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GLOBAL CHALLENGES REPORT

In the Global Challenges intensive course, several topics were discussed
regarding the challenges our planet is facing. The episode I would like to
analyse, concerns the intervention on the topic of covid-19 by the guests:
Paulo Telles de Freitas and Rita Patrocinio de Jesus.
The question posed is "Will pandemic remain a global threat?"
Prediction is difficult since the spread of covid-19 has been heterogeneous
across countries, so there can be no single solution. From here on, there were
some main points that I decided to analyse in more detail.
The pandemic was determined and brought to light several inequalities. The
World Health Organisation itself has defined healt inequalities as "avoidable
inequalities in health between groups of people within countries and between
countries". Let us, therefore, make an analysis from the point of view of: socio-
economic, geographical location and vulnerability of the population, in order
to better understand in detail and find strategies that can improve healthcare
in the period of change we are experiencing. Research in the UK has shown
that mortality has reached very high rates especially in the older population
and that men are more likely to die than women, in all age groups. Also very
relevant is the type of ethnic group to which one belongs: black men are 3
times more at risk of death than the white population. Geographically, one of
the major distinctions to be made is between rural and urban areas: in fact,
urban communities have a higher transmission rate than rural areas and this is
due to the awareness of the poor access to health services and the lower
population living there. Taking the US as a case in point, if the need for the
covid-19 test exceeds reimbursability limits, rural providers operating in a
private system are forced to discontinue care for the uninsured. It is therefore
crucial to take measures to try to limit the covid-19 effect, even if some factors
are difficult to control.
What are these factors? Studies suggest that rural communities tend to have
pre-existing health conditions compared to urban communities. A population
study in the UK shows that people with type 1 and type 2 diabetes have a
significantly higher covid-19 mortality rate, demonstrating how even one pre-
existing factor can have a serious impact on health during a pandemic.
One of the key issues discussed is certainly socio-economic inequalities, which
relate to: liquid and material availability, such as housing, education, food,
employment and working conditions. All this is associated with a worse state
of health, not only physical but also mental. The study conducted by Monika K.
Goyal, in an exclusively paediatric centre, aimed to assess ethnic/racial and
socio-economic differences in the infection rates of acute respiratory
syndrome SARS among children. The work showed that children living in
families with a lower average family income had the highest rates of positivity
compared to those living in a higher average family situation. The study found
that even after adjusting for socio-economic variables, racial and ethnic
disparities persist. Indeed, children of black and minority ethnic groups had
higher infection rates than non-Hispanic white children.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826045/#cit0029)

In addition to healt inequalities, the impact of covid on mental and physical

health was discussed. During the outbreak of an infectious disease, as in the
case of covid-19, the psychological reactions of the population are crucial in
determining the spread of the disease and especially helpful in understanding
the emotional distress and social unrest during and after the outbreak.
First, it must be recognised that, in a normal situation, people with mental
illnesses have a lower life expectancy and worse physical health than the
general population. Consequently, people with mental disorders were at
higher risk of Covid-19 infection.
Secondly, there was an increase in anxious and depressive symptoms among
people who did not show pre-existing signs, with some experiencing post-
traumatic stress disorder.
Thirdly, health and social workers, especially those who have worked in public
health, emergency services, emergency departments and intensive care are
more likely to suffer from anxiety, depression and post-traumatic trauma.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184387/)

During the covid-19 crisis, the health services were under undue pressure due
to the significantly increased number of patients requiring treatment. Doctors
not only perceived an increased risk to themselves due to the exposure to
sicker patients, but also aggravated their stress due to the lack of appropriate
personal equipment and protection during a pandemic. An additional stress
factor is the increased risk of infection for the families of frontline health
workers. (https://www.cambridge.org/core/services/aop-cambridge-core/content/view/
3259D0FF579B301246410C8627E447FD/S2056469420000443a.pdf/the-mental-health-of-doctors-during-the-
covid-19-pandemic.pdf)

