"Debordering" public health: the changing patterns of health border in modern Europe

According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference).

Need for integrative thinking to fight against emerging infectious diseases. Proceedings of the 5th seminar on emerging infectious diseases, March 22, 2016 - current trends and proposals

We present here the proceedings of the 5th seminar on emerging infectious diseases, held in Paris on March 22nd, 2016, with seven priority proposals that can be outlined as follows: encourage research on the prediction, screening and early detection of new risks of infection; develop research and surveillance concerning transmission of pathogens between animals and humans, with their reinforcement in particular in intertropical areas (“hot-spots”) via public support; pursue aid development and support in these areas of prevention and training for local health personnel, and foster risk awareness in the population; ensure adapted patient care in order to promote adherence to treatment and to epidemic propagation reduction measures; develop greater awareness and better education among politicians and healthcare providers, in order to ensure more adapted response to new types of crises; modify the logic of governance, drawing from all available modes of communication and incorporating new information-sharing tools; develop economic research on the fight against emerging infectious diseases, taking into account specific driving factors in order to create a balance between preventive and curative approaches.

Healthcare worker compliance with seasonal and pandemic influenza vaccination

Healthcare workers (HCWs) can be an important source of transmission of influenza to patients and family members, and their well-being is fundamental to the maintenance of healthcare services during influenza outbreaks and pandemics. Unfortunately, studies have shown consistently low levels of compliance with influenza vaccination among HCWs, a finding that became particularly pronounced during recent pandemic vaccination campaigns. Among the variables associated with vaccine acceptance in this group are demographic factors, fears and concerns over vaccine safety and efficacy, perceptions of risk and personal vulnerability, past vaccination behaviours and experience with influenza illness, as well as certain situational and organisational constructs. We report the findings of a review of the literature on these factors and highlight some important challenges in interpreting the data. In particular, we point out the need for longitudinal study designs, as well as focused research and interventions that are adapted to the most resistant HCW groups. Multi-pronged strategies are an important step forward in ensuring that future influenza vaccination campaigns, whether directed at seasonal or pandemic strains, will be successful in ensuring broad coverage among HCWs.

Influenza pandemics: past, present and future challenges

Influenza epidemics occur regularly and prediction of their conversion to pandemics and their impact is difficult. Coordination of efforts on a global scale to control or reduce the impact is fraught with potential for under and overreaction. In light of the 1956 pandemic and more recently the SARS and H1N1 pandemics, the public health community took steps toward strengthening global surveillance and a coordinated response in keeping with the continuing memory of the tragedy seen in 1918. The scientific, professional, and technical resources of the 21st century are now advanced far beyond those then available. The H1N1 pandemic which commenced in 2009 progressed differently than predicted; its course was difficult to predict with any degree of certainty. Public responses to national immunization programs against the H1N1 virus have been weak. International movement of diseases can lead to creation of new endemic areas and continuous spread such as that which happened with West Nile Fever and Chikungunya. The lessons learned and the public and political responses to each actual or threatened pandemic will serve public health well in dealing with future challenges.

The doers of good. Scandinavian historians revise the social history of eugenics(1997-2001)

Late disclosure of the large scale of sterilization practices in the Nordic countries created an outburst of scandal: did these policies rely on coercion? To what extent? Who in the end was responsible? Sterilization practices targeted underprivileged people first. The mentally retarded and women were their first victims. Operations were very frequently determined by other people's manipulative or coercive influences. Should the blame be put on the Social-Democrats in power throughout the period (except in Finland and Estonia)? Apart from Denmark, perhaps, local physicians and local services, more than governments, seemed to have strongly supported sterilization practices. Teetotalers and feminists shared responsibilities. How can one explain that eugenics finally declined? Based on a sound application of the Hardy-Weinberg law, the science of the eugenicists was correct. Was it politics? But uncovering of the Nazi crimes had only a very small impact on eugenics. Some authors underline the fact that the Nordic scientific institutions were particularly suited to liberal values. Others point to the devastating effect on eugenics once hereditarist psychiatry fell from favor in the middle of the sixties.

