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The Discourse and Discontents of Communicable Disease Prioritization



The Discourse and Discontents of Communicable Disease Prioritization

Prioritization in global health depends on the finite resources afforded to communities by their governments and the private sponsorship of corporate donors that fund program initiatives and emergency response efforts aimed at addressing emergent health crises. Ongoing debates in Global Health over which problems to prioritize and which programs to fund, should be discussed considering recent outbreaks like SARS and H1N1 and their impact on communities across the globe. Global health institutions, governments and the nonstate actors they support, should prioritize communicable disease in their research and development strategies; while, coordinating their resources towards building resiliency in public health institutions and emergency response systems.
Communicable diseases, (CDs) such as HIV, Zika virus, Ebola and other viral infections can spread across the planet in ways that were not possible for most of human history. Planetary capitalism has assumed dominance over the global economy and connected the world through neoliberal policies and military-backed systems of global travel and trade. This presents new challenges for epidemiological responses to CD prevention and response that require systemic changes in international agenda setting for Global Health and human development.
Societies, through globalization, are constantly connecting individuals and communities across temporal and spatial boundaries, which create unique conditions that contribute to the spread of infectious disease. Unlike noncommunicable diseases, (NCDs) CDs have the potential to overwhelm the capacity of communities and reach pandemic scales in a short amount of time. These epidemics and pandemics can cause society-wide emergencies and threaten the security of the world system. For this reason, they should be prioritized and supported by international institutions and both local and global emergency response and surveillance systems.
Powerful agencies such as the United Nation’s World Health Organization (WHO), World Bank, and World Trade Organization (WTO) command vast resources and authority over the development of global health initiatives, as well as the political institutions that govern them. Together, these groups play an essential role in determining which problems are prioritized and which programs are afforded international support. The impact of these organizations on Global Health is immense and is only limited by their capabilities to develop institutional capacities for the detection, investigation, response and reporting of public health events, including CD epidemics, within their operational territories.  
In this context, the main objective of prioritizing CDs is to make the best use of limited resources for disease surveillance, taking into account the changing needs of the world system. Prioritization only makes sense if it happens within the right context; political endorsement of the process and willingness to accept the results of the exercise are prerequisites. By establishing CDs as the greatest threat to the security of nations, global health and development agencies leverage their power over governments to influence policy-making and encourage officials to make adjustments to their national health and emergency response systems. In low and middle-income countries, these resources are normally directed away from governmental institutions towards private entities that have a greater capacity for managing crisis and other adverse public health events, including pandemics. Most of the time these changes take place following a disease outbreak, to take advantage of lessons learned, public pressure, and the political will to change.
For example, the devastation caused by the AIDS virus on the African continent inspired many sub-Saharan governments to make significant changes in their national health policies to focus on the roll out of CD treatment, emergency management, and preventive strategies to address future threats. Uganda and South Africa are an excellent case for comparison. South Africa afforded the constitutional right to health care to its citizens but failed to deliver life-saving drugs to treat the global AIDS pandemic in their country; while Uganda used their limited government resources to partner with nonstate actors to deliver medicines which reduced the spread of HIV infection. South Africa suffered greatly from their inaction and has since learned that prioritizing CD efforts is necessary to maintain community health as well as socioeconomic stability. By prioritizing CD in local and global health policy and development, communities can prepare for emergent health crises and respond to emergencies that threaten the security of nations as well as the world system that supports them.

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