BWH Clinical & Research News

The Next Generation: On the Lookout for Threats to Global Health

Fully loaded C17 Globemaster III carrying multiple CCATT patients during annual exercises (August 2016, Wright Patterson AFB, Dayton, OH).

Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month’s column is written by Vin Gupta, MD, MSc, a fellow in Pulmonary and Critical Care Medicine at BWH, policy researcher at the Harvard Global Health Institute (HGHI) and a member of the U.S. Air Force’s Critical Care Air Transport Team. Gupta shares his firsthand experiences as a part of CCATT and what he sees as the major threats to global health security.

Vin Gupta

Struggling health systems abound throughout our world. Over the last 15 years, through various initiatives globally, I have observed firsthand how fledgling health systems have struggled to provide the most basic of services amid a more complicated tableau of challenges, including climate change and the rising incidence of both non-communicable and pandemic disease vectors.

Through my involvement with the United States Air Force’s Critical Care Air Transport Team (CCATT) as a reservist and as a third-year fellow in the Division of Pulmonary & Critical Care Medicine at BWH, I have observed many examples around the world of these barriers to what we consider basic health care.

I have seen people living on the fringes of poverty on the outskirts of Phnom Penh, Cambodia, who cannot obtain long-acting insulin and the challenges for someone living in Shanghai – the most affluent province in China – to get a mammogram or colon cancer screening. There are larger-scale problems, too, that can start at a local level: drug-resistant malaria may unknowingly go untreated in pockets of East Africa. Information about regional flu strains in Southeast Asia may go unshared due to interstate political rivalries, impacting the makeup of the following year’s flu vaccine. These experiences across Asia and Africa have given me critical insight into how political instability and social ruptures can have a ripple effect as societies become progressively less healthy.

The good news is that the United States military is becoming a prime partner in the effort to combat the scourge of pandemic diseases and bolster our nation’s global health security agenda. One potential partnership is with HGHI, where I work as a policy researcher. Our team has been working to characterize the effects of climate change on fledgling health systems throughout the Global South and ways in which U.S. aid assets can bolster climate resiliency efforts.

Combating Pandemic Diseases

Our nation’s Air Force boasts a rising capacity to respond to any global crisis or catastrophe within 24 hours through its ever-growing aeromedical evacuation capability. CCATT, which was established in the mid-1990s, is becoming one of the primary engines behind this immediate response system. CCATT is a cohort of military physicians with training in critical care medicine or trauma surgery. A deployable team consists of one physician, an intensive care nurse and one respiratory therapist. The team can descend anywhere in the world and transport up to six critically injured or ill patients to regions of safety, generally Landstuhl Military Hospital in Germany or the continental United States.

I joined the cohort in 2012, given my clinical interests in ICU medicine and long-term research work in global health security. Joining CCATT was, in my view, a necessary experience to better understand the challenges of tackling global crises, health-related or otherwise, in the modern age.

As global crises fester in areas of the world where the United States has a minimal military footprint, having the ability to provide rapid, critical care to our service members and aid workers requires the commitment of highly trained physicians, nurses and respiratory technicians.

An ongoing challenge is that transporting large amounts of resources to contend with the next crisis is not always financially, logistically or politically possible. Yet, ignoring unexpected world events in our age of globalization and rising interconnectedness is also not an option. That is why the growing capacity of CCATT is relevant to all of us in the Brigham community who are working in or thinking about global humanitarian, health or conflict issues. Given the locations of recent conflicts, the next major pandemic disease or health crisis is unlikely to occur in an area where we have significant on-the-ground assets. If we are going to respond effectively, we need adaptable resources that can place troops and other non-military support personnel in regions far from centralized bases and be confident that extraction or medical evacuation is possible at all times.

The Specter of Climate Change

As a reservist, I have been afforded opportunities (largely in a research capacity) to participate in the evolution of health systems in southern Uganda, rural Cambodia and northeast China, all diverse regions of enormous geostrategic importance to global security. My experiences within CCATT have been transformative and complemented my ongoing research initiatives at HGHI. They have reaffirmed to me the multidimensional aspects of global health security, as factors such as climate change can have devastating effects on health around the world.

This year, I assumed a leading role in the Strategic Health Diplomacy Initiative based at HGHI. The Institute is tasked to provide evidence-based guidelines for policymakers within our nation’s foreign aid and development communities regarding emerging global health security challenges. Led by Director Ashish Jha, MD, MPH, HGHI is particularly focused on pandemic preparedness, global health quality, and better understanding the effects of climate change on already health-fragile nations throughout the Global South.

Our nation’s recently published Global Health Security Agenda emphasizes how the rising incidence of neglected tropical diseases like the Ebola and Zika viruses will only become more commonplace in the era of climate change. The agenda elaborates further, speaking to how fledgling health systems across our Global South are ill-prepared to face the effects of climate change over the next 50 years. Rising malnutrition, water insecurity, diarrheal diseases and emerging zoonotic infections are anticipated to only become more prevalent as climate change puts added stress on poor and health-vulnerable countries. In fact, the World Economic Forum recently highlighted climate change as the single-greatest threat to global stability over the next 20 years, primarily because of its effects on the health of vulnerable populations. If the provision of regular insulin, appropriate anti-malarials or effective flu vaccines has proven difficult, then the specter of climate change’s manifold health consequences on vulnerable populations is far more daunting.

Through the efforts of the U.S. military and initiatives like HGHI, I remain hopeful that we can combat the emerging threats of pandemic diseases and climate change before it is too late to reverse their effects on global health in our interconnected world.