STIA Midterm

Three themes reflected by global health

development, security, public health

basis of public health

collective health

Epidemiological first transition

transition of nomadic/hunter-gathering lifestyle to agriculture and domestication of livestock

• Increased settlement = increased ease in spreading diseases

Epidemiological second transition

Post WWI with new medications and transportation

Green Revolution transformed food supply

Epidemiological third transition

Spurred by HIV/AIDS in the 1980s

Rise of emerging infections

John Snow

used the Germ Theory and expanded on it when he found the cause of Cholera outbreaks in the 1800s

Broad Street Pump: cholera was coming from germs in the water

Rudolf Virchow

Known as father of modern pathology for this theory of cellular pathology

Social structures are a determinant in improving individual health, “medicine is a social science”

Atlantic Charter 

• emphasized development in post-war and colonial states

• development theory is not perfect, especially when neglecting social factors

Marshall Plan

funding for post-war European states development efforts

UNICEF SPHC

Selective Primary Health Care

GOBI FFF focus (growth monitoring, oral hydration, breastfeeding, immunization, food, female literacy, family planning)

Comprehensive PHC 

Holistic, broad-scope services covering promotion, prevention, rehabilitation, 

Addresses social determinants of health

President’s Emergency Plan for Aids Relief (PEPFAR)

program by George W. Bush to prevent, care, and treat for HIV/AIDS

Credited with saving 50 million lives since 2003

Global Alliance of Vaccines and Immunizations

GAVI. example of private-public collaboration

aim to vaccinate children in low-income countries

Horizontal healthcare approach

broad global healthcare approach, primary-care focused 

not very results-based

Focus on infrastructure to better allow for the treatment of diseases in general, comprehensive, championed at Alma Ata conference

Vertical healthcare approach

focus on specific health conditions, mostly championed during Reagan/Thatcher years

Very results-based

Four types of MHPSS

MHPSS = mental health and psychosocial support

from low to high (on pyramid)

1. Respectful : basic services and security

2. community and family strengthening supports

3. focused, non-specialised supports

4. specialised services

DARPA

Defense Advanced Research Projects Agency

Conducts competition to spur innovation in select areas relevant to defense

The Russell-Einstein Pugwash Manifesto

During Cold War (1955) memo to warn the world about the dire consequences of a nuclear war

Office of Scientific Research and Development

OSRD 1941-47

Founded after German invasion of Paris

argued US military tech was not prepared to take on Axis Powers

Focused research on radar, Manhattan Project, mass production of penicillin, vaccines, microwave

2022 CHIPS & Science Act

set aside resources to create a Directorate for Technology, Innovation, and Partnership with the national science foundation

Epistemic Communities

group of people who have expert knowledge and essentially use it to shape policy in a particular area

Share a set of norms in their expertise

Example: International Panel on Climate Change

Global Thermohaline Conveyor Belt

deep ocean current that may be collapsing due to differences in salinity and temperature

currently responsible for warming UK and Western Europe

→ collapse would mean decreasing temperatures

First industrial revolution 

18th century

water and steam power mechanizes production

Second Industrial revolution

19th century

electric power creates mass production

3rd Industrial Revolution

20th century

electronics and information technology automate production

4th industrial revolution

Currently happening

Digital revolution blurring the lines between physical, digital, and biological spheres

Inequality is a great concern

Companies continuously innovate 

Governments face pressure from new distributions of power Individuals face new privacy challenges 

Asilomar Conference

1975 conference on the environmental and health risks of DNA modification

Led to a worldwide moratorium on DNA manipulation until the risks were more understood → Asilomar discussed under what conditions to lift the moratorium

Agreed that research should continue but under strict guidelines. Assigned risk estimate to different types of experiments

Participants included scientists, lawyers, journalists and government officials

Two systems of safety from Asilomar

1. physical containment

2. biological containment

Physical containment

One system resulting from Asilomar

The degree of risk of an experiment matches with the kind of lab space required (open bench vs airlocks)

Biological containment

One system resulting from Asilomar

Research done on riskier bacteria, for example, would have to be done on genetically modified strains that can’t survive outside of the lab

Precautionary principle 

proving causality is hard; don’t wait until there is absolute proof to fend off possible damage/risks 

AKA better safe than sorry 

Atlantic Meridional Overturning Circulation

part of the Global Thermohaline Conveyor Belt that is located in the Atlantic 

its slowing down would cause the warming of the south atlantic and cooling of the north atlantic 

Human germline editing

gene editing technique that alters the DNA of reproductive cells (sperm, eggs) or embryos, making the changes heritable and passed on to future generations

research advisory committee

RAC

Operation Warp Speed

name of the operation for the deployment of COVID faccines 

Example of a public-private acceleration model (Pfizer + gov)

Kendall Square

Biotech capital of the world

collection of four institutes in radius of 150 yards

Cambridge city council

said they don’t trust the federal government to make decisions about work that’s being done within the bounds of the city

1972: establishes the US’ first zoning rules for biotech-related research in Cambridge

IAEA General Conferences of 1990 and 2009

stated that armed attacks on nuclear power facilities violate international law

Kerch Strait Energy Bridge

4 undersea electricity cables connecting Crimea to Russian mainland; completed in 2016

World bank energy indicator

a country must be able to reliably provide 100% of its population energy in order to be considered a developed nation

ENTSO-E

European Network of Transmission System Operators for Electricity

36 Countries who share a flow of energy, 40 operators

Science in diplomacy 

informing foreign policy objectives with scientific evidence

Diplomacy for science

using diplomatic efforts to facilitate international scientific collaboration

Science for diplomacy

uses scientific collaboration to improve international relations

WHO Preamble

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

Health is a fundamental right

Social determinants of health

1. Age, sex, and constitutional factors

2. individual lifestyle factors

3. social and community networks

4. living and working conditions

5. general socio-economic, cultural and environmental conditions

Germ theory 

scientific principle that microorganisms called germs cause many diseases

developed by Louis Pasteur and Robert Koch

Replaced miasma theory in the late 19th century

Miasma theory

obsolete medical theory that diseases were caused by inhaling “bad air” or miasma, which was a noxious form of poisonous vapor emanating from rotting organic matter

Colonial history of global health institutions

medical practices driven by colonial interests

health of the colonized population not for their own well-being but for their exploitation of labor or desire to protect the colonists from disease

1. imposes top-down solutions without local consultation

2. emphasis on “magic bullet solution” without paying attention to social determinants of health

3. improves health of the population to more efficiently exploit

4. seeks to win hearts and mind through health interventions with ulterior motives (political or economic influence)

four characteristics to the necolonialist healthcare approach

World Health Organization, UNICEF, World Bank, Atlantic Charter, Marshall Plan

Post WWII global health governing bodies

Alma Ata Conference

“Health for All” with the Cold War in the background — took place in the Soviet Union (Kazakhstan), discussed

primary health care, Western capitalist nation pushback

Selective Primary Health Care

smaller in scope, aims to provide low-cost basic health care interventions for developing countries

easier support from donor community, met NGO need for measurable, fast results

Top-down, vertical program

Not engaging sectors outside health ministries

Comprehensive Primary Health Care

aims to uplift entire populations to levels of health that allows wide-scale productive economic and social interactions

Allostatic load

a physiological measure of the cumulative burden of stress on the body assessed by markers of physiological dysregulation

Syndemics

product of the SYNergies between multiple factors that contribute to health and the cluster of one or more epiDEMICS within a population; locally driven

Three required factors of syndemics

Clustering: 2+ diseases/epidemics

Interactions: between two or more diseases that change how illness is experienced

Drivers: societal deviations, structural problems, and political decisions that change how disease is experienced

SAVA Syndemic

Substance, Abuse, Violence

Shows that there is a relationship between all three

VIDDA Syndemic

Violence, Immigration, Depression, Diabetes, Abuse

deconstructs the dynamics among the above, relationship

Whitehall 1

identified the link between hierarchical status and cardiovascular disease
men in lower job ranks had much higher mortality than those in higher ranks

Whitehall 2

stressful jobs and low social control are a major cause of stress-related illness

4 ways of addressing syndemics

Upstream solutions: impacts the causes of syndemics (school, food, housing, health care, immigration, min wage…)

Clinical interventions: social workers, pyschologists

Community-based interventions: peer group counseling

Downstream solutions: impacts effects of syndemics, womens collective groups, medical bankruptcy forgiveness…

Yield of a nuclear detonation

amount of energy of the initial explosion

measured in equivalent amount of TNT required to form a detonation of the same energy

Intercontinental ballistic missile

a type of missile that is launched from a nuclear station, uses rocket propulsion to reach space where it sheds its booster, follows projectile motion and re-enters the atmosphere eventually hitting its target (it is protected by a ‘re-entry vehicle’). 

• Re-entry: Most missiles are calibrated to explode slightly off the ground to maximize damage

• Can reach anywhere in the world in 30 min

categories of energy stemming from a nuclear missile

thermal radiation (35%), blast and shock (50%), nuclear radiation (15%) - initial radiation = 5%, residual nuclear radiation = 10%

Chronology of nuclear damage

1. initial release of energy: trillions of calories from fission chain reaction, energy converted into intense light of short wavelength

2. formation of fireball: short wavelength intense light are radiated into and absorbed by atmosphere - heats up air immediately

3. advancement of shockwave: air around fireball is compressed. mach stem → reflects shockwaves out

4. blast-wave reverse course: as fireball rises, there is space for air to fill, winds reverse directions and creates ideal conditions for a fire

4 key issues of biotechnologies

• safety

• universal access

• prioritization

• social engagement

CRISPR/Car-T Cell Therapy

World’s first therapy using donor cells sends autoimmune diseases into remission, used in autoimmune diseases, example of systemic sclerosis

Synthetic biology

creating/coming up with new microorganisms that do not exist in life

Steps of CRISPR

RNA guides the enzyme (CAS-9) to a specific point on the DNA molecule, then unwinds it and cuts and inserts genetic information. The cell then repairs the cut, either by disabling the gene or inserting new genetic information using a provided template

