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Hello Everyone,
My name is John Flanagan and I am chairing along with a friend of mine, Malcolm Flaherty. We are both juniors at BC High and I attended the BC High conference last March as a delegate representing Qatar in regards in attempt to find a way to create a healthy earth. I wish I had prepared more. I would have been a more effective delegate.
Nevertheless, I am grateful to be given the opportunity to lead a very familiar topic to all of the delegates, and eager to make meaningful progress in a very current and serious topic. I just hope that no one makes the same mistake as I did, because work gets done when you do your research.
For Malcolm,
John Flanagan’22
My email address is [email protected] and Malcolm’s is [email protected]
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Introduction to the Topic:
The majority of this background guide came from the World Health Organization, NAIMUN
(North American Invitational Model UN at Georgetown University), University of North Carolia
Model UN, and the New York University Model UN.
Statement of the Problem
Terms like Novel-Coronavirus, Novel Ebola and Zika Virus stand out as the most
headline grabbing epidemics in working memory, at least in Western Media. COVID-19 is the
disease caused by a new coronavirus called SARS-CoV-2. The World Health Organization
(WHO) first learned of this new virus on 31 December 2019, following a report of a cluster of
cases of ‘viral pneumonia’ in Wuhan, People’s Republic of China.
Though the Ebola and Zika virus were centered in West Africa and Brazil respectively,
fear of the diseases spread like wildfire across the world. In our current state of global
interconnectedness, where one can step on a plane in Chicago and wake up on a different
continent, and with increasing rates of urban density, disease has the opportunity to spread
further and faster than ever before.1 What were once local or regional outbreaks have the
potential to arrive on the doorstep of any nation, thus making any infectious disease on one part
of the planet the concern of every nation.
Delegates should arrive in committee with an understanding of where efforts can be made
to improve the response to an epidemic at every step along the path of progression: from
1 Hannah Ritchie and Max Roser, “Urbanization,” Our World in Data, June 13, 2018, https://ourworldindata.org/urbanization. BC High MUN 29
prevention, to identification, to tracking, to quarantine, and hopefully to elimination of the
disease.
The Nature of Pandemic Disease
The current definition of an epidemic is the “occurrence in a community or region of
cases of an illness, specific health-related behavior, or other health-related events” that occur in
excess of what is normally expected.2 While in an epidemic the location and time period in
which the cases happen are specified, the number of cases depends on a variety of factors,
including the size of the community, type of population exposed, and whether the region has
been previously exposed to the disease. A pandemic, on the other hand, implies an epidemic that
occurs “over a very wide area, crossing international boundaries and usually affecting a large
number of people”.3 This term fails to include any specific definitions regarding population
immunity, virology, or disease severity, aspects that are vital to addressing public health
concerns.
The consequences of the failure to include certain topics in the definition of a pandemic
can be seen in the ongoing debate between interpretations of seasonal vs pandemic influenza.
The main distinction between the two is characterized by the time of year that influenza takes
hold. Although seasonal influenza does cross international borders and affects a large number of
people, the fact that the virus occurs annually is important. A true influenza pandemic occurs
when an out-of-season, almost simultaneous, transmission takes place world-wide.4
2 “WHO | Definitions: Emergencies,” WHO, accessed May 17, 2019, https://www.who.int/hac/about/definitions/en/. 3 Last, Spasoff, and Harris, A Dictionary of Epidemiology. 4 “WHO | The Classical Definition of a Pandemic Is Not Elusive,” WHO, accessed May 17, 2019, https://www.who.int/bulletin/volumes/89/7/11-088815/en/.
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While it was easy to identify a pandemic, the classical definition failed to describe the
influenza pandemic in terms of the potential range of transmissibility and disease severity. The
consequence was a slow response to the virus.
