Epidemic communities : climate change, emerging disease and the governance of science

Scientific knowledge is often relied upon for informing crucial societal decisions. Where this knowledge is uncertain, and/or where these decision are made amidst a contexted political landscape, science tends to become the focus of intense scrutiny, as has been evident throughout the history of climate change politics. One consequence is that instead of "scientising" decision-making, science itself becomes more explicitly politicised. This thesis argues that in order to contribute to contemporary debates about the governance of science, it is essential to move beyond the question of whether or not policy-relevant scientific knowledge is credibly and to examine how scientific knowledge is made to be credible. Drawing upon the concept of co-production and other insights from Science & Technology Studies (STS), this thesis presents a detailed examination of how research into the health impacts of climate change (infectious diseases especially) gradually gained in prominence in both public health and climate change circles. Particular analytical attention is paid to an epistemic community of climate change and health (CCH) researchers, following the ways in which they interacted with global political entities such as the World Health Organization (WHO) and the Intergovernmental Panel of Climate Change (IPCC). Based upon in-depth interviews with actors intimately involved in CCH research, this thesis documents how the rise of CCH research influenced and was influenced by particular scientific and political contexts related to the governance of climate change as well as emerging infectious disease. The examination of a longstanding controversy surrounding CCH research reveals many socio-economic and political assumptions embedded in it, further demonstrating its contingency. However, despite that CCH research is both uncertain and contested, actors in the political world often need to know what the state-of-the-art of the field is. To examine the implications of this, the CCH controversy as treated by the assessment reports of the Intergovernmental Panel on Climate Change (IPPC) is explored. Although IPCC follows a complicated set of procedures aimed at ensuring scientific and political legitimacy, this thesis demonstrates that values and normative judgements are important components of scientific assessments, helping to co-construct particular science-policy orderings at the expense of alternative ones. Amidst ongoing debates about how to shore-up the credibility of climate change science and politics, this thesis argues that the way in which IPCC assessments are currently performed, as well as their tendency to present findings as "consensus", may undermine their political and scientific credibility

Hesitancy, trust and individualism in vaccination decision-making

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Key dimensions for the prevention and control of communicable diseases in institutional settings. a scoping review to guide the development of a tool to strengthen preparedness at migrant holding centres in the EU/EEA

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool

The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence.

There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the "SIR" (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control

Multi-institution analysis of racial disparity among African- American men eligible for prostate cancer active surveillance

There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African-American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003–2014 were used to assess potential racial disparity. Of the 333 (14.8%) African-American and 1923 (85.2%) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p \u3c 0.01), pre-op PSA (5.2 v 4.7; p \u3c 0.01), and maximum percentage cancer on biopsy (15.1% v 13.6%; p \u3c 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed. © Dinizo et al

Measles among migrants in the European Union and the European Economic Area

Aims: Progress towards meeting the goal of measles elimination in the EU and the European Economic Area (EEA) by 2015 is being obstructed, as some children are either not immunized on time or never immunized. One group thought to be at increased risk of measles is migrants; however, the extent to which this is the case is poorly understood, due to a lack of data. This paper addresses this evidence gap by providing an overview of the burden of measles in migrant populations in the EU/EEA. Methods: Data were collected through a comprehensive literature review, a country survey of EU/EEA member states and information from measles experts gathered at an infectious disease workshop. Results: Our results showed incomplete data on measles in migrant populations, as national surveillance systems do not systematically record migration-specific information; however, evidence from the literature review and country survey suggested that some measles outbreaks in the EU/EEA were due to sub-optimal vaccination coverage in migrant populations. Conclusions: We conclude that it is essential that routine surveillance of measles cases and measles, mumps and rubella (MMR) vaccination coverage become strengthened, to capture migrant-specific data. These data can help to inform the provision of preventive services, which may need to reach out to vulnerable migrant populations that currently face barriers in accessing routine immunization and health services

Prevalence and heritability of handedness in a Hong Kong Chinese twin and singleton sample

Funding: Research Grants Council of the Hong Kong Special Administration Region (CUHK8/CRF/13G & C4054-17WF), by an internal grant entitled “Reading Development in Chinese and in English: Genetics and Neuroscience Correlates”(4930703) from The Chinese University of Hong Kong (CM is the PI on both grants), by a Hong Kong: Scotland Collaborative Research Partnership award from the Hong Kong Grants Council (CMis the PI for the Hong Kong side) and the Scottish Funding Council (SP is the PI for the Scotland side). It was additionally funded by an International Exchange Kan Tongo Po Visiting Fellowship to SP. SP is a Royal Society University Research Fellow.Background Left-handedness prevalence has been consistently reported at around 10% with heritability estimates at around 25%. Higher left-handedness prevalence has been reported in males and in twins. Lower prevalence has been reported in Asia, but it remains unclear whether this is due to biological or cultural factors. Most studies are based on samples with European ethnicities and using the preferred hand for writing as key assessment. Here, we investigated handedness in a sample of Chinese school children in Hong Kong, including 426 singletons and 205 pairs of twins, using both the Edinburgh Handedness Inventory and Pegboard Task. Results Based on a binary definition of writing hand, we found a higher prevalence of left-handedness (8%) than what was previously reported in Asian datasets. We found no evidence of increased left-handedness in twins, but our results were in line with previous findings showing that males have a higher tendency to be left-handed than females. Heritability was similar for both hand preference (21%) and laterality indexes (22%). However, these two handedness measures present only a moderate correlation (.42) and appear to be underpinned by different genetic factors. Conclusion In summary, we report new reference data for an ethnic group usually underrepresented in the literature. Our heritability analysis supports the idea that different measures will capture different components of handedness and, as a consequence, datasets assessed with heterogeneous criteria are not easily combined or compared.PreprintPublisher PDFPeer reviewe