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The years 2011, 2012, and 2013 witnessed both significant developments and setbacks in global polio eradication efforts. On the positive side, January 13, 2012, marked a full year since India had detected a case of wild poliovirus. On the negative side, polio continued to be endemic in three countries-Pakistan, Afghanistan, and Nigeria-and in those countries the goal of eliminating polio seemed more challenging than ever. Between December 2012 and January 2013, sixteen polio workers were killed in Pakistan, and in February 2013, nine women vaccinating children against polio in Kano, Nigeria, were shot dead by gunmen suspected of belonging to a radical Islamist sect. In addition, after a 95 percent decline in polio cases in 2010, the number of cases in Nigeria rebounded in 2011. Recognizing that polio was unlikely to be eliminated in these countries in the near term, the Global Polio Eradication Initiative moved its target date for eradication from 2013 to 2018.

These setbacks sparked a debate about the appropriate strategy for global eradication of polio. Indeed, some experts believed that recent setbacks were not caused by poor management but were instead the result of epidemiological characteristics and preconditions that might render polio eradication unachievable. These experts argued that global health efforts should focus on the control or elimination of polio rather than on the eradication of the disease.

This case presents an overview of polio and the Global Polio Eradication Initiative and recounts the successful effort to eradicate smallpox. The case enables a rich discussion of the current global strategy to eradicate polio, as well as the issue of whether eradication is the appropriate global public health objective. More generally, the case provides a concrete example of a particular type of global public good, namely infectious disease eradication.

After analyzing and discussing the case, students will be able to:

• Understand the nature of a global public good

• Perform a back-of-the-envelope benefit-cost analysis of polio eradication

• Discuss the appropriate strategy for eradicating an infectious disease

• Apply game theory to analyzing which countries would be likely to contribute funds toward global polio eradication

• Discuss the role of private organizations in the provision of global public goods

Understand the nature of a global public good

Perform a back-of-the-envelope benefit-cost analysis of polio eradication

Discuss the appropriate strategy for eradicating an infectious disease

Apply game theory to analyzing which countries would be likely to contribute funds toward global polio eradication

Discuss the role of private organizations in the provision of global public goods

This paper attempts to discuss the synergies between the sustainable development goals (SDGs) and Ebola preparedness and response – with a specific outlook about how the five (5) targets in SDG.3 can be prioritized and integrated into the measures taken against the battle of Ebola virus disease (EVD) in the Democratic Republic Congo (DRC) as well as any other sporadic health disasters and emergencies elsewhere.

This paper draws on the published literature, including reports, peer-reviewed articles, statistical data and relevant documents identified from authenticated sources.

Sustainable development, which is the nitty-gritty of SDGs, is underscored as a germane in almost all regional and international frameworks. However, as traditional natural hazards persist, alongside the persistence of civil conflicts and instability, socioeconomic challenges such as EVD pose serious hindrances to SDGs, and achieving them by 2030 might be a deferred dream, especially in low- and middle-income countries such as DRC.

This paper will help to inform the decisions of bureaucrats at different levels, especially those aimed at promoting and integrating health into sustainable development.

The recent 2018 EVD outbreaks in DRC, which galvanized the regional and global attention, call for an approach that elucidates an interaction between the SDGs and countermeasures of responding to this deadly disease in the DRC and elsewhere.

Observes that the World Health Organization (WHO) has promoted the goal of “Health for All” since 1977. The Workers’ Health Programme of WHO aims to: strengthen international and national policies for health at work; develop a healthy work environment; develop healthy work practices and health promotion; strengthen occupational health care and services; establish appropriate support for occupational health; develop occupational health standards which are science‐based; develop human resources for occupational health; establish appropriate information systems and raise public awareness; strengthen research; foster collaborative efforts.

The learning outcomes are to understand the definition of public value and the strategic drivers behind public value creation, understand the nature of social innovation in the public sector, identify the critical opportunities and challenges involved in sustaining innovation in the public sector and identify the role that non-profit organizations can play in supporting and sustaining social innovation.

This case puts participants in the shoes of a global health innovator’s leadership team as the organization approaches a funding crisis. The organization, VillageReach, is on a quest to expand across the public health system of Mozambique and experiences a funding dilemma. The case reveals the challenges of working with governments to achieve large-scale, systemic change. It explores the conundrum of using international donor funding to embed new practices in government service delivery. Ultimately, it asks participants to choose between the pursuit of new, small-scale innovative projects and the large-scale rollout of a national programme.

This teaching case is written for courses focused on social entrepreneurship, social innovation and social change. It can also be used in courses focused on non-profit management and public sector innovation. Specifically, the teaching case is suitable for two audiences: social enterprise and non-profit managers focused on strategy, development and operations (the case focuses on an enterprise that relies primarily on donor funding) and health-care managers and administrators. Generally, the case is suitable for undergraduates in their final year of study as well as graduate-level business and public administration courses, including MBA, MPH, MPA, EMBA and Executive Education courses.

Teaching Notes are available for educators only.

CSS 3: Entrepreneurship.

At the invitation of Miss Olga Nethersole, founder and honorary organiser of the People's League of Health, a number of medical and science councillors and official members of the League met at luncheon at Claridge's Hotel, London, on October 18th, to welcome the members of the newly appointed Veterinary Council. The speeches which followed dealt with the campaign of the League for a safe milk supply, and the part which veterinary science, in conjunction with the other interested professions, might play in attaining the desired end.—Prof. T. J. Mackie, D.P.H., of the Department of Bacteriology, Edinburgh University, said that the formation of the new Veterinary Council was a significant event in the history of the League. It emphasised the absolute necessity of enlisting the co‐operation of the veterinary profession in the campaign for human health. If we were to guard our own health we must pay due respect to the health of our domestic animals, and particularly those from which we received our essential foods, such as milk. It was common knowledge to both the medical and the veterinary profession that our milk supplies, collectively speaking, were not safe, and that, in fact, they might carry a constant menace to the public health. Milk‐borne tuberculosis dominated the whole question of our milk supplies. It must be remembered, however, that tuberculosis was only one of the milk‐borne infections. There were others such as diphtheria, enteric fever, scarlet fever, and undulant fever. Yet there was distinct apathy, and sometimes antipathy, to the simple measures that would regulate this state of affairs. The League were to be congratulated on having performed a valuable public service in their critical survey of the question of bovine tuberculosis, and bringing out in fair relief the essential facts in regard to tuberculosis of animal origin in human beings. Some of the facts in the report could not be too often and strongly repeated. In England and Wales, for instance, it had been shown that every year the bovine type of tuberculosis bacillus caused at least 4,000 new cases of human tuberculosis and at least 2,000 deaths. And seven per cent. of the ordinary samples of vended milk contained this organism. He could speak feelingly, for in Scotland they had rather more than their share of tuberculosis of the bovine type in the human subject. When one reflected on all that had been done in various ways for the improvement of public health, it seemed almost incredible that food was being sold daily with a seven per cent. and sometimes a 14 per cent. chance of it containing a germ capable of producing a crippling or even fatal disease without any warning to the public. If tuberculosis were not an insidious disease, but an explosive epidemic, even if its incidence were not so high, these conditions would not have been tolerated so long as they had been. The veterinary profession recommended the eradication of disease from herds as the fundamental remedy. It was the fundamental remedy, but even the highest grade tubercle‐free milk might carry a very dangerous infection, and, in any case, he did not think the objects which the veterinary profession had at heart, and with which he sympathised, and compulsory or universal pasteurisation on the other hand, were mutually exclusive. He did not see that pasteurisation would set back the clock of progress against the eradication of tuberculosis in the herds. The problem was an urgent one. The eradication of the disease from dairy cattle must proceed slowly and against difficult obstacles, and they could not wait. It was estimated that, if the eradication of tuberculosis were continued at the present rate in this country, it would be 400 years before we reached the stage that had been reached in America. Even if it were expedited, it must remain a relatively slow process. He could not understand those individuals who were content to tolerate the continuance of bovine tuberculosis in the human being in the hope that some day a raw tubercle‐free milk might be universal. Our agricultural and public health organisations were doing the people an injustice in their tacit sanction of the ordinary raw market milk. If they were not prepared to countenance compulsory pasteurisation, at least in the large communities, the only alternative was an official designation of that milk, which would make it clear to the public that it was not free from potential danger. He sometimes wondered what would be the effect of such an official designation if there were displayed in the retail milk shops an official notice stating to the public that such milk was not free from diseases dangerous to human subjects, and that they were warned not to use it without previous sterilisation. He was sure that if that were done the problem would very soon solve itself. Some Local Authorities were pressing hard for powers of compulsory pasteurisation. He thought the League might very well carry on the campaign by educating public opinion and influencing Parliament to that end. If the Government Departments were not willing to move in the matter and take action, then the public must be informed in the clearest possible terms what the position was. The League, in tackling the milk problem by its own methods, had a magnificent opportunity of making a great contribution to the important cause for which it stood.—Professor J. Basil Buxton, of the Institute of Animal Pathology at Cambridge University, said that pasteurisation could not by any means dispense with the necessity for clean milk. They must produce clean milk, however much or however little they might cook it or otherwise treat it afterwards.—Professor Gaiger, President of the Royal College of Veterinary Surgeons, said that they had an enormous job in front of them if they were going to make our milk free from the germ of bovine tuberculosis.—Sir Leonard Hill said that if we could get the people on the right diet we should enormously diminish the amount of disease. Of all the foods milk was one of the most important, and we ought to make the supply safe. Pasteurisation should be made compulsory at once.—Major D. S. Rabagliati, Chief Veterinary Inspector to the County Council of the West Riding of Yorkshire, told the gathering of the important work carried out by his Local Authority, who were the pioneers in the veterinary inspection of cows. He maintained that even if there were compulsory pasteurisation that was no reason why they should not have a clean supply of milk.