Spread of Disease
In addressing pandemics and health crises, it is necessary to identify the ways that
diseases can spread. One of the most common types of diseases are airborne diseases. These
diseases can spread through the air as small droplets or tiny aerosol particles. The germs in these
droplets can often live on surfaces and spread when people touch those surfaces.5 Another
transmission route is that of fecal spread. Some infections can be spread when microscopic
amounts of feces from an infected person are taken in by another person by mouth.6 Sometimes
this occurs directly from soiled hands to the mouth or indirectly by way of objects, surfaces,
food, or water. More generally, infections can be spread through blood or other body fluids. This
occurs when an infected person comes into contact with the bloodstream or mucous membranes
of an uninfected person, such as through kissing or breastfeeding.7 Furthermore, viruses and
bacteria can be spread through food, as hygiene, preparation, and safety practices regarding food
differs between nations and cultures.12 Other ways in which infectious diseases can spread is
through sexual contact, contact between animals or insects and humans, and even contact
5 “Understand How Infectious Diseases Spread | Travelers’ Health | CDC,” accessed May 19, 2019, https://wwwnc.cdc.gov/travel/page/infectious-diseases. 6 Lorna Fewtrell and Jamie Bartram, eds., Water Quality: Guidelines, Standards, and Health: Assessment of Risk and Risk Management for Water-Related Infectious Disease, World Health Organization Water Series (Geneva: World Health Organization, 2001).
7 “Understand How Infectious Diseases Spread | Travelers’ Health | CDC,” accessed May 19, 2019, https://wwwnc.cdc.gov/travel/page/infectious-diseases. 12 Ibid. BC High MUN 29
between a mother and an unborn child. Although it may be easy to impose restrictions on the
interactions between individuals and between people and their environment, it is important to
recognize that there are cultural practices that may facilitate the spread of diseases. disaster preparedness.
Globalization
One aspect of globalization that warrants further investigation is how the wide-ranging
changes associated with it are affecting infectious diseases and epidemiology. The rate of
infection depends on a mix of biological and social factors. Transmission is not only affected by
the type of infecting agent but also by the living conditions of the human population in which the
agent is being spread, including the social and cultural practices, as well as, the population size,
age-distribution and population density.8 Changes in any of those variables can influence the
emergence, re-emergence, or disappearance of certain infectious diseases. It is necessary to note
that there is likely no one change in global trends that can be pointed to as the root cause of
increased disease transmission. chances of successfully implementing measures to prevent,
control and treat infectious diseases.
One impact of globalization is that individuals and population groups respond differently
to change. This causes differences between populations in vulnerability to infectious diseases.
Globalization is creating greater inequities within and across member states, which in turn
enables infectious diseases to disproportionately affect the poor.9 Whether it is due to inequities
8 Special Programme for Research & Training in Tropical Diseases (TDR), “Globalization and Infectious Diseases: A Reivew of the Linkages” (UNICEF/UNDP/World Bank/WHO, 2004). 9 Ibid. BC High MUN 29
in basic living conditions or the availability of and access to health care in certain areas, there is
strong indication that poorer populations do not receive as many benefits of globalization and,
therefore, innovations of infectious disease prevention
Current Resources to Respond to Epidemic
We are continuously reminded of the ways that people all over the world are vulnerable
to infectious diseases, known and unknown. Will history continue to repeat itself? The answer
must be yes and that is why current epidemic response resources are key to understanding how to
respond to pandemics. The World Health Organization currently maintains an emergency
response framework that is guided by various principles including country focus, evidence-
based programming, partnership, accountability, and gender, age, and vulnerability sensitivity.10
Furthermore, the WHO focuses on the epidemic phases when developing ways to stage response
interventions. The dynamics of diseases typically occur in four phases: introduction or
emergence, localized transmission, amplification, and, finally, reduced transmission immunity.
Using these phases, it is easier to develop a response to the disease and the sequence of
interventions (anticipation, early detection, containment, control and mitigation, and elimination
or eradication) that then become necessary.
