1. West Nile Virus: Social Challenges of Emergent Disease
SEARCH Seminar
December 15, 2009
Sabrina McCormick, PhD
AAAS/EPA & GWU

3. Morbidity and Mortality; 1999-2008
As the story indicates, WNV arrived in the US in Its caused over 1100 deaths and tens of thousands of cases. There are three manifestations of WNV- asymptomatic, fever, neurological. 1/150 experience neurological.

4. What are the central social problems in addressing emergent disease?
Communication Institutional Social contention
The central SOCIAL challenges to addressing these kinds of emergent illness. I intend to answer this question by examining three phases of the disease process. NEXT

5. Public Health Intervention
(1)
Diagnosis
(2)
Public Health Intervention
(3)
Community Responses
Prevention
&
Preparedness
Institutions
Training
Social systems
Media Governance
1- diagnosis
2- intervention
3- community response
there are multiple possible problems in each phase…
These problems can overlap and intersect. All of them are ones that we need to devote greater attention to when it comes to CC and illness. We know little about how these problems crop up as new illnesses occur or existing illnesses get worse. I am going to use the case of WNV to explore how these social problems manifest themselves in this particular case. Within that process I will give you more details on what you have cursorily seen in a short video I will first show you. But before I do that, I want to very briefly discuss why I am using this term – social problem.
Patient experiences
Risk perception Trust of government
Behaviors

6. Three Phases

7. Diagnosis Local to national engagement Human to animal health agencies
NYC DOHMH
NY State
CDC Vector Borne Program
Human to animal health agencies
Bronx Zoo
U.S. Army
Give brief story of Queens, Bronx Zoon, CDC, etc.

8. Intervention Aerial spraying, distribution of DEET
Communication through media channels
Disease surveillance
Once four cases of the disease were discovered, a crisis response plan was triggered.
Over 300,000 cans of DEET, spraying malathion across 100% of the city.
ARboNet

9. A media campaign was instituted to communicate with public about what was happening. We did a print media analysis…
I want to highlight two aspects of that analysis – what interventions were recommended and which voices were heard in reporting.
Intervention slide: (percentage of articles. Total N=1500 articles)
NEXT

10. Community Responses Initial confusion, fear, anger Why?
These are quotes pulled from questions and comments offered by the public during the review of the response. This was held in 2001(?) after it was demanded by several community groups.
These are representatives of what happened more broadly in several locations – lawsuits were leveraged against the state by those concerned about spraying, the most recent of which was initiated last year in CA.

11. Voice in Reporting;

12. Community Responses Lack of participatory governance
“We were extremely upset with the insecticide applications that occurred last fall without any proper notification and demand that we be notified on time if similar operations occur this year.”
“Spraying may address the immediate problem of WNV, but what about the possibility that it will cause cancer 20 years from now?”
Lawsuits: NY and CA

13. Roots of Contention
Inadequate communication channels between agencies, practitioners, government, and communities
Lack of mediating governance mechanisms
Differential risk perception and tolerance

14. For the Future…
Need further exploration of the social dimensions of emergent infectious disease
Particular attention to institutional factors in disease management
Processes through which risk perceptions and tolerances are shaped and legitimized
Interventions need to harmonize differing risk perceptions and agendas, especially with improved communication

16. Social Problem Characteristics:
Public in nature
Gap between social ideals and reality
Significant groups define the problem
Solution possible through collective action
Climate change alters renders existing social practices and behaviors inadequate.
I see emergent disease, and WNV in specific, as a social problem. There are 4 criteria that reflect a social problem: 1)
Public in nature
Gap between social ideals and reality
Significant groups define the problem
Solution possible through collective action
This framework highlights how illness is not just a personal, but rather an inherently social issue, experienced by communities, localities and larger scale social systems.
It shows how there is a gap between what we would like to see happen and what often takes place in disease management.
Using the framework of social problems also demonstrates how those very people who define the problem- be they a health care practitioner, government agency or community resident - influence the outcome.
Finally, this framework demonstrates how solutions are possible if we bring multiple stakeholders together to address emergent illness.
Ultimately, it demonstrates that-- Climate change alters disease patterns such that pre-existing institutions, practices, etc. are inadequate for handling new conditions.