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November-December 2009

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Pandemic 2.0: Can Information Technology Help Save the Planet?

The World Health Organization (WHO) hosted the first large scientific meeting about the previously unknown A/H1N1 influenza on 29 April 2009, heading a teleconference that included more than 100 participants and following up with a continuous stream of international scientific, technical, and consultation meetings to integrate and disseminate scientific information and help its member countries to mitigate the adverse impacts of the influenza A/H1N1. That the WHO has assumed a leading role in combating the ongoing spread of the “swine” flu might seem expected. In fact, the heavy burden of such a responsibility would have been impossible for this international organization to carry only a decade ago.


In September 1994, for example, WHO failed to respond to a devastating outbreak of bubonic plague in Surat, India. The local newspaper The Hindu Universe reported, “People fleeing the affected zones are heading in all directions and taking the hysteria with them. With the discovery of three people afflicted with plague in a Bombay hospital, panic has gripped that city as well. Tetracycline, an antibiotic for plague treatment, has disappeared from chemist shops not only in Bombay but also in Delhi.”1


In a fragmented and multi-actor context, mechanisms for rapid information sharing are vital.

As the crisis escalated, WHO did not take action beyond issuing press releases and organizing one official visit to Surat more than two weeks after the first reports. The human, economic, and political implications were severe. Although fewer than 60 people died from the plague, the outbreak led to economic losses estimated to US$260 million in Surat alone, boycotts and travel restrictions against India, as well as highly speculative allegations in national media that the plague was the result of covert U.S. genetic engineering.


In 2003, less than 10 years later, WHO was able to meet the challenges posed by the previously unknown infectious disease SARS (severe acute respiratory syndrome). When SARS spread rapidly across the world, from southern China to Hong Kong, Vietnam, Canada, Singapore, and the United States, WHO swiftly disseminated information and coordinated laboratory networks, national health agencies, and nongovernmental organizations to contain the spread of the disease.2


What explains this sudden increase in the international organization's capacity to deal with surprising infectious disease outbreaks? What lessons can be learned for addressing the additional challenges posed by global environmental change? The explosive emergence of the Internet and associated information technologies seem to provide a fundamental part of the answer to the first question, with deep implications for sustainability governance.


Governance for Sustainability

Social science scholars are becoming increasingly interested in analyzing the ability of actors to deal with not only incremental environmental degradation but also surprising shocks and stresses. Despite the explicit interest among scholars in research topics such as social learning, adaptability, flexibility, and resilience, we know surprisingly little about the repercussions of a rapidly changing information landscape and media environment on collective action and governance.


Practically every approach to complexity governance for sustainability, including “adaptive governance,” “reflexive governance,” and “transition management,”3 treats the dynamics of information technology as a black box—that is, scholars seldom elaborate the implications of a rapidly expanding set of information and communications technologies on sustainability governance.4 This is troublesome considering the fundamental role that information collection and diffusion plays in any attempt to perceive and learn from changing circumstances, as well as to solve problems and coordinate within a complex system made of many parts.


One of the most important insights evolving from research regarding the institutional dimensions of global environmental change is that an increasingly interconnected world is governed by institutions that remain fragmented, poorly coordinated, and unable to deal with unwanted impacts of rapid technical and ecological change.5 Decentralization, the proliferation of public–private partnership arrangements, the growing influence of nongovernmental organizations and expert communities on policy processes, and the increased impact of multilateral agreements on domestic policy are all indications of an increased diversity in institutional landscapes.6 As a result, decision-makers at the local, national, and international levels attempting to deal with epidemic outbreaks or respond to complex humanitarian emergencies are forced not only to act quickly despite uncertainty but also to promptly coordinate their actions with a range of governmental, semi-governmental, and nonstate actors. In such a fragmented and multi-actor context, mechanisms for rapid information sharing are vital.


The spread of social media such as Twitter and Facebook, Internet-based surveillance systems, and online coordinated collaborations are already having a tangible impact on collective action, political behavior, and social movements internationally.7 As WHO's increasingly effective response to emerging infectious diseases illustrates, in an era of global environment and technological change, achieving governance for sustainability requires that we reflect on a range of information management challenges facing countries, organizations, and international partnerships.