10 World Health Organization, “Emergency Response Framework,” n.d., https://apps.who.int/iris/bitstream/handle/10665/258604/9789241512299eng.pdf;jsessionid=256C1F75F51E56EE2E 69F5F0A72782C9?sequence=1. BC High MUN 29
Distrust of Public Health Efforts
While the WHO is quick to respond to emergencies, often the problem regarding
infectious disease management relates to long-term care and resource building for the affected
country. For example, in the United States, distrust of the healthcare system is relatively high in
the general population.11 In countries like the Democratic Republic of Congo, the lack of trust in
institutions trying to implement a control strategy has likely enabled the Ebola Virus to spread
faster.12 For example, in 2011 the CIA recruited a Pakistani doctor to go door to door offering
Hepatitis B vaccines as a cover for the acquisition of DNA samples that could be used to find
Osama bin Ladin, the leader of Al Qaeda.13 Following the assassination of bin Ladin, Taliban
commanders banned other vaccination programs to prevent the interference of the CIA. As
movements related to this distrust, such as the anti-vaccination movement, expand, fear of public
health institutions and fear during epidemics will only increase, inhibiting the ability of public
officials to respond to outbreaks and implement the necessary strategies to save lives.
History of the Topic: This section of the background guide will feature some of the epidemics
of our distant and more recent past in order to demonstrate the changing ways communities and
governments have responded to devastating infectious disease.
11 Armstrong K, Rose A, Peters N, Long JA, McMurphy S, Shea JA. Distrust of the health care system and self- reported health in the United States. J Gen Intern Med. 2006;21(4):292–297. doi:10.1111/j.1525-1497.2006.00396.x 12 Patrick Vinck et al., “Institutional Trust and Misinformation in the Response to the 2018–19 Ebola Outbreak in North Kivu, DR Congo: A Population-Based Survey,” The Lancet Infectious Diseases 19, no. 5 (May 1, 2019): 529– 36, https://doi.org/10.1016/S1473-3099(19)30063-5. 13 Lawrence O. Gostin, “Global Polio Eradication: Espionage, Disinformation, and the Politics of Vaccination,” The Milbank Quarterly 92, no. 3 (September 3, 2014): 413–17, https://doi.org/10.1111/1468-0009.12065. BC High MUN 29
The Plague
“The Plague” was actually the disease behind three global pandemics: “The Justinian
Plague of 541-544”, “The Black Death of 1347-1352”, and its final pandemic emergence as the
“Great Plague of London from 1665-1666”.14 The Plague outbreak that this section will talk
about is the Black Death, in order to demonstrate early ideas about the causes of pandemic and
disease, strategies to contain pandemic spread, and treatment options for the ill.
At the time of the Black Death there were two main ways that those practicing medicine would
treat and explain disease: the humoral theory of medicine, and miasma theory.
The first, formalized by Hippocrates between 460-370 BCE, was the humoral theory of
medicine wherein the body was governed by the four main liquids/humours of the body.15 Blood,
yellow bile, black bile, and phlegm generated in the body were associated with different
properties of wet and dry, and hot and cold, and it was thought that when there existed an excess
or shortage of any of these humours disease was sure to follow. This encouraged medical
treatments based on restoring balance to the humours. This involved prescriptions such as eating
spicy food to counteract a shortage of one’s warm humour, or vomiting or bloodletting to
counteract an excess of blood or bile.
The humoural theory encompassed the “proper” treatment of the ill while miasma theory
was more concerned about the source and spread disease. Rather than the concept that disease
was communicable from human to human, miasma theory explained that individuals could catch
14 John Frith, “The History of Plague-Part 1. The Three Great Pandemics,” The Journal of Military and Veterans’ Health 20, no. 2 (n.d.), https://jmvh.org/article/the-history-of-plague-part-1-the-three-great-pandemics/. 15 Eddie Playfair, “Pathologically Wrong: Humours and Miasma.,” Eddie Playfair (blog), March 18, 2018, https://eddieplayfair.com/2018/03/18/pathologically-wrong-humours-and-miasma/. BC High MUN 29
ill from the air if it contained bad smelling decomposing materials or gases made poisonous from
other sources. Such a theory gave rise to medical treatments based on the pursuit of “fresh air.”