To minimise maladaptive social behaviour, it is necessary to: make truthful,

non-alarming and timely announcements that are applicable and evidence-
based. When public communication is inconsistent, erroneous and dishonest
(we can find examples in state governments around the world), the public can
be expected to respond negatively, worsening the impact of the virus. A series
of experiences such as: the impossibility of caring for and treating sick family
members due to contact restrictions; the death of relatives, friends and
acquaintances; the impossibility of organising funerals, burying and mourning
the dead, have led to an increase in post-traumatic stress symptoms and
adjustment disorders.
Physical estrangement and social isolation can also lead to increased stress and
friction within families. For women, children and the elderly, the risk of having
experienced or witnessed violence, with much difficulty in seeking help, has
worsened psychological conditions, as well as increased cases of violence
between family members. In addition, the consumption of substances such as
alcohol and the sale of cannabis have increased exponentially. Children and
adolescents were affected differently from adults, with long-term
consequences as they experienced the crisis during a critical period of
development. The effects depend on their genetic vulnerability, the reactions
of their parents or carers and whether they have been exposed to abuse.
Finally, as a final analysis, we can say that covid has led to the closure of most
sectors of the economy, resulting in sudden and unforeseen mass
unemployment. In the absence of welfarist economic measures, the result was
the onset of mass poverty, which disproportionately affected poor nations
without the presence of a welfare system. In most industrialised countries,
various economic measures have been taken, but problems due to the
complexity of implementing massive subsidies and slow economic activity have
left many people vulnerable to poverty and its mental health consequences,
such as anxiety and depression.
(https://journals.sagepub.com/doi/full/10.1177/0706743720926676)

The discussion then turned to the concept of quarantine. Let us see how it has
evolved throughout history up to the present day with the Covid pandemic.
Historically, quarantine was defined as the segregation of individuals suspected
of carrying a contagious disease. Nowadays, the term means: the compulsory
physical separation of healthy individuals who have been potentially exposed
to a contagious disease. In contrast, the term 'isolation' means the separation
of individuals already known to be infected.
Historical and religious documents, such as the Old Testament, testify that
even in ancient times, individuals with diseases were separated from others;
people suffering from leprosy had to live in isolation for their entire lives. It
was therefore a reason for social discrimination, not very different from what
has happened nowadays with the so-called 'hunt for the untore'.
The modern concept of 'quarantine' began to be used in connection with the
plague epidemic of 1377, when the rector of the port of Ragusa officially issued
an isolation period of 30 days for ships and 40 days for travellers by land, and it
is precisely from the number forty ('quarantine') that the term quarantine
derives. Over the next 100 years, similar laws were introduced in Italian and
French ports.
Gradually, notions of the mechanism of contagion were acquired. During the
early Renaissance, physicians had no clear idea of contagion, although many
epidemic waves had occurred over the previous centuries. It was only during
the 16th century that Girolamo Fracastoro defined and enhanced the concept
himself, through the hypothesis that small particles were capable of
transmitting disease. This led the medical profession to supplement previously
adopted remedies with more precise quarantine interventions that became
the basis of modern epidemiology.
It is interesting to note that in the 20th century, measures similar to those
used against the plague were taken to combat tuberculosis, referred to as the
great white plague. Before the tubercle bacillus was recognised as the
causative agent of the disease, sanatoria had been set up as a simple and
inexpensive means of breaking the chain of transmission of the disease, as
they ensured isolation. They had a definite role in controlling tuberculosis,
which is why they spread throughout Europe and North America between
1880 and 1930. Even in the 1950s, although some antibiotics such as
streptomycin were already on the market, tuberculosis hospitals were
considered important for treatment as they were places dedicated to the
isolation of affected patients, as recommended by quarantine practice.
So-called 'health officers' were established and became of paramount
importance. Among their various functions was that of providing the individual
national health systems with appropriate corporate entities and legislative
bodies, as well as, of course, looking after the health of the population as a
whole. In many European countries, including Italy, these 'officers'
represented, even in the second half of the 20th century, the basis of the
entire public health organisation dedicated to the monitoring and control of
infectious diseases.
However, quarantine is not a remedy that can solve every problem, it has its
limitations. This is highlighted by the recent risk of bioterrorism, in which a
potentially large and diverse number of agents may be involved. Moreover,
other recent outbreaks, such as AIDS, cannot be considered suitable for
quarantine not only for medical reasons, but also for ethical and legal issues.
However, good quality evidence overall suggests that the basic concept of
quarantine is still fully valid and that the implementation of proper quarantine
procedures must be adapted to individual health, social and geographical
conditions. From this point, a debate has arisen in the recent covid situation: is
a state allowed to interfere so much in people's private sphere? This question,
which has certainly left its mark on our lives on the socio-economic and
cultural front, has found much difficulty in gaining approval, especially in the
context of compulsory quarantine and compulsory vaccinations, which we will
discuss in a moment.
(https://www.researchgate.net/publication/
8240512_The_concept_of_quarantine_in_history_From_plague_to_SARS )