Global Change, Human Health, and Governance

Emerging infectious diseases such as influenza A/H1N1, avian influenza (H5N1), Ebola hemorrhagic fever, Nipah virus, dengue fever, and SARS are health risks that emerge at the interface between globalization and global environmental change.8 The underlying explanation for the increasing rate of emerging infectious diseases globally is far from simple: they proliferate as the result of a combination of interacting multispeed (rapid and slow) and multiscale (local to global) changes in human and natural systems.9


A number of recurring dengue epidemic outbreaks in Brazil between 2007 and 2009 illustrate the complexity underlying a rapidly changing health risk landscape. Dengue's rapid expansion and increasing impact on vulnerable communities in Latin America are driven by an array of large-scale factors. These include unplanned urbanization, extreme weather events, deforestation, land use change, the increased use of nonbiodegradable products, and rapid growth in trade, travel, and transit. Local circumstances also contribute to what can become a rapidly escalating health crisis. Dense residential areas, insufficient waste management practices, and eroded health infrastructure are ideal conditions for mosquito breeding and the rapid spread of disease.10 Similar sets of complex social–ecological drivers have been identified for other emerging infectious diseases, such as avian influenza, Ebola, Nipah virus, and West Nile fever.11


This underlying human–environmental complexity has important implications for health policies and governance for sustainability. Rather than a limited set of defined rules and regulations, an opaque “cluster of institutions”12 tend to frame both the emergence and social response to emerging infectious diseases. One might assume that dealing with avian influenza outbreaks is a relatively straightforward medical and veterinarian challenge involving continuous monitoring and prompt interventions, such as isolation and culling of infected poultry. In fact, early warnings and interventions typically engage a wide range of public and private actors at multiple levels of social organization embedded in a highly complex institutional and legal setting. At the global level, these actors include WHO, the World Organization for Animal Health, the Food and Agriculture Organization, Health Canada, and the United States Centers for Disease Control and Prevention (CDC). At the national level, epidemics engage affected national and local governments; scientific communities, including veterinary medicine and epidemiology; and nongovernmental organizations, such as Doctors without Borders.13


While this diversity can offer considerable benefits in theory,14 it also creates serious early warning and response challenges. Promptly integrating epidemic information from diverse sources has proven difficult. Differences in organizational goals, approach, and culture often make agencies and nonstate actors reluctant to share information with each other, even in times of crisis.15 The failure of international organizations to integrate medical, virological, and biodiversity science when addressing the emergence and spread of avian influenza is an important case in point.16 Information and communication technology may fill the gap.


Epidemic Early Warning and Information Technology

The need for early and reliable warning of pending infectious disease outbreaks has been a major concern for the global community since the creation of the first international health regulation in the mid-nineteenth century, when cholera epidemics overran Europe.17 Recent advancements in information and communication technology are fundamentally improving the potential to detect surprising disease outbreaks. The Internet giant Google, for example, had one of its biggest public relations successes during 2008 and 2009 with its tool Google Flu Trends, a software that uses saved online search queries such as “fever” or “sore throat” to predict the emergence of a flu outbreak up to two weeks before government epidemiologists.18

In addition, The New York Times, The Guardian, the Financial Times, and Wired recently featured the use of a new generation of monitoring systems with the ability to transform the chaotic chatter on the Internet into “infoveillance,” early warning signals of pending infectious disease outbreaks.19


Even more interesting is how information technologies change the way international organizations, states, and private actors interact. WHO's management of early warnings of A/H1N1 is an illuminating example of the interplay between information technological change, global risks, and governance.


The first warning of an unknown infectious disease outbreak in Mexico arrived at the WHO on 10 April 2009.20 The warning was based on local media reports describing an unusual cluster of flu-like respiratory illnesses in the region of Veracruz. Officials at the WHO contacted Mexican authorities the same day to verify these reports. The answer arrived two days later: the outbreak had already been investigated, and all cases had proved to be regular influenza. One week later, WHO officials again contacted Mexican health authorities after receiving unofficial reports of unusual pneumonia deaths. Mexican authorities again responded that tests indicated nothing unusual.


Everything changed on 22 April. Mexican health authorities contacted WHO with a formal report indicating a rapidly increasing rate of unexpected pneumonia cases. The next day, the CDC reported that the same sort of virus found in Mexico had been identified in California. What began as isolated cases of respiratory illnesses in a small Mexican town was billed five days later as a possible pandemic. With the first early warnings now promptly confirmed, WHO could at this instant start to mobilize its response capacities.