Plague was thought to be a “hot” and “moist” disease
spread by poisonous airs. Therefore, under the
humoral theory of medicine doctors made
recommendations such as avoiding hot baths and
excessive physical activities that would cause one to
breath in too deeply.16 Humors were linked to
different emotional states, and individuals were
recommended to avoid “jealousy, anger, sadness, and
fear.”33 Bloodletting remained a popular treatment or
preventative measure for the plague. Belief in the
miasma theory of disease lead to strategies aimed at
preventing the bad airs from entering one’s home or
communities, such as filling spaces with pleasant smelling things, instructing butchers
to slaughter animals outside of city limits to avoid the smells of their entrails, or
replacing bad airs through the process of fumigation.34 One could also always flee to
escape the bad airs.
Some things to highlight from this period are the vulnerability of minority populations in
times of crisis, as local populations tried to find the source of the terrifying new disease and
16 Joseph A. Legan, “The Medical Response to the Black Death,” Spring 2015. 33 Ibid. 34 Ibid. BC High MUN 29 traditional explanations failed. While the actions of the government in isolating the healthy population from plague victims and those suspected of the plague was well-advised, many government methods were more terrifying for the lay person then the possibility of contracting the plague elsewhere, and thus families were prompted to flee these high-risk cities to the counterproductive end of likely spreading the plague further.40 Finally, while some cities engaged in the first public health practices, many other local communities and regional governments did not engage in any preventative or responsive behaviors for decades if not centuries, leaving the larger region at risk much like how individuals who refuse vaccination decrease the herd immunity of their larger community.17
Regardless of what the mind wants the believe, reports state that are over 85 million and counting cases worldwide, and a total of 1.84 million confirmed deaths from the virus. With symptoms that are basically the same as a winter flu, it was very difficult to decide when the winter weather in February 2020 straggles along to the Western Hemisphere. However, it was strangely enough until June 2020 that Italy had become the first notable hotspot behind China for the virus as their cases skyrocketed. The flu-like symptoms spread to the elderly quickly turned fatal, as Italy peaked with the percentage of fatality’s from a COVID-19 case to 14.53% on June
21, 2020. The highest number following this percentage rate took place in the United States on
March 4, 2020, which capped off at 7.2%.
Countries have taken some different precautions with responding to this disease, obviously due to the fact that more country’s hold a bigger population than others. For example,
17 “The Black Death and Early Public Health Measures,” accessed September 5, 2019, http://broughttolife.sciencemuseum.org.uk/broughttolife/themes/publichealth/blackdeath. BC High MUN 29
the country of Denmark, which was projected to account for roughly 6.1 million people in 2020,
was able to diminish the virus effectively and efficiently. Other countries have followed suit with
their strategy of “social-distancing” and “quarantine”; two words that should never be repeated
again after this pandemic is neutralized. Nevertheless, the results from Denmark’s action led
bigger nations to adapt the same laws.
COVID-19’s footprint in what used to be normal life: education, sports, restaurants, and
being outside in general. The world adapted modern technology into one’s lifestyle. Globally, it
appears that the virus has become a nonfactor to some countries. An example of this took place
on New Year’s Eve, as the city Dubai was lit up with costly firework displays to a massive
crowd watching from the street.
Problems/Obstacles/Threats/Strengths/Weaknesses:
Because of modern technology and medicine, longer life expectancies, and rapid
communication, the world has been able to keep this virus at a low. However, the numbers of
COVID-19 fatalities in Italy taught health professionals who are trying to combat the virus
something worth noting. Of the 63.5 thousand deaths from COVID-19 in Italy, more than 85%
of the patients were 70 years and above.
Possible Solutions In addressing epidemics and pandemics, organizations throughout the world typically use a
similar framework, in which solutions to the problem of pandemic disease should all fall under
the categories of mitigation, preparedness, response, and recovery. Working in a cycle,
emergency management plans function so that communities are always involved in at least one
phase of emergency management at any time. Communities are actively engaged in the process BC High MUN 29
of disease control in culturally appropriate manners through the use of Risk Communication and
Community Engagement (RCCE) such that community members can understand and impact
their own health outcomes.
