyers and sellers. Rural farmers face the triple burden of stigma for creating conditions that promote bird flu, destruction of their flocks, and the risk of living at an epicenter.

This chapter examines a risk scenario that could form one of the most significant communication challenges both nationally and globally: an influenza pandemic. A pandemic occurs when a new influenza strain emerges and spreads rapidly because people have no natural resistance to it. Drawing upon the evidence gathered from healthcare workers — who might plausibly have an enhanced understanding of the potential risks — the chapter considers how information and knowledge might be exchanged amongst the wider public. This should help in understanding how risk communication efforts might most effectively engage with people, before (as well as during) an outbreak. Before outlining this evidence, the characteristics of pandemic influenza that may impact on people's understanding, information needs, and response are summarized.

Our knowledge of the amount, pattern, and origins of genetic diversity varies enormously among human viruses. The four groups of viruses discussed in detail here (herpes viruses, AIDS viruses, influenza A viruses, and dengue viruses) exhibit varied patterns of diversity, with different factors important in each case. Rates of evolution vary by 5-6 orders of magnitude, from slowly evolving DNA viruses (herpes viruses), to rapidly evolving RNA viruses (AIDS and influenza A viruses). The timescales of diversification within a clade of human viruses vary by 4-5 orders of magnitude, from a few years for H3N2 influenza viruses, to perhaps 100,000 years or more for some herpes viruses. This depends on how long the viruses have been infecting humans, and whether the virus has been subject to random genetic drift, founder effects, selective sweeps of an advantageous variant, its route of transmission, and its interaction with the host immune system.

This chapter reviews the evolution and ecology of emerging diseases. Human infectious diseases are caused by more than 1400 pathogen species with considerable diversity in lifestyles. Almost all pathogens of newly emerging diseases come from animal reservoirs. Most are viruses, especially RNA viruses. The emergence of a new infectious disease in the human population involves exposure to the pathogen, successful infection of the hosts, and sufficient transmission between hosts. These different levels of emergence make up the ‘pathogen pyramid’. Both ecological and evolutionary changes can affect a pathogen's position on the pyramid. HIV/AIDS, influenza (H5N1), SARS, Ebola, and monkeypox are emerging diseases. From the available data it is hard to tell if ecological changes alone caused these diseases to emerge or if evolutionary changes were sometimes involved as well. The past provides some guidelines as to which kinds of pathogen are most likely to emerge in the future.

From June 1918 until May 1920, the Six Brown Brothers spent most of their time in road tours of Jack o' Lantern, but they continued to record for Victor, and during Jack o' Lantern's 1918 and 1919 summer recesses, they appeared in Florenz Ziegfeld's Midnight Frolic. Bert Williams, the great mixed-race comedian who, like Tom Brown, worked in blackface, was one of the Frolic's stars. In December 1918, Percy Brown died in the world epidemic of the so-called Spanish influenza. In 1919, the act began also to record for the Emerson Phonograph Company, and H. A. Waggener gave Tom an 1863 Sax soprano saxophone, which he began to use onstage.

The closing months of the First World War coincided with one of the most virulent pandemics of the twentieth century. In Ireland, at least 23,000 people died from influenza between 1918 and 1919. This chapter suggests that Ireland suffered to a similar degree to other regions of the British Isles. It investigates popular beliefs that war itself was directly accountable for the influenza pandemic and its subsequent spread across Ireland. Moreover, international conflict suppressed contemporary reportage of the disease in Ireland, contributing to a subsequent amnesia with respect to influenza across the country. Making effective use of case studies from Ulster, the chapter details how war impacted on medical and welfare responses to influenza as the pandemic struck amidst ongoing shortages in medical personnel and supplies. In addition, the chapter suggests that an absence of effective state recommendations on preventative measures (a consequence of prioritising the war effort) had detrimental consequences for the Irish population.

The marked decline in infectious-disease-associated mortality that took place in the United States during the first half of the 20th century contributed to the sharp drop in infant and child mortality and the more than thirty-year average increase in life expectancy over the past 100 years. The 19th-century discovery that microorganisms are the cause of many diseases led to substantial improvements in sanitation and hygiene, formulations of vaccinations, development of diagnostic tests, and the introduction of antibiotics. Despite this overall progress, devastating pandemics of infectious diseases occurred during the 20th century including the influenza in 1918 and human immunodeficiency virus first recognized in 1981. This chapter reviews major 20th-century achievements in the control of infectious diseases in the United States and ends with a discussion of challenges for the 21st century.