The history concerning vaccines did not begin with Jenner's smallpox vaccine
and will not end with the recent vaccines against the new coronavirus. Its
history begins in ancient China with an immunisation procedure called
'inoculation', used to trigger immunity against smallpox. The first written
account of the procedure dates back to 1549.
The practice of inoculation reached Constantinople (modern-day Istanbul) in
the mid-1600s. From there, it moved to Europe and North Africa. From North
Africa, the practice arrived in the Massachusetts Colony. A local Boston
physician adopted and promoted inoculation when a deadly smallpox epidemic
arrived in Boston in 1721. It was then clear that inoculation in a controlled
environment and under medical supervision was preferable to contracting
smallpox 'naturally'.
In the late 1700s, Edward Jenner observed that people previously infected with
cowpox were immune to smallpox. He conducted a series of experiments and
the subjects of these experiments showed a mild reaction to cowpox and no
reaction or disease to smallpox inoculation. The first vaccine was born. In the
1930s, scientists developed the electron microscope used to visualise
structures smaller than those seen through an optical microscope. This led to a
revolution in virology, as individual viral particles were seen and classified
according to their shape and size. On the basis of these characteristics, viruses
were quickly catalogued and vaccines arrived almost as quickly. In the 1940s,
scientists worked on vaccines mainly against influenza, polio, measles and
other viruses deemed dangerous to national security. At that time, it was
realised that polio consisted of three types of viruses in the same group, so a
vaccine against one type did not protect against the others, but thanks to
knowledge of the different types of viruses in the same group, scientists found
vaccines against all types of strains. In 1954, Jonas Salk and his team developed
the first vaccine against polio. But in the 1960s, oral polio vaccine began to be
administered as a replacement for Salk's vaccine, which had lost public
confidence after the Cutter incident. As of 2002, the vaccine used is the Salk
vaccine or IPV containing the three killed polio viruses. Nowadays polio has
been eliminated in almost the entire world, type 1 is only present in Central
Asia.
The 1950s and 1960s also brought great cooperation between nations to
eliminate and then eradicate smallpox. Thanks to programmes in developed
countries, all individuals were vaccinated from a young age, with no exceptions
allowed other than medical ones. Those who did not want to be vaccinated
faced heavy fines and the inability to participate in public spaces such as
schools or even in certain jobs. Thanks to a worldwide effort to vaccinate every
living person, smallpox became the first human virus to be eliminated, the last
case being detected in 1978. Since then, the smallpox vaccine has only been
used for personnel working in close contact with the virus and for members of
the armed forces as part of the preparation against an intentional release of
the virus.
With regard to covid-19 vaccination, there has been much criticism concerning
the policies undertaken by the various states. In many EU states, the
vaccination was made compulsory, as in the case described above (of
smallpox), without vaccination it was not possible to enter public but also
private spaces in many cases. This opened up again the question of how much
a state could affect the individual sphere of people. But as the well-known
political philosopher John Stuart Mill pointed out: there are cases in which in
order to defend society and freedom, the intervention of the public subject is
necessary.
To avoid running into the same problems as covid, with the arrival of
monkeypox, WHO decided to consider it an endemic in Africa and declared the
disease a global health emergency in 2022.
The factors that have led to the increase in infections worldwide are many:
globalisation and travel, global warming, the spillover infection, bioterrorism,
refugees and asylum seekers and the low survaillance, but we could make a
much longer list.
Regarding global warming: changing seasons and weather introduce many
insects. It is therefore not uncommon to find cases of death from mosquito
bites even in socially and economically advanced places.
We use the term spillover infection to refer to human contact with an animal
population that has a high concentration of transmissible pathogens. This can
occur in the forest reservation or in the national park.
Bioterrorism is another of the global challenges to be combated. It consists of
the use of biological agents that are harmful to humans, in actions such as
attacks or massacres aimed at creating collective panic.
On the subject of surveillance, periodic checks of the water or nature are
necessary so that diseases dangerous to human safety are not transmitted.
The episode on the Covid situation ended with a beautiful reflection on the
concept of one healt: humans, animals and the environment influence each
other, everything is interconnected. It is necessary for each of us in our own
small way to respect this connection.