Transnational Health and Security: Emerging

Infectious Disease Surveillance in Cambodia

Sophal Ear, Ph.D.
Assistant Professor
Naval Postgraduate School
27 October 2010
Disclaimer: Material contained herein is made available for the purpose of peer review and discussion and
does not necessarily reflect the views of the Department of the Navy or the Department of Defense.
Transnational
threats can only
be dealt with by
transnational
cooperation
PDIR Felizardo M.
Serapio, Jr. (Ret)
A Thermal Scanner is placed at the corridor of the Ninoy Aquino International Airport to
monitor the body temperatures of arriving passengers in continuing Bird Flu watch
Wednesday Jan. 31, 2007 in Manila, Philippines.
Contents
1. The Problems
2. Timeline Context
3. Cambodia Case Study
4. H1N1 (hitting closer to
home)
5. Conclusion: The End or
the Beginning?
Myriad Problems
Poor to non-existent
surveillance
Poor diagnostic
laboratory capability
Disincentive to report
(bad publicity, bad for
business)
Viral sovereignty (in
Indonesias case)
Page 213:
In 2006, Indonesia claimed viral
sovereignty over samples of
H5N1 collected within its borders
and announced that it would not
share them until the WHO and
developed countries established
an equitable means of sharing the
benefits (e.g., vaccine) that could
derive from such viruses.
Page 3:
in the poorest countries
per capita expenditure on all
aspects of health care [is] 3%
expenditure in high-income
countries staff in over 90%
not familiar with quality
assurance principles more
than 60% of laboratory
equipment is outdated or
not functioning
August 2001: the more
things change
2010
Director of Laboratory Systems Development at
a major American university with whom the
GAOs description was shared for insights wrote
the following from my own experiences in
countries (Southern Caucuses, Central Asia,
Southeast Asia, India, Sub-Saharan Africa) I
believe the status has not changed much from
the date of the report.
TimelineContext
Human Pandemic Flu Timeline
Spanish (H1N1) HK flu H3N2 HPAI H5N1 H7N2 H7N3 H10N7
Downside of Globalization:
Global Reach of Diseases
Quality of Health Care, 2002
H5N1: Highly Pathogenic Avian Influenza
Avian influenza
situation in China
8 June 2010 -- 22-year-old pregnant woman died
on 3 June exposed to sick and dead poultry.
Of the 39 cases confirmed to date in China, 26
have been fatal: mortality rate of 66%!
http://www.youtube.com/watch?v=X6vFaMy0w0
0
Cambodia Case Study
Lucky guy, thanks to Namru-2...
H5N1 Animal Outbreaks 04-08
2008
2007
2006
2005
2004
2007
2006
2005
2008
H5N1 Human Victims 05-08
Issues Raised in Cambodia
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Low Staff
Compensation
Donor Dependence
Pathologies
Poor staff
management/HR
Patronage networks
detrimental to work
environments
No compensation for
culling
Differing host and
donor priorities
Goal: reduce pandemic potential that could
strike donor countries themselves
Enter Super Chicken &
Pandemic Preparedness
Message: Behavior Change but $$$?
Scientists Technology should be on tap,
but not on top.
Now this is not the end. It is not even the
beginning of the end. But it is, perhaps, the
end of the beginning.
--Churchill
Thank
you
&
Questions