The purpose of this paper is to examine the experiences of the USA and other nations with developed veterinary infrastructure and identify the critical factors that led the evolution of the US foot-and-mouth disease (FMD) response strategy.

A thorough literature review was conducted, including official reports of US FMD outbreaks and peer-reviewed articles on outbreaks in previously FMD-free countries. Textual analysis was conducted on past and current publicly available US FMD response plans, identifying the use of the term “vaccination” or “emergency vaccination” indicating the potential use of these strategies.

The USA has shifted from a strategy of exclusively stamping-out to a response strategy that would consider emergency vaccination, including vaccinate to slaughter and vaccinate to live, in any FMD outbreak. The factors that led to this shift in policy include economic factors, the emergence of new vaccine technologies, the changed landscape of the US livestock industry, and the experiences of other typically FMD-free countries.

An outbreak in the USA is likely to rapidly outpace the current capacity for stamping-out. Experience from other FMD outbreaks, and lack of publicly available literature from the USA, indicates that it is critically important that further consideration, sufficient attention, and stakeholder deliberation need to occur to ensure vaccination strategies (to live and to slaughter) are implementable in an outbreak.

The majority of peptic ulcers are associated with Helicobacter pylori infection and it is now clear that eradication of H. pylori dramatically reduces ulcer recurrence. Other important outcomes of H. pylori infection include chronic gastritis (which may be asymptomatic), gastric cancer and lymphoma. Aims to give a brief overview of the discovery, epidemiology, pathophysiology, diagnosis and treatment of H. pylori associated disease.

The purpose of this paper is to introduce an efficient method for solving susceptible‐infected‐removed (SIR) epidemic model. A SIR model that monitors the temporal dynamics of a childhood disease in the presence of preventive vaccine. The qualitative analysis reveals the vaccination reproductive number for disease control and eradication. It introduces homotopy perturbation method (HPM) to overcome these problems.

The paper considers HPM to solve differential system which describes SIR epidemic model. The essential idea of this method is to introduce a homotopy parameter, say p, which takes values from 0 to 1. When p=0, the system of equations usually reduces to a sufficiently simplified form, which normally admits a rather simple solution. As p is gradually increased to 1, the system goes through a sequence of deformations, the solution for each of which is close to that at the previous stage of deformation. One of the most remarkable features of the HPM is that usually just few perturbation terms are sufficient for obtaining a reasonably accurate solution.

HPM is employed to compute an approximation to the solution of the non‐linear system of differential equations governing the problem.

The paper is of value in presenting, via some tables and figures, some numerical experiments which resulted from applying new methods on test problem.

In 1934 the Milk Marketing Board came into being, and with it the “Milk in Schools Scheme.” and all its promises to provide millions of school children with milk “approved” by County Medical Officers. Much effort has been made on school milk in this county. Often it is found that the milk “approved” does not reach the schools, but other milk does, which has not been covered by the arrangements made by the county council with the Ministry of Agriculture's veterinary staff. This is usually discovered when a school sample is found tuberculous, and arising from the subsequent enquiry. The steps taken as practised in this county are: (a) The proposed producer and supplier is visited, and his methods and cows inspected. (b) A sample of the “bulk” milk is procured for cleanliness and disease tests (the test for tubercle bacilli takes six weeks—this is unfortunate, but it is the best our laboratories can do). (c) The supply to the school is “approved” and the veterinary surgeon of the Ministry is requested to clinically inspect the herd quarterly—(no authority exists to tuberculin test cows without permission of the owners). Visits to schools are made frequently and samples of milk are tested from time to time. Those schools situated in convenient areas in the county receive “pasteurised” milk, which, incidentally, does not always satisfy the requirements of law, despite the cry often heard that pasteurisation is the cure for all unsatisfactory milk. The supplier has to be relied upon to deliver the “approved” milk—if he does not, the control instigated is somewhat lost, except the milk he is actually delivering is tested about once in three months. As there are some 250 schools taking milk this work is considerable. What control is operative in other counties I cannot say, but it is felt that the control of milk supplied to children leaves very much to be desired. As previously stated, steps ought to be taken to direct, wherever possible, “tuberculin tested” milk into the schools. At present this milk is largely wasted. Suppliers to schools, in the main, are not desirous of the business, and decline it whenever possible. County councils are also active through their agricultural and advisory departments. Very useful work had been done in this direction, but such activity is non‐statutory, and the Dairy Instructors may only visit farms when help is requested. The scope of this work has been enhanced by the inclusion in the war agricultural departments of a milk production section. Thus a further staff has been created, which possesses new sampling officers to sample milk, after it has been sold and received at the collecting depots throughout the country. This staff, which at the moment is declared to be for war time only, probably supersede numerically all the peace time milk administrators. The reasons for setting up the war time staff is to prevent losses of milk due to bad production, and to increase production. It is obvious that if the peace time arrangements could be consolidated, and a bold administration proceeded with, to compel the producers and others to comply with the law on the subject, there would be no need for a new body, which probably will remain after peace comes. What is needed, and this has been the case for many years, is a real drive for clean, disease‐free milk. The position as outlined in this lengthy statement is not due to the present emergency. The muddle has been in operation throughout all the past. What is required, in my opinion, is modification of the legislation whereby all the administrative control of milk, other than marketing (which the Milk Marketing Board can manage), is brought under the control of a central authority. If county councils are to continue in the post‐war period I am of the opinion that this body should be that central authority. One department, possessing the necessary classes of full‐time officers, including a section for educational and advisory work, could effectively and uniformly administer the law, which would result in the clean, safe milk which England craves for. I think it would be too much to hope for, whereby the Ministry of Agriculture's veterinary staffs might be included once more on the county council staff. On second thoughts, it may be well that they remain where they are, provided the staffs are adequate to cover at regular intervals all the herds, with powers to tuberculin test, as well as to clinically examine, when necessary. It has never yet been made a penal offence to dispose of cows which react to the tuberculin test, consequently a producer may, and does, pass tuberculous cows on through the open market to other producers. Surely the sale of such animals should be prevented as a first step to stop the spread of infection, and some means found of gradually eliminating them by destruction. An arrangement could be made whereby the county council staff may work in close co‐operation with the Ministry's veterinary surgeons, mainly by indicating where tuberculous infection exists as a result of milk sampling. The Animal Health Divisions of the Ministry are established throughout the country, each serving a small group of counties with veterinary staffs housed in each county. Such a new beginning would obviate the necessity of “putting the cart before the horse,” which is really the trend of things as seen in the establishment of the National Milk Testing Scheme. This scheme will show that large quantities of milk has a poor keeping quality, because of the lack of inadequate inforcement of the law. I say get the law administered in the first place. I cannot close without touching on the subject of marketing. For years milk producers have not been paid enough for their product. I used to think that better payment would almost solve the dirty milk problem, because this would enable the farmer to pay a wage which would attract the labour of more suitably educated persons who would thereby respond to modern methods. Milking cows properly is not the job for the village idiot: it is highly skilled work. However, judging by the small number of producers who have taken advantage of the Designated scheme, whereby they receive extra payment, doubts arise as to whether better prices would of necessity improve the nature of production. It must be remembered that the law has required milk producers to provide a clean milk, but, because for one reason and another this has not been done, the legislature, by the introduction of the Designated Orders, recognised clean and dirty milk, extra payment being arranged to induce the production of clean milk to those who had hitherto not carried out their legal obligations. All milk should be of one grade, conforming to a bacteriological standard of purity, and eventually all cows should pass periodically the tuberculin test. It is very necessary, however, to pay producers a fair price, and enforcement of the law would thereby become easier. You will never have a pure milk supply by the continuance of a policy of tinkering and patching. The whole set‐up needs altering, and vested interests prevented from barring the way to progress. There are other diseases besides tuberculosis which need dealing with in the interests of agriculture generally, but it seems that tuberculosis is the one which is the most capable of transmitting serious disease to man, with the exception of contagious abortion. The recently introduced plan whereby, for the payment of a premium by the dairy farmer, a periodic clinical inspection of his cattle is undertaken is good as far as it goes, but it is only tinkering about with the few herds which to date have adopted the scheme. Already official samples of milk from such herds have been noted to be tuberculous. In view of the large sum of money which is apparently available, but which in one way or another is being largely wasted, why not embark upon a bold scheme of disease eradication by compulsory methods, instead of the Ministry of Agriculture and Fisheries scheme of “attestation,” which again is voluntary.