WHO might be expected to be one step ahead of its member countries due to its resources and global perspective, but WHO's early-warning capacity is in fact the result of a profound transformation in global health governance over the last decade. The use of Internet-based and other “unofficial” information by international organizations would not only have been technically infeasible 10 years ago but also would have tread controversial legal terrain.


In contrast to WHO's response to the A/H1N1 pandemic, the bubonic plague outbreak in Surat illustrates a serious failure of the WHO to deal with epidemic emergencies. One of the main reasons for the failure in Surat was that WHO's information system, then based entirely on phones and fax machines, collapsed under the pressure of a rapidly escalating number of requests from journalists, governments, and concerned citizens. In addition, while WHO did not have staff in place in Surat, global media such as BBC did and could rapidly broadcast images of the unfolding crisis. The WHO coordination center based in Geneva, despite repeated demands from a range of public and private actors, could do little more than wait for official reports from the affected country.


Bearing in mind the international media coverage, the failure for WHO could not have been worse from a public-relations perspective. WHO's authority to handle international health threats continued to be questioned in the aftermath of repeated epidemic emergencies such as the 1995 Ebola hemorrhagic fever outbreak in Kikwit (Zaire), the 1997 outbreak of Rift Valley Fever in eastern Africa, the intentional spread of anthrax in the United States in 2001, and the global spread of SARS in 2003.21 A new generation of disease-surveillance systems based on e-mail and the Internet nevertheless seem to have helped WHO reinforce its leadership role in global health governance.


Organizations and Information

Sociologist Arthur L. Stinchcombe's insight that all organizations can be understood as information-processing structures is fundamental to unraveling the theoretical implications of rapid information technological change.22 Whenever organizations fail to uphold this task, other often-competing interests challenge them. Changes in information technology hence have the potential to induce both political and institutional change.

This was precisely what happened to WHO after the 1994 bubonic plague outbreak in Surat and other failed responses to high-profile outbreaks over the past decade. These shocks unfolded in a time when WHO's role as a global leader in health information and management was seriously challenged by other international actors, such as the World Bank and the World Trade Organization.23


A new generation of disease surveillance systems based on mining the Internet for unofficial data nevertheless helped WHO reinforce its leadership role in global health governance. This evolution started in the mid-1990s with the creation of ProMED, a moderated, Internet-based reporting system for the global dissemination of information about outbreaks of infectious diseases and of chemical origin established with the support of the Federation of American Scientists and SatelLife. Health experts could now rapidly share information about emerging infectious disease events via a moderated e-mail list, which made a major difference in disseminating early warnings.24


A second and perhaps more important information technology innovation was the Global Public Health Intelligence Network (GPHIN). Health Canada developed this early detection system for WHO in the mid 1990s. GPHIN is based on Web crawlers, software programs that automatically and methodically browse the World Wide Web for particular information. GPHIN gathers data about unusual disease events by monitoring Internet-based global media sources such as news wires, Web sites, local online newspapers, and public health e-mail information services in seven different languages. GPHIN can detect the first hints of about 40 percent of the 200–250 outbreaks WHO subsequently investigates and verifies each year.25 Dr. David Heymann, the director of the WHO Programme on Emerging and other Communicable Diseases (1995–1998), reflected on the implications of Internet-based monitoring systems for WHO operations:


All of a sudden, we had a very powerful system that brought in much more information from more countries. And we were able to go to countries confidentially and validate what was going on, and if they needed help, we provided help. And we provided help by bringing together many different institutions from around the world that started to work with us.26


WHO's use of Internet-based unofficial data may represent a fundamental shift in global health governance. The older (pre-Internet) model was built explicitly on respecting the information authority of member countries. This model resulted in serious failures in the international surveillance system as a whole when countries chose to conceal information about unfolding disease events to avoid social, political, and economical repercussions. This happened during the bubonic plague outbreak in Surat in 1994 and the 2003 SARS outbreak in southern China.27


Access to additional Internet-based information decoupled from national government reports threatens the information monopoly of states and strengthens WHO's monitoring capacity. It has also forced a change in what was until now a rigid and malfunctioning international regime: the International Health Regulations (IHR), a legally binding instrument of international law. Member states made a series of revisions to the IHR in 2005 to respond to increasing rates of emerging infectious disease outbreaks, including changes in the sort of information that WHO is allowed to use in their communications with individual countries. Articles 9 and 10, for example, elaborate explicitly that “WHO may take into account reports from sources other than notifications and consultation,” meaning those provided officially by state parties.


Networks for Global Health Governance

Recent changes in the IHR also illustrate the importance of information technology development as a driver of institutional change. The main mechanism at play is rapidly decreasing transaction costs for information retrieval, analysis, and dissemination. Solving coordination problems depends heavily on whether actors have access to information about other actors' intentions, preferences, and reputations. If information retrieval is associated with high costs, a mutually beneficial collaboration may not materialize.28


Health governance scholars generally agree that the 2005 IHR provides the fundamental legal context for international responses to early epidemic warnings. Yet much of the international system's ability to respond to these crises lies in the ability of international organizations and public and private actors to collaborate, invest in joint projects, share information, and build robust alliances to better detect and respond to epidemic emergencies.


This motivates the creation of a global strategy for dealing with epidemic outbreaks that explicitly focuses on improving and expanding a range of international surveillance and response networks. There is some evidence that such a strategy is emerging. The clearest example is the 1997 creation of the Global Outbreak Alert and Response Network coordinated by WHO to make better use of highly limited economic and human resources once epidemic outbreaks unfold, and coordinate verification and interventions with other public and private actors.29 In addition, a range of similar and parallel attempts are expanding collaboration between monitoring and response systems regionally (see Table 1 on page 26).


The potential benefits of emerging networks in global health governance should not be underestimated. Not only do they bring together actors normally separated by geographical boundaries, sector segmentation, and different knowledge bases (for example, veterinary medicine and epidemiology), they also facilitate the provision of staff and resources when prompt communication and response is needed. However, a network-based health governance strategy does not come without trade-offs and is not without weaknesses.


A new generation of disease surveillance systems based on mining the Internet for unofficial data helped WHO reinforce its leadership role in global health governance.


All networks are not created equal. On the contrary, the specific structure of networks plays a fundamental role in their ability to deal with changing circumstances and shocks. Organizational networks risk two types of possible failures. The first has been described as congestion-related failure and emerges when the top level of a hierarchical network is unable (or uninterested) in passing on information to other nodes (actors) in the network.30 The failure of the WHO to rapidly verify and disseminate information about the 1994 bubonic plague outbreak in Surat is a good example.


The second type of failure is related to the network's ability to function in the face of random collapses in its nodes. This sort of robustness is of particular interest in cases where a minor collapse could have severe system impacts. Criminal and terrorist networks, natural resource management networks, and critical infrastructure such as transport networks are all examples of structures where targeted or random failures can have system-wide effects. Hence, even though networked forms of governance can be seen as a fruitful strategy for overcoming coordination challenges, their robustness can never be taken for granted.


Not all important driving forces for emerging networked forms of governance are related to developments in information technology, but rather to scarce financial and human resources. Only a minor share of the total of public and private funds flowing into stemming the spread of HIV, tuberculosis, malaria, avian influenza, and other major killers over the last five years actually helped build the solid foundation of laboratory capacity; affordable local health care; and access to nurses, social workers, and doctors needed to deal with an increasing rate of emerging infectious diseases. Instead, as Council on Foreign Relations Senior Fellow in Global Health Laurie Garrett argues, “The efforts this money is paying for are largely uncoordinated and directed mostly at specific high-profile diseases—rather than at public health in general.”31

Table 1. Examples of early warning and response networks for emerging infectious diseases

NAME (YEAR ESTABLISHED)MEMBER BASE

Pacific Public Health Surveillance Network (1996)

Pacific countries

Southern Cone Surveillance Network for Emerging Infectious Diseases (1998)

Countries in the Aamazon basin and the “Southern Cone” of South Aamerica

Integrated Disease Surveillance and Response in the Great Lake Region (1998)

Burundi, Democratic Rrepublic of Congo, Kenya, Uganda and the United Republic of Tanzania

Asian Rotavirus Surveillance Network (2000)

Asia

Rede RM (Red Nacional de Monitoreo de la Resistencia Microbiana en los Servicios de Salud/Network of Microbial Resistance Monitoring and Control) (2005)

