Epidemics, Management of

The standard biomedical definition of epidemic is the sudden spread of a disease among a number of people in excess of normal expectancy. Unlike most social problems, infectious disease epidemics are grave social problems not only because of the possible deadly nature of the disease but also because of the element of surprise and the social context of contamination. For most communities affected by an infectious disease epidemic, the outbreak is unexpected. The mode of contamination tends be a simple daily life activity involving social relations and practices that are innocuous under normal circumstances but that must be halted once the link with the disease becomes evident (e.g., preparing, buying, and selling food; collecting, storing, and drinking water; sharing garments or eating utensils; or engaging in close social and physical contact). The disruption of normal social and economic activities in the affected communities is one of the major consequences of epidemics that transform what begins as one person's illness episode into a large-scale social problem or crisis.

Thus the management of epidemics as a crisis is a problem of governance. Generally, governance refers to the management of the affairs of the collective to ensure safety, fairness, and equality of opportunity for all its individual members. Seen from the perspective of crisis management, unforeseen epidemics are realtime tests of the effectiveness of a country's governance in a time of crisis, and foreseen epidemics testify to the country's level of preparedness. Either way, the political leaders' style of governance becomes a definitive factor in the country's efforts to prevent or contain the epidemic. Consequently, the political and health authorities in the country or region affected by an epidemic are major stakeholders as they are naturally expected to find a solution and implement the measures necessary to deal with the crisis.

The world's experiences with bubonic plague, cholera, typhoid, yellow fever, and countless other infectious disease epidemics of the ancient past have been amplified by encounters with recent epidemics such as HIV/AIDS, SARS (severe acute respiratory syndrome), and the threat of human transmission of the H5N1 virus, commonly known as “avian influenza” or “bird flu.” It is a sign of the times that, compared with past generations, although the world might still be caught unaware by an epidemic in the 21st century, economically advanced countries today are in a better position to manage epidemics. Still, the ability to manage epidemics varies widely across countries depending on the nature of the disease, economic resources, technical expertise, and the overall level of preparedness, among other things.

The accumulated knowledge and experiences with past epidemics highlight three important areas of attention in their management: the scientific and biomedical efforts to develop an effective cure and vaccine against the infectious disease; the types of people affected by the disease; and the leadership actions and decision making that affect the level of success in managing the crisis. The biomedical and scientific efforts to find cures and vaccines are beyond the scope of this entry. The objects of attention here are the other two areas: people and the decision-making process.

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