Global Health Institute

Influenza is a serious disease that leads to the sickness, hospitalization and death of millions of people around the world every year. According to a study conducted by the Centers for Disease Control and Prevention (CDC), on average, eight percent of the U.S. population gets sick from the flu each season, with a range of between three percent and eleven percent, depending on the season. Even though many people do not take the influenza seriously, the greatest death event in the 20th century was caused by an influenza pandemic. The 1918 Spanish Flu killed more people than the Great War (World War I), at somewhere between 21 and 50 million people worldwide in a time when our transportation and global communication systems were not as advanced. 

More recently, during the 2009 H1N1 swine flu pandemic, it was estimated that between 700 and 1400 million people worldwide contracted the illness, including 60.8 million Americans. Based on previous pandemics, we know that a new pandemic can have catastrophic consequences. This is not a matter of “if,” this is a matter of “when”; history suggests that a different influenza virus will emerge and result in the next pandemic. 

A potential influenza pandemic can overwhelm our health and medical capabilities as a result of hundreds of thousands of deaths and millions of hospitalizations. It will also disrupt the social life and cause substantial economic damage, which primarily result from lost work time and reduced productivity of patients and caregivers. Therefore, in 2005, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Homeland Security (DHS) developed the HHS Pandemic Influenza Plan and the National Strategy for Pandemic Influenza, respectively, to prevent, control, and mitigate the effects of influenza A(H5N1) and other influenza viruses assessed to pose high risk to humans. While our national strategy to respond to an influenza pandemic is very comprehensive, I believe that there are two things we need to do: we must continue engaging globally by investing in global health programs and we need to emphasize the one health approach to influenza. 

Global Health: One of the main health challenges that poses global concerns is the fact that public health threats, health emergencies and infectious diseases do not recognize or respect political borders. While the National Strategy for Pandemic Influenza argues that “the most effective way to protect the American population is to contain an outbreak beyond the borders of the U.S.,” earlier this month, the Trump Administration decided to cut more than $3 billion in global health programs, including half of the annual funding to the World Health Organization. While the Fiscal Year 2021 budget invests $998 million to continue on-going influenza activities in the U.S., the U.S. government cannot isolate itself from the rest of the world. This major budget cut worries me not only because it threatens our preparedness measures for an influenza pandemic, but also to any major health emergency. The news came out in a time when the world is fighting a coronavirus outbreak that was declared as a Public Health Emergency of International Concern (PHEIC). 

One Health Approach to Influenza: The concept of One Health recognizes that the health of people is connected to the health of animals and the environment. Both documents discussed the highly pathogenic avian influenza A(H5N1) virus, which mainly occurs in birds. Avian influenza viruses do not normally infect humans. However, these viruses can undergo genetic mutation or exchange of genetic material with a human influenza virus, which make them transmit efficiently between humans. 

While the existing efforts that deal with an influenza pandemic are multi-disciplinary, there is an obvious emphasis on the human and animal components and de-emphasis on the environment component. There are still some global shortenings in environmental and epidemiological detection measures implemented in live poultry markets. For instance, when H7N9 was first reported in China in 2013, multi-sectorial approach was not taken until the number of human infections rapidly spiked. Therefore, when there is an outbreak in a poultry market, we must recognize that this is not only a problem for the Department of Agriculture to address; there will be a great need for coordination and cooperation among local governments, veterinarians, environmental experts, disease control and market management departments.

Mohammed Jibriel (G’20) is a graduate student at the Department of Microbiology and Immunology studying Biohazardous Threat Agents and Emerging Infectious Diseases and a Legislative fellow with the office of Congresswoman Nydia M. Velázquez.

On Tuesday February 11, 2020, Dr. Deus Bazira, DrPH, MPH, MBA, BPharm, joined the School of Foreign Service’s ‘Conversations in Global Health’ class to discuss his experiences in the field of global health. Born in Uganda, Dr. Bazira guided the class through the academic and professional journey that led him to South Africa, Maryland, and ultimately Washington D.C. With a strong passion for learning, Dr. Bazira developed an interdisciplinary lens of law, public policy, business, and diplomacy with which to tackle his ultimate objective: strengthening health systems in emerging economies at both the policy and practice level. Through this lens, Dr. Bazira has been able to analyze global health systems and determine several ways by which they can be made more efficient for maximum humanitarian benefit. 

During our discussion, Dr. Bazira discussed the issues surrounding integrating the private sector into public health initiatives. Public-private partnerships, according to Dr. Bazira, are essential for the delivery of health services in developing countries. However, the profit motive of many pharmaceutical and private healthcare industries frequently creates obstacles for low-income communities’ access to health services. In his paper “Leveraging the Private Health Sector to Enhance HIV Service Delivery in Lower-Income Countries,” Dr. Bazira emphasizes the need for enabling policy, market incentives, and regulations that will allow the commercial sector to work cohesively with the public sector in order to optimize service provision in public health initiatives. He suggests that without meeting these criteria, universal health coverage — or “health for all” — are unrealistic goals. 

Dr. Bazira explained that the key to understanding Global Health is familiarizing oneself with the ins and outs of health systems. He passionately advocates for exploration through education; in order to truly understand the intricacies of the intersection between business, diplomacy, and healthcare, one has to be conversant in and knowledgeable about each field. Dr. Bazira gave several anecdotes about his experiences as a pharmaceutical expert working to advance health policy. He recalled realizing that in order to create change, he needed to gain academic expertise in business, specifically in management strategy. By employing the interdisciplinary lens that he had spent his career developing, Dr. Bazira was able to work with Ministers of Health, the World Bank, and pharmaceutical companies to create cohesive, collaborative plans for strengthening health systems across Africa. 

As a PreMed STIA major concentrating in Global Health and Biotechnology, Dr. Bazira instilled in me a curiosity for how to combine my interests in private medical practice with my broader aspirations of working towards health equity. I am inspired to discover how my education in Foreign Service and Medicine can help me contribute to this objective. I look forward to building off of Dr. Bazira’s insight in order to become the most effective patient advocate and promoter of health equity that I can be. 

Syona Hariharan (SFS ’22) is an undergraduate on the PreMed track studying Science, Technology, and International Affairs in Georgetown’s School of Foreign Service. She is concentrating in Global Health and Biotechnology and minoring in Spanish.