Latin America

EpiNorth: Co-operation Project for Communicable Disease Control in Northern Europe (1998)

Northern Eeurope

Euronet-P4: European Network of Biosafety Level 4 Laboratories (2004)

Europe

Global Avian Influenza Network for Surveillance (2006)

Global

OFFLU: World Organisation for Animal Health/Food and Agricultural Organisation of the United Nations Network of Expertise on Avian Influenza (2005)

Global

World Health Organization Global Influenza Surveillance Network (1952)

Global

Global Outbreak Alert and Response Network (1997)

Global

Global Early Warning System for Major Animal Diseases, including Zoonoses (2006)

Global

Table 2. Initiatives for sustainability supported by information technology

E-mail and ecological monitoring (a)Information technology and forest fires (b)Information technology and climate collaboration (c)

Electronic mailing lists helped disseminate and compile field observations tracking global-scale coral bleaching during the 1997–1998 El Ni≁o event. These proved invaluable for prompt assessments of the mass-bleaching event, with reports ranging from detailed accounts and measures of bleaching and mortality, to brief anecdotal reports obtained during a rapid site visit.

In 2005, Brazil experienced one of the worst droughts in 30 years, compounded by extensive forest fires. Access to satellite imagery, near-real-time data on hot spot distributions, and meteorological data shared via the Internet were critical to the successful disaster response.

MIT's Center for Collective Intelligence hosts “Tthe Climate Collaboratorium” combining Internet-mediated interations, computer simulation, and collectively generated idea repositories to “help large, diverse, and geographically-dispersed groups systematically explore, evaluate, and come to decisions concerning systemic challenges.”


SOURCES: [a] V. Galaz et al., “Can Web Crawlers Revolutionize Ecological Monitoring?” Frontiers in Ecology and the Environment (e-View, 2008); [b] E. Boyd, “Navigating Amazonia under Uncertainty: Past, Present, and Future Environmental Governance,” Philosophical Transactions of the Royal Society B: Biological Sciences 363, no. 1498 (27 May 2008): 1911–16; [c] T. W. Malone and M. Klein, “Harnessing Collective Intelligence to Address Global Climate Change,” Innovations 2, no. 3 (2007): 15–26.

Beyond the Information Technology Hype

Emerging infectious diseases such as influenza A/H1N1 serve as a chilling reminder of the stakes at play when trying to govern for sustainability in settings where system complexity is vast, uncertainties are chronic, and surprises are recurring. Information and communication technologies already play a key role in responding to these challenges. They facilitate the extraction and integration of early warnings, reduce the cost of information dissemination and coordination in networked settings, and help build institutional capacity to reduce human health risks.

This insight is of relevance not only for health care scientists and professionals but also for sustainability science and policy in general. As a result of emerging information technologies, communication is not as costly and difficult as it once was. While this recent technological transformation is no panacea, it can support innovative ways to overcome a range of sustainability problems worsened by institutional segmentation; knowledge fragmentation; and a lack of coordination between public, private, and organizational actors. At best, it can further facilitate cross-sectoral collaboration among actors, network arrangements across levels of social organization, and global scientific cooperation on issues such as ecosystem service assessment and management, climate change modeling and policy, coastal management, agricultural research, and water management. Table 2 on page 26 exemplifies what Internet-supported collaboration already achieves for sustainability governance.


Admittedly, dealing with increasing rates of emerging infectious disease is a challenge that goes far beyond the international hype regarding Internet-based monitoring systems, file sharing, and Web 2.0. Information and communications technology is useless unless the full array of political, demographic, technological, and social-ecological drivers that increase human health risks are also addressed, including human-induced land use changes, unplanned urbanization, eroded health infrastructure, forced migration, climate change, increased antibiotic resistance, and chronic poverty.


Information and communications technologies are here to stay. Hopefully we can use them wisely to meet the challenges facing us in the Anthropocene.

This work was supported by the Stockholm Resilience Centre, and by grants from the Swedish Research Council Formas and Foundation for Strategic Environmental Research (Mistra).


1. L. Garrett, “The Return of Infectious Disease,” Foreign Affairs 75, no. 1 (1996): 66–79. Quote from G. R. Pallipparambil, “The Surat Plague and its Aftermath,” unpublished essay, http://entomology.Montana.edu/historybug/YersiniaEssays/Godshen.htm (accessed 1 August 2009).


2. D. L. Heymann and G. Rodier, “Global Surveillance, National Surveillance and SARS,” Emerging Infectious Diseases 10, no. 2 (2004): 173–75; D. L. Heymann, “SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty,” Annals of the Academy of Medicine 35, no. 5 (2006): 350–53; and E. S. Michelson, “Dodging a Bullet: WHO, SARS, and the Successful Management of Infectious Disease,” Bulletin of Science, Technology and Society 25, no. 5 (2005): 379–86.


3. C. Folke, “Resilience: The Emergence of a Perspective for Social–Ecological Systems Analyses,” Global Environmental Change 16, no. 3 (2007): 253–67; J-P. Voss, D. Bauknecht, R. Kemp, eds., Reflexive Governance for Sustainable Development (Cheltenham, UK: Edward Elgar, 2006); and R. Kemp, D. Loorbach, and J. Rotmans, “Transition Management as a Model for Managing Processes of Co-evolution towards Sustainable Development Transition Management,” in M. M. Andersen and A. Tukker, eds., Perspectives on Radical Changes to Sustainable Consumption and Production (Roskilde, Denmark, and Delft, The Netherlands: RISØ and TNO, 2006): 387–406.


4. For example, see O. R. Young, L. A. King, and H. Schröder, eds., Institutions and Environmental Change: Principal Findings, Applications, and Research Frontiers (Boston, MA: The MIT Press, 2008); and F. Biermann and P. Pattberg, “Global Environmental Governance: Taking Stock, Moving Forward,” Annual Review of Environment and Resources 33 (2008): 277–94. Both papers summarize important insights related to the role of international agreements and organizations in global environmental governance. A closer look, however, reveals a limited understanding of the political and institutional implications of the rapid evolution of information and communication technology for sustainability governance.


5. F. Berkes et al., “Globalization, Roving Bandits, and Marine Resources,” Science 311 (17 March 2006): 1557–58; and O. R. Young et al., “The Globalization of Socio-ecological Systems: An Agenda for Scientific Research,” Global Environmental Change 16: 304–16.


6. J. Pierre and G. B. Peters, Governing Complex Societies (Houndsmills, UK: Palgrave Macmillan, 2005).


7. C. Shirky, Here Comes Everybody: The Power of Organizing without Organizations (New York: Penguin Books, 2008); and B. Bimber, A. J. Flanagin, and C. Stohl, “Reconceptualizing Collective Action in the Contemporary Media Environment,” Communication Theory 15, no. 4 (2006): 365–88.


8. K. E. Jones et al., “Global Trends in Emerging Infectious Diseases,” Nature 451 (21 February 2008): 990–94; and A. Costello et al., “Managing the Health Effects of Climate Change,” Lancet 373 (2009): 1693–733.


9. R. K. Plowright et al., “Causal Inference in Disease Ecology: Investigating Ecological Drivers of Disease Emergence,” Frontiers in Ecology and the Environment 6, no. 8 (2008): 420–29; and Millennium Ecosystem Assessment, Ecosystems and Human Well-being–Health Synthesis (Geneva: World Health Organization, 2007).


10. Based on J. Spiegel et al., “Barriers and Bridges to Prevention and Control of Dengue: The Need for a Social-Ecological Approach,” EcoHealth 2, no. 4 (2005): 273–90.


11. J. Patz et al., “Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence,” Environmental Health Perspectives 112, no. 10 (2004): 1092–98; and D. Kapan et al., “Avian Influenza (H5N1) and the Evolutionary and Social Ecology of Infectious Disease Emergence,” EcoHealth 3, no. 3 (2006): 187–94.


12. Young, King, and Schröder, note 4.


13. I. Scoones and P. Forster, “The International Response to Highly Pathogenic Avian Influenza: Science, Policy and Politics,” STEPS Working Paper 10 (Brighton, UK: STEPS Centre, 2008).


14. C. Folke, T. Hahn, P. Olsson, and J. Norberg, “Adaptive Governance of Social-Ecological Systems,”Annual Review of Environment and Resources 30 (2005): 441–73; and B. Low, E. Ostrom, C. Simon, and J. Wilson, “Redundancy and Diversity: Do They Influence Optimal Management?” in F. Berkes, J. Colding, and C. Folke, eds., Navigating Social-Ecological Systems (Cambridge, UK: Cambridge University Press, 1998), 83–114.