This chapter relates a brief history of the modern research university. Although centers of academic learning have long existed, the role of these institutions in discovering new ideas was the brainchild of a Prussian aristocrat and the idea quickly gained traction in the United States under Abraham Lincoln and a shrewd Quaker grocer by the name of Johns Hopkins. The latter's eponymous university played a key role in understanding the most devastating public health crisis of the 20^th century, Spanish flu. The origins of the pandemic and its impact, which ranged from hastening the end of the Great War through enhancing scientific understanding of disease, are discussed. The connections between the Spanish flu and the discovery of the polio vaccine are outlined as is the impact of NIH during the latter half of the century. The chapter concludes by conveying the discoveries, first of cholesterol itself and later of a means to lower cholesterol with a revolutionary new class of drugs known as statins. The development of these new medicines had implications not just for health of patients but for the companies developing these drugs as well.

This chapter focuses upon one particular geographic region in suburban Washington, DC, which serves as a microcosm for the challenges and opportunities of the larger drug development enterprise. Our story begins with the efforts to sequence the human genome, an ambitious project that led to an increasingly bitter and highly publicized rivalry between the personalities of Craig Venter and Francis Collins from the private and public sectors, respectively. This same initiative gave rise to the dramatic growth in a cadre of biotechnology companies in suburban Maryland dedicated to exploiting the commercial opportunities associated with the human genome. The bubble would ultimately be burst as a result of various legal and executive decisions and in doing so, obliterated billions of dollars in wealth and effectively shudder an entire sector. All the while, another upstart biotechnology company, MedImmune, continued on a lower profile but ultimately more successful path to introduce innovative new medicines. However, this company would itself suffer a series of setbacks of its own making that resulted from the failed commercial launch of an improved influenza vaccine.

This chapter discusses the 2007 controversy that ensued when Indonesia briefly stopped sharing its flu strains with the World Health Organization (WHO). It then looks at the World Health Assembly's (WHA) May 2011 “Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits.” Indonesia had refused its virus samples to protest the inequities it received in the distribution of vaccine developed through Global Influenza Surveillance and Response System (GISRS). Negotiations over sharing medical benefits concerned access by developing nations to the means of diagnosing and treating novel influenza during a pandemic. The 2009 H1N1 pandemic confirmed the inequity of global pandemic vaccine distribution. The Framework stabilized the GISRS and therefore is now a major contribution to pandemic influenza preparedness. Its reliance on contract suggests that the WHO lacks the political legitimacy to impose public rules and thus it is settling for a less-intrusive form of regulation.

There is an underdeveloped potential for using neuroscience as a particular input in the process of law-making. This chapter examines one such instance in the area of public health law. Neuroscience could play an important role in elucidating and strengthening the relevance of the conditions underlying and re-enforcing our ability to cooperate in balancing the benefits and burdens necessary to achieve particular goods; for instance, the protection of public health in an outbreak of pandemic influenza. In particular, the chapter focuses on how a better understanding of the neurobiological basis of reciprocity could be used to help increase support and compliance with public health laws — especially those involving restrictive measures (such as quarantine and isolation).

Respiratory virus illnesses are a major health problem in that the acute infections and their consequences account for a substantial proportion of all consultations in general practice. These illnesses are also one of the main causes of absence from work and education. Colds and influenza affect most of the population and it is highly desirable to increase our knowledge of these illnesses, with the practical aims of lowering health care costs, decreasing absenteeism from work and improving the quality of life.

The recent emergence of a highly pathogenic strain (H5N1) of avian influenza that affects both birds and humans has raised global concern about its spread. Given the rapid spread of the disease and the desire for proactive monitoring and preparedness, I present a prototype forecasting framework for H5N1 dispersal for when/ if it arrives in North America via migratory bird movements. The prototype summarizes movement patterns by six species of arctic-breeding Anseriformes and emphasizes the importance of spread along all coasts of North America, as well as along the lower Mississippi River. This forecasting system is applicable only to the extent that migratory birds are the principal mode of dispersal and spread of the disease. The H5N1 situation calls for considerable effort in (1) understanding details of bird migration globally, (2) sharing avian biodiversity data globally, and (3) exploring novel approaches to data analysis and interpretation.