Mitigation Mitigation involves actions taken to prevent or reduce the cause, impact, and consequences of a
pandemic.18 One of the most important steps of mitigation is identifying appropriate clinical and
epidemiological-related public health actions, where clinical actions address actions taken in
medical facilities and epidemiological-related actions address broader issues of pandemic
response. Delegates should base their actions on current public health and science-based
standards that are established on both an international and national level. An evidence-based
public health approach could potentially have numerous direct and indirect benefits, including
access to more higher-quality information on best practices, a higher likelihood of successful
prevention programs and policies, greater workforce productivity, and more efficient use of
public and private resources.19 For example, in Vietnam a study conducted on the financial burden of cancer generated new evidence regarding the impact of poverty on cancer treatment.20
Given this evidence, Vietnam’s National Strategy for Cancer Control plans to implement policies
18 Federal Emergency Management Agency, “FEMA Disaster Response Management,” n.d., https://training.fema.gov/emiweb/downloads/is111_unit%204.pdf. 19 Giedrisu Vanagas, Malgorzata Bala, and Stefan Lhachimi, “Evidence-Based Public Health 2017” (BioMed Research International, November 15, 2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705863/. 20 Kien V. D., Van Minh H., Giang K. B., Dao A., Tuan L. T., Ng N. Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam. International Journal for Equity in Health. 2016;15(1, article 169) doi: 10.1186/s12939-016-0460-3. 122 Federal Emergency Management Agency, “FEMA Disaster Response Management,” n.d., https://training.fema.gov/emiweb/downloads/is111_unit%204.pdf. BC High MUN 29
that can reduce or remove the financial barriers and provide financial protection for cancer
patients.
Preparedness Preparedness includes planning, training, and designing educational activities for events
that cannot be mitigated.122 This could include the use of a safe, effective, and affordable vaccine
or the development of a better and more trustworthy institution of public health law. Law is an
especially key form of preparedness as it can improve access to vaccinations and contraceptives
and can facilitate the screening, counseling, and education of those at risk of infection.21
However, in many communities there exists a level of distrust for larger medical institutions,
which often results in the rapid spread of disease that leads to unnecessary and preventable
deaths.
Particularly in the context of bioterrorism, systems for infectious disease surveillance are
important. Technologies like mobile health tools to digitize and transmit diagnostic results from
multiple locations will be key in managing disease control programs and providing real-time
disease surveillance directly from the point of care.22 For example, the successful experiences in
Senegal, Nigeria, and Mali, during the 2014 Ebola epidemic demonstrated the importance of
preparedness, especially in regards to diagnostic response, and the importance of having the
capacities in place to mount a rapid and comprehensive emergency response. Although in the
21 World Health Organization, “Health Law: Controlling the Spread of Infectious Diseases,” n.d., https://www.who.int/healthsystems/topics/health-law/chapter10.pdf. 22 Global Solutions for Infectious Diseases, “GSID System,” accessed July 19, 2019, http://www.gsid.org/our_programs.html. BC High MUN 29
case of these nations the diagnostic response was ultimately effective, it was also slow and
expensive.
Response The response phase occurs in the immediate aftermath of a disaster. This phase depends
heavily on the level of preparedness of a community. A key aspect of the response is speed.
Previous responses to diseases such as HIV/AIDS are examples of how some outbreaks that
initially do not infect large populations can grow to global proportions if they are not
aggressively addressed early on. While early surveillance of the epidemic commenced relatively
early on, preventative actions for HIV/AIDS were not fully put in place until much later. On the
other hand, when outbreaks of respiratory diseases caused by SARS coronavirus and influenza
viruses have occurred, concerted efforts were immediately commenced. Medical professionals,
epidemiologists, and other specialists to assist with on-site investigations and emergency
operations centers around the world provided round-the-clock coordination and response. A
country must have the capacity to not only isolate the organism but to conduct the necessary
epidemiologic investigations to rapidly identify the cause of an outbreak or epidemic and to take
effective actions to contain and prevent the spread of the disease.