Comme en 1918 ! La grippe « espagnole » et nous

The 1918 pandemic is still unique in the history of flu pandemics. The pathogenicity of the virus was extreme, and young adults more than infants and old people were its main victims. Many a death was caused by complications. The response of the French authorities didn't live up to the emergency requirements. Hospitals being requisitioned by the military, the civilian population lacked everything: beds, doctors, nurses, ambulances, drugs. For want of preventive or curative medicine, authorities could have done very little at any rate: public health measures (quarantine and isolation of the sicks) were unable to stop contagion. More than the war itself, present day historians indict the war-boosted increase in railways and sea communications between the continents and between the rear and the front. This momentous growth in transportation activities brought about a "bacterial equalization" throughout social categories and regions of the world. A most singular episode, whose historical chances to replicate within the next ten years are rather slim.

[Scandinavian eugenics: Nordic historians provide new approaches]

Late disclosure of the large scale of sterilization practices in the Nordic countries created an outburst of scandal: did these policies rely on coercion? To what extent? Who in the end was responsible? Sterilization practices targeted underpriviledged people first. The mentally retarded and women were their first victims. Operations were very frequently determined by other people's manipulative or coercive influences. Should the blame be put on the Social-Democrats in power throughout the period (except in Finland and Estonia)? Apart from Denmark, perhaps, local physicians and local services, more than governments, seemed to have strongly supported sterilization practices. Teetotalers and feminists shared responsibilities. How can one explain that eugenics finally declined? Based on a sound application of the Hardy-Weinberg law, the science of the eugenicists was correct. Was it politics? But uncovering of the Nazi crimes had only a very small impact on eugenics. Some authors underline the fact that the Nordic scientific institutions were particularly suited to liberal values. Others point to the devastating effect on eugenics once hereditarist psychiatry fell from favour in the middle of the sixties.

Making food safety an issue: internationalized food politics and French public health from the 1870s to the present

Food safety is an ever more conflictive issue receiving media attention. “The increased activity of interest groups, the impact of the Common Agricultural Policy and changes in the retail economy have combined to transform [a relatively closed] food policy community into an issue network”. This account of recent changes lacks the historical dimension that might endow it with meaning. It is hardly appropriate to describe the current situation as a reawakening after a long slumber. In France at least, complaints about food safety voiced in numerous newspaper articles echo enduring concerns and a permanent sense of alarm. In 1957, Demain ran a catalogue of food scares: industrial bread causing eczema; wine adulterated with sulphur anhydride (for safe transportation); eggs and milk feared by doctors to be toxic (because chickens were being fed with chemicals or fish, and cattle with ground up rubbish); and filthy conditions on cattle and poultry farms. Much the same sort of list could have been drawn up early in the century during meetings of the Société Scientifique d'Hygiène Alimentaire (created in 1904), or run in the press following passage of the 1905 Food Adulteration Act, or printed in popular pamphlets such as Dr Raffray's Le péril alimentaire (1912). As the Common Market took shape in the 1960s, repeated articles in the daily newspapers relentlessly focused on the issue of food and public health. In France, arguments were continually framed in the language of the 1905 act.

[Education or constraint: measles vaccination in France during the belle époque]

The dreadful nature of the epidemic of 1870 explains why smallpox, not cholera, played a central role in the French public health regulations. And yet, France went it alone on the matter. The rules required isolation for the contagious sick and mandatory notification of the disease almost everywhere, nevertheless France relied only on persuasion. True, the public health law of 1902 provided the State with new weapons. But would such a mandatory decree be sufficient to awake popular opinion? There was no resistance to the law, like in England or Germany. However, the new regulations took several decades to be enforced, if only because of the poor state of the sanitary administration. Smallpox vaccination was eventually implemented when the authorities discovered that proximity and easier accessibility to services and facilities are of primary importance for patients.