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Prevention or Cure? National Responses to Global Infectious Diseases as a Function of Environmental and Agricultural Change


<OL> <LI> To identify and outline global dynamics (globalization, changing agricultural practices, environmental change) underlying the emergence and spread of transnational diseases, such as BSE/vCJD, SARS, avian flu, malaria, TB. <LI> To systematically compare how different countries perceive and respond to these diseases, examining "first defenses", longer-term institutional responses, risk responses and perceptions, relative socio-economic impacts. What or who are the agents of change in pushing for particular responses? <LI> To critically examine the continued power of the notion of quarantine in a globalized/free market world (of agricultural products and citizens or travelers)<LI> To trace out the impacts of global-national-local interactions and linkages, examining how the WHO, in particular, works with national and local authorities to address global diseases <LI> To determine how health policy is becoming foreign policy: especially of concern with the perceived threat of bioterrorism, and the impact animal diseases have on international trade. <LI> To ask how countries learn from each other and from previous experiences in reforming institutions and responses to combat new threats. How do breakthroughs in disease treatments, vaccinations etc. percolate across national borders, and what political-economic obstacles exist to this process?

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NON-TECHNICAL SUMMARY: The emergence and spread of transnational diseases such as SARS and mad cow disease is becoming a serious economic and political problem worldwide. The study examines and compares the different ways countries and international organizations perceive and respond to these transboundary diseases. <P>

APPROACH: <BR> Literature Review: I will continue my review of the relevant social scientific and scientific literature in the fields of comparative risk assessment, risk and risk perception, global health issues, particular diseases, institutions, immigration and quarantine politics. I will identify and participate in the activities of relevant academic communities, such as Science and Technology Studies, Public Health, Trade and Agriculture. <BR> Initial projects: I have already begun work on BSE as a major case, focusing on policy responses in Europe, the US, Japan, and BSE-free countries such as Australia. I intend next to work on the implications of the different dynamics identified in the "justification" section of this proposal, in particular, how they have mediated particular disease vectors, speed and extent of travel, and so on. At the same time, I plan to work on the paradox of quarantine (including agricultural produce) in a globalized world: what it means, how that meaning has changed over the years, when it is effective, and how it is implemented, across several different countries, selected according to the criteria below. Identifying country cases and diseases: I intend to study diseases that share these common characteristics: they are infectious, have a reasonably high media profile, and occur transnationally. Otherwise, they have different vectors of infection, speed of infection, and are different in the sort of risks they pose. I intend to use the extensive literature on HIV/AIDS as it changed the way global health politics are managed, and set up particular expert communities and agencies that have an impact on other areas of disease control. Using these criteria, I would like to research the following diseases: BSE/vCJD, SARS, avian flu, hepatitis C, tuberculosis, malaria and West Nile virus. My initial choice of countries to examine is based on 2 structural variables: whether they are relatively isolated (few land borders with other countries; little transit traffic of people or goods) or "high traffic" (bordering on many countries, high throughput of people and goods), and whether they are wealthy (advanced industrialized democracies) or emerging economies: this may (but also may not) control for regulatory capacity. <BR> Interviews and Fieldwork: In order to explain why different countries perceive and respond to different transnational diseases in the way they do, and in order to identify the agents of change in terms of redesigning institutional responses, I intend to carry out interviews, archival and document analysis, and analysis of media coverage in the respective countries. Interviews would focus on key public officials at the national and international levels. Potential "non-state" agents of change include the medical community and public health experts, health-oriented social movements (such as exist around HIV/AIDS), pharmaceutical companies, large foundations. <BR> Writing Up and Output: In addition to a book, I expect to generate at least 3 further peer-reviewed articles out of this project (including one on how my findings affect California), and articles intended for more popular journals and newspapers.

O&#039;Neill, Kate
University of California - Berkeley
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