Recovery The final phase is the recovery, which focuses on restoration efforts. Depending on the
type and level of disaster, the recovery period for a particular community can be prolonged. In
general, delegates should develop recovery abilities for their nations that focus on identifying BC High MUN 29
critical assets, facilities and other services that can guide and prioritize recovery operations.23
These services can be offered by a number of groups working in the public health, emergency
management, health care, human services, mental/behavioral health, and environmental health
sectors. It will be important for delegates to establish a system that identifies and monitors
different recovery needs that are unique to each member state. Furthermore, areas in need of
disaster relief require additional supporting recovery operations from groups specializing in this
field.
Bloc Positions
National Borders and International Trade A nation’s willingness to allow transit across its national borders is highly correlated with
its economic dependence on more flexible borders, such as a reliance on tourism or a reliance on
the movement of goods and services produced and rendered by other nations and their citizens.
The openness of a nation’s borders, as determined by economic pressures or other political
motivations, will determine a nation’s outlook on methods to contain and prevent the spread of
pandemic.
Nations that maintain closed borders, or are able to do so due to independence from
international markets, may be more hostile concerning measures that could possibly protect their
already more isolated nations from the spread of a pandemic. As the 2005 International Health
Regulations stated its goal is to “prevent, protect against, control and provide a public health
23 Center for Disease Control, “Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health,” January 2019, https://www.cdc.gov/cpr/readiness/00_docs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf. BC High MUN 29
response to the international spread of disease… [and to] avoid unnecessary interference with
international traffic and trade,” the World Health Organization typically condemns nations that
close off their borders in ways more drastic than what the WHO has called for per each crisis
response.
Generally Open Borders or Dependence on a Highly Globalized Economy
Nations in this category are dependent on highly globalized systems of trade and may
suffer larger economic consequences of a WHO mandated quarantine or shutdown of trade.
However, it is important to separate nations with highly globalized systems of trade into if their
economies are strong enough to handle the stress of travel restrictions. Nations with more
precarious economies would shy away from “quarantine” dependent methods to restrict the
spread of pandemic disease.
Foreign Aid For nations with limited resources to deploy towards public health emergencies,
nongovernmental aid organizations (NGOs) and UN deployed efforts can be important partners.
Such organizations can bridge important gaps in the coverage government is able to provide.
Yet, WHO member states have many priorities that may result in opposition to the presence of
NGOs and international aid efforts. States may have national security concerns, possibly seeing
foreign aid as a way for outside bodies to control their nation from afar depending on who is
funding this foreign aid.24 Foreign aid workers may be held less accountable to abide by
24 “Why Countries Should Welcome, Not Fear, Foreign Funding of NGOs,” Lawfare, May 13, 2018, https://www.lawfareblog.com/why-countries-should-welcome-not-fear-foreign-funding-ngos. BC High MUN 29
domestic standards and regulations, as they will simply return to their home nation at the end of a
crisis.
Nations would find themselves divided in policy based on their existing trust of foreign aid
bodies and tolerance for these organizations and workers. Nations will also be divided on policy
related to foreign aid into nations who primarily provide foreign aid, and nations who primarily
receive foreign aid. Nations that primarily provide foreign aid would emphasize autonomy for
their aid efforts and protections for aid workers, while nations who primarily receive foreign aid
would likely base policy around how to hold foreign aid workers and organizations accountable
to national standards.
Questions to consider:
1. Could the world’s response have been better coordinated? What could be changed to confront
the next virus?
2. We invite delegates to think of a response to this latest COVID-19 crisis along with the
inevitable viruses to come in the future. What went wrong?
3. How do we plan for a swift and effective execution against any future diseases that come and
try to change our everyday lives?