Biodefense Strategies to Reduce the Impact of Communicable Diseases in Developed Countries: The Need of New Policies Designed for Mobile and Vulnerable Populations

Giancarlo Ceccarelli^1,2*, Adriano Purgato², Ugo G. Pacifici Noja² and Laura Elena Pacifici^1,2

¹Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Via del Policlinico 155, 00161 Rome, Italy

²Department of Emergency Services - Office for International Health Cooperation - Italian Red Cross, Via del Policlinico 155, 00161 Rome, Italy

*Corresponding Author:

Giancarlo Ceccarelli
Department of Public Health and Infectious Diseases
University of Rome “Sapienza”, and Department of Emergency Services
Office for International Health Cooperation - Italian Red Cross, Rome Italy
E-mail: Giancarlo.Ceccarelli@uniroma1.it

Received Date: September 24, 2012; Accepted Date: September 26, 2012; Published Date: September 28, 2012

Citation: Ceccarelli G, Purgato A, Pacifici Noja UG, Pacifici LE (2012) Biodefense Strategies to Reduce the Impact of Communicable Diseases in Developed Countries: The Need of New Policies Designed for Mobile and Vulnerable Populations. J Bioterr Biodef 3:e106. doi:10.4172/2157-2526.1000e106

Copyright: © 2012 Ceccarelli G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Migration is a major global phenomenon which influences the health of individuals and populations; currently, estimates suggest that there are more than one billion migrants world-wide. Conditions surrounding modern migration may expose migrants to increased health risks and negative health outcomes: in fact increased movement of people across borders has a great influence on the incidence of communicable diseases, relevant to public health, in developed countries. In addition, migration is continually emphasizing public health responses to the threat of communicable diseases at the international level.

For these reasons, during the 61st World Health Assembly (May 2008), a resolution on the health of migrants was endorsed. Member States were invited to promote health policies which were sensitive to the needs of migrants and specifically: “to gather, document and share information and best practices for meeting migrants’ health needs in countries of origin or return, transit and destination”. Moreover the Assembly Resolution 61.17 on the Health of Migrants calls upon Member States: “to promote migrant-sensitive health policies” and “to promote equitable access to health promotion, disease prevention and care for migrants” [1]. This new way of health promotion is based on the idea that global biodefense is a goal achievable with policies addressed to a continuative attention focalized on migrants and vulnerable populations. However, actually few binding regional or global health protection agreements are operating to respond to the true scope of contemporary migration. Moreover, where migration health policies exist, they operate primarily in isolation at regional or national levels and cover only fragmented snapshots of people’s movement. Currently in many developed countries surveillance system for communicable diseases are based primarily on screening tests at the entry. For example in the United States of America, the basic strategy of control of communicable diseases is based on a medical examination for all refugees and all applicants for an immigrant visa. In the same way also aliens in the United States who apply for adjustment of their immigration status to that of permanent resident are also required to be medically examined. Aliens applying for temporary admission may be required to undergo a medical examination at the discretion of immigration officer, if there is reason to suspect that an inadmissible health-related condition exists. This monitoring system appears to be very effective in reducing the impact of transmissible diseases imported by migratory movements. However, this resource is not sufficient to control completely the epidemiological risk related to communicable diseases. In fact we should consider that often migrants arrive in good health and only later they get sick: this is called the “healthy migrant effect”. A growing body of literature describes that in general there is a selection in the people who migrate, as migrants are often younger and healthier than the majority of population in their countries of origin. However, some migrants may not respond to the concept of “healthy migrant”; this is the case for many quota refugees who migrate because of a need for protection and who often have chronic diseases or disabilities [2].

An element which contributes even further to complicate this situation is the fact that the “healthy migrant effect” may fade out over time because migrants are exposed to risk factors in the recipient country: some of the risks experienced after arriving in the recipient country include language barriers, long-lasting asylum seeking processes, lack of knowledge about health services in the new social context, and marginalization.

From a legal and regulatory point of view, it should also be noted that restrictive migration policies could cause an increasing number of migrants to travel in a clandestine manner; moreover labour and economic downturns lead also many regular migrants to occupy the lower social strata of society and give them limited access to health care and living conditions.

In addition to the elements previously described it is very important to consider that North America and Europe also share several neglected infections of poverty: in fact given the recent global economic crisis, a large group of autochthon population of these areas lives in condition of fragility or poverty and could be a reservoir for communicable diseases [3,4].

Another factor, not often known but still important, is that there are large temporary movement of people related to tourism and business activities which may be misunderstood because of the spread of communicable diseases.

Finally, not least of all the above considerations, it should be noted that many policies and regulations are bogged down on linguistic misunderstandings and different definitions of the words: in fact, as summarized by Lurie and Decosas respectively “most studies simply classify people as either migrants or non-migrants. In reality the situation is considerably more complex; there are in fact many different types of migration, and each type may carry with it different risk factors. In addition, people’s migration status is likely to change several times over the course of their lives” [5] and “migrants may be defined by their legal status or ethnicity, or migration can be categorized using parameters of duration, motivation, and distance” [6].

Substantial global movement of peoples from low- and middleincome countries is expected to increase during the coming years, along with the proportion of marginalized migrants significantly.

In the near future it is necessary to share experiences and lessons learned, proposing protocols and models in order to advocate for the adoption of policies which will promote the health of mobile and vulnerable populations. Policies to protect public health and migrant will be most effective if they address the multiple phases of the migratory process. In fact, health intervention opportunities are available at each stage including travel, destination, interception, and return [7].

Anyway migrant-inclusive health policies are not sufficient and they must be complemented with policies addressed to protect also vulnerable autochthon populations and to prevent that they can be a reservoir of communicable diseases.

Finally, it is crucial to remember that every policy should always be based on human rights principles that foster available and accessible care for all mobile and vulnerable peoples.

As globalization appears to be an irreversibly process and biodefense from communicable diseases is linked to population mobility and vulnerability, it is time for decision-makers from the migration and health sectors to write new adequate policies to make migration safe and to protect public health from these pathologies.

References

1. (2008) 61st World Health Assembly – Resolution. WHO
2. Thomas SL, Thomas SD (2004) Displacement and health. Br Med Bull 69: 115-27.
3. Hotez PJ (2009) Neglected diseases amid wealth in the United States and Europe. Health Aff 28: 1720-1725.
4. Hotez PJ, Gurwith M (2011) Europe's neglected infections of poverty. Int J Infect Dis 15: e611-e619.
5. Lurie M, Garnett G, Abdool Karim S, Sturm W, Wilkinson D, et al. (1998) Research Protocol. Migration and the Spread of HIV and Other Sexually Transmitted Diseases in South Africa: Interlocking Urban and Rural Cohort Studies.
6. Decosas J, Adrien A (1997) Migration and HIV. AIDS 11: S77-84.
7. Zimmerman C, Kiss L, Hossain M (2011) Migration and health: a framework for 21st century policy-making. PLoS Med 8: e1001034.