Considerable effort has gone into making mathematical and computer models of smallpox spread and control measures, typically consisting of vaccination and quarantine. The orally available antiorthopoxvirus drug tecovirimat has recently completed Phase 2 clinical trials and shows promise as a smallpox control agent. We constructed 2 computer simulations to explore the use of tecovirimat in combination with vaccination and social cooperativity to control an outbreak. Two scenarios were considered: (1) a homogenously mixed, deterministic simulation of a single metropolitan area; and (2) a stochastic network of the 50 largest US metropolitan areas connected by commercial air traffic. Metropolitan-level mass vaccination coupled with drug treatment for all individuals who develop a fever considerably outperforms treating only those who develop smallpox's distinctive rash. Incorporating mass chemoprophylaxis represents another large improvement. More aggressive responses are more robust to low cooperation of the population with public health efforts and to faster disease spread. However, even with the most aggressive public health intervention, an attack that initially infects hundreds or thousands of individuals will need to be fought in multiple cities across the country.
Rapidly emerging mobile communications platforms, such as mobile phones, in countries across Africa, Iraq, and Afghanistan offer new opportunities for direct public engagement in health systems, placing tools and timely information into the hands of those who need it most. Early results from pioneering work suggest real benefits of mobile devices in addressing access to care, monitoring and treating diseases, and providing continuous medical education and training. The Military Health System, a $43-billion global healthcare system within the U.S. Department of Defense, in partnership with other U.S. government agencies and nongovernmental organizations and the international health sector, can make valuable contributions to creating a sustainable global m-health infrastructure.
Health system stabilization and reconstruction support is a vital component of post‐conflict and disaster assistance efforts, and has been an essential component of overall reconstruction efforts in Iraq. However, decades of conflict, deprivation of key resources, mismanagement, sanctions, and a massive exodus of health care providers have exacted a grave toll on Iraq's health care capacity; furthermore, the health system continues to suffer from the impact of the ongoing insurgency and sectarian violence. Iraq's key public health indicators are among the worst in the region. In light of these pressing concerns, the humanitarian situation in Iraq presents a unique and ongoing challenge to the international community, aid agencies, and other key stakeholders. This symposium served as a forum for international leaders to review reconstruction efforts thus far and collaboratively plan future steps in Iraq's health system reconstruction.
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