UN Convention on Biological Diversity (CBD) definition

defines any technological application that uses biological systems, living organisms, or derivatives to make or modify products or processes for a specific use

Four subdivisions of biotechnology

1. traditional genetics

2. molecular biology

3. cell culture

4. bioinformatics

Classical Biotechnology

1800-1900: theory of evolution by Charles Darwin

Common ancestry, introducing genetics, changes in DNA, adjustments to the environment and natural selection, laws of inheritance, germ theory

Louis Pasteur: germ theory

Robert Koch: tuberculosis

Modern biotechnology

post WWII

X-Ray, double helix model of DNA, operon, monoclonal antibodies

Rosalind Franklin, 1952 XRays

Watson and Crick, 1953 double helix DNA

1961: Jacob and Monod’s operation

Ancient biotech

pre-1800

methods of food preservation, alcoholic fermentation

Central dogma of molecular biology

How genetic information flows within biological systems

DNA stores genetic information, RNA is made through DNA through

Transcription: DNA makes RNA, enzyme binds to the DNA and turns it into DNA transcription

Translation: protein is synthesized via amino acids, three codons make an amino acid, and the collection of amino acids together

Key biotech sectors

1. Medical: new drugs

2. Agriculture: GMOS, lab-grown meat

3. environmental: oil-degrading bacteria that break down hydrocarbons

4. industrial: bioethanol, bio plastics

Biotech + business

many pharmaceutical companies have dedicated biotech wings

Challenges to businesses in the biotech/pharma industry

1. high regulatory hurdles: trial process, ethical qualms

2. a lot to gain from the industry = many competitors in the field

US - China biotech competition

• China produces 7x the number of biotech papers as the US

• Developing economies = gov-funded biotech research

• Developed economies = private sector funded biotech research

• US National Academy of sciences is concerned about US biotech funding

• Biotech presents high return for US economy

• China funds university researchers, whose innovations and discoveries are used by private labs

• US strategy: private companies lead in proprietary R&D

Classical Biotech: Charles Darwin

Species share a common ancestor

Natural selection to keep and shed certain traits

Classical Biotech: Gregor Mendel

Laws of inheritance:

1. law of segregation

2. law of independent assortment

3. law of dominance

Classical biotech: Louis Pasteur

Germ theory: micro-organisms are the vector for disease, not just miasma (bad air)

Classical biotech: Robert Koch

Tuberculosis: isolated and displayed the agent causing it

Modern biotech: Rosalind Franklin

Photograph 51. used X-ray crystallography to provide the core evidence for the double helix structure of DNA

Initially didn’t receive credit because of social stigma and sexism

Modern biotech: Watson & Crick

Used Rosalind Franklin’s photo to solidify the conception of a “double helix model of DNA”

Modern Biotech: Jacob and Monod

Discovered the lac operon, showed how bacteria can control gene expression for lactose metabolism through repressor protein

Modern Biotech: Kohler and Milstein

discovered monoclonal antibodies, didn’t patent it

(Modern biotech) Hargobind Khorana

• came up with DNA synthesis : created the first complete, functional artificial gene

• build a custom DNA sequence from scratch without needing a natural DNA template from an organism

(Modern Biotech) Karl Mullis

• PCR: polymerase chain reaction invented

  • makes copies of specific DNA segment starting from a very small amount of genetic material

(Modern biotech) Ian Wilmut

Cloned dolly the sheep

created an exact genetic copy; built from a single somatic cell

(Modern biotech) Craig Venter

Human genome sequencing and synthetic genomes

ID distribution of genes, mapped the human genome

Turner syndrome

One X-Chromosome is missing

Only happens in women, because embryos with only a Y chromosome cannot survive (lack too many essential genes)

Down syndrome

Trisomy 21, extra copy of chromosome 21

Jennifer Doudna and Emmanuel Charpentier

Who created CRISPR Cas 9

Clustered Regularly Interspaced Short Palindromic Repeats

CRISPR

CRISPR mechanism

CRISPR - Cas9 uses a guide RNA to direct the Cas9 enzyme to a specific DNA sequence, where Cas9 makes a cut that the cell repairs, allowing genes to be disrupted, corrected, or inserted precisely.

Four ethical problems with CRISPR Cas-9

1. Safety: mosaicisim, cascading effects, off-target editing

2. Prioritization: when and who should be used on

3. Universal access: everyone or just wealthy? cost?

4. societal engagement: will public’s trust be cultivated prior to deployment of tech

CRISPR Cas9 safety implications

1. Mosaicism: not all cells in an organism have the same DNA → unpredictable side effects

2. Off-target editing: when CRISPR or other editing tools cut DNA at wrong site. Instead of editing the intended gene, other parts of the genome are accidentally changed. could disrupt important genes. cancer. difficult to predict or detect

3. Cascading effects: through generations that don’t show up until too late. Changes to germline cells are passed down to generations. effects may not appear now, but could appear in later descendants. Clinical trials are meant to monitor these risks.

Synthetic biology

designing and constructing new biological systems. reuse, repurpose, and reconfiguration of biological systems

gene therapy, cell therapy, RNA therapies, gene-modified therapies