15. A. Boin, P. ‘t Hart, E. Stern, and B. Sundelius, The Politics of Crisis Management: Public Leadership under Pressure (Cambridge, UK: Cambridge University Press, 2005).


16. P. Daszak and A. Chmura, The Role and Contribution of Biodiversity Science Expertise to Understanding and Illuminating Decision-Making on the Emergence and Spread of H5N1 Avian Influenza: Lessons for the International Communities as We Face This and Other Emerging Diseases Linked to Biodiversity Issues, report prepared for The Executive Secretariat of the Consultative Process Towards an International Mechanism of Scientific Expertise in Biodiversity Science (2007).


17. The 1851 International Sanitary Conventions are the origins to the current International Health Regulations.


18. J. Ginnsberg et al., “Detecting Influenza Epidemics Using Search Engine Query Data,” Nature 457 (19 February 2009): 1012–14.


19. C. C. Miller, “Putting Twitter's World to Use,” New York Times, 13 April 2009; D. Jeffries, “Information Outbreak,” The Guardian, 7 May 2009; C. Nutall, “Valley View: Technology Makes Us All Data-Gatherers,” Financial Times, 2 December 2008; and A. Madrigal, “Google Could Have Caught Swine Flu Early,” Wired Science, 29 April 2009, http://www.wired.com/wiredscience/2009/04/google-could-have-caught-swine-flu-early/ (accessed 1 August 2009). For an elaboration of “infoveillance,” see G. Eysenbach, “Infodemiology and Infoveillance: Framework for an Emerging Set of Public Health Informatics Methods to Analyze Search, Communication and Publication Behavior on the Internet,” Journal of Medical Internet Research 11, no. 1 (2009): e11.


20. Based on G. Harris, “Questions Linger over the Value of a Global Illness Surveillance System,” New York Times, 1 May 2009.


21. Garrett, note 1; and D. P. Fidler, SARS, Governance and the Globalization of Disease (Houndsmills, UK: Palgrave Macmillan, 2004).


22. A. Stinchcombe, Information and Organizations (Berkeley, CA: University of California Press, 1990).


23. Fidler, note 21.


24. E. Mykhalovskiy and L. Weir, “The Global Public Health Intelligence Network and Early Warning Outbreak Detection,” Canadian Journal of Public Health 97, no. 1 (2006): 42–44; and S. Morse “Global Infectious Disease Surveillance and Health Intelligence,” Health Affairs 26, no. 4 (2007): 106–77.


25. Ibid.


26. Dr. David Heymann, director of the WHO Programme on Emerging and Other Communicable Diseases, in interview with the author, 25 March 2008.


27. Fidler, note 21. See also R. A. Cash and V. Narasimhan, “Impediments to Global Surveillance of Infectious Diseases: Consequences of Open Reporting in a Global Economy,” Bulletin of the World Health Organization 78, no. 11 (2000): 1358–67.


28. M. S. Chwe, “Communication and Coordination in Social Networks,” Review of Economic Studies 67, no. 1 (2000): 1–16.


29. Heymann and Rodier, note 2.


30. P. S. Dodds, D. J. Watts, and C. F. Sabel, “Information Exchange and the Robustness of Organizational Networks,” Proceedings of the National Academy of Sciences 100, no. 21 (14 October 2003): 12516–21.


31. Quote from L. Garrett, “The Challenge of Global Health,” Foreign Affairs 86, no. 1 (2007): 14–38. See also P. Farmer, Pathologies of Power: Health, Human Rights and the New War on the Poor (Berkeley, CA: University of California Press, 2003).


32. Institute of Medicine and National Research Council, Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin: Workshop Report (Washington, DC: The National Academies Press, 2008), 50.


Victor Galaz is a political scientist and research theme leader at the Stockholm Resilience Centre, Stockholm University, Sweden. Among his publications in English are articles in peer-reviewed journals such as Frontiers in Ecology and the Environment, Environmental Politics, Ecology and Society, and Governance. His work on information and communication technological innovations has been featured in international media such as Wired.com, The Guardian, and New Scientist.

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