Syllabus Cover Letter – Shannon Newman

The following syllabus is for a proposed 400-level course. The course would optimally be 3-credit hours,

meeting three days a week for one hour each. Class sizes would be limited to ~20 students.

The primary format for classes will be discussion-based. I will introduce topics through initial lectures at

the beginning of the week and follow-up with case studies, activities, and student-led discussions

throughout the week. Because it is uncertain the exact kind of time schedule the course would run, I

have outlined the topics for each week, summarizing the relevance of the topic and pointing out key

questions that will be addressed that week. Additionally, I have included the assignments, in the form of

required readings from the textbook as well as examples of possible supplemental readings to facilitate

discussion and examine case studies.

Because this is an upper-level course and students may be unfamiliar with the challenges of some of the

assignments such as reading primary literature and putting together a formal research paper, a series of

scaffolding activities will take place throughout the quarter such that the students feel supported and

able to meet these challenges. The first week, we will have a class long workshop to learn how to read

and dissect primary literature since this will be a foundation of many of the class readings and

discussions. Additionally, practicing this technique will afford students opportunity for feedback and

additional help throughout the quarter. For the research paper, there will be two in-class workshop days

where students can independently work on their proposal, using other students and me as resources

and to help brainstorm ideas. A mid-quarter outline will give students the opportunity to receive direct

feedback and allow me to assess how I can best support them.

Human Impact and the Globalization of Infectious Disease School of Interdisciplinary Arts and Sciences: Science, Technology, and Society Program – UW Bothell

Instructor: Shannon Newman

E-mail: slnewman@uw.edu

"Gentlemen, it is the microbes who will have the last word." – Louis Pasteur

Course Description and Objectives:

Since 1976, when it was first recorded, there have been 20 major outbreaks of the Ebola virus.

Throughout these years, infectivity rates as well as mortality rates have varied. The most recent 2014

Ebola outbreak in West Africa resulted in over 28,000 cases and 11,000 deaths, the largest outbreak in

history, with a 40% mortality rate. While the epidemic has subsided, lingering questions remain: Why

now? Why in Africa? Will Ebola forever be endemic in that region? When/where will the next outbreak

be, if there even is one?

Questions like these are coming in more contexts than ever in our increasingly populated world. Most

recently, concerns about the possible global spread of the new Zika virus and what preventative

measures are necessary to stop it are widely circulated. Despite great scientific advancements in

treatment and prevention, the rates of infectious disease continue to ebb and flow, and such diseases

remain the leading cause of death of young children and adolescents, and are responsible for 16% of

annual deaths worldwide. As the world experiences increased globalization, disease becomes more

pervasive in diverse environments and cultures. Moreover, many already wide-spread diseases start to

develop increased antibiotic resistance, in part due to maltreatment and cultural misconceptions of

antibiotic usage. Anthropologists, epidemiologists, and public health officials continuously try to

improve the ways in which they work together to improve not only disease diagnosis, but also to

identify the political, cultural, ecological, and economic barriers that inhibit international goals of

treatment and eradication of public health maladies, and how these barriers can be overcome.

This course will introduce students to factors that may be involved in the globalization of infectious

disease, ranging from cultural practices to global warming and the emergence of new or untreatable

versions of diseases. Using case studies, students will learn in greater detail how each of these factors

contributes to the spread and policy of infectious disease.

The objectives of this course are to:

Identify and discuss the major causes of disease burden as well as the pattern and variability in

health issues around the globe

Critically articulate the magnitude and complex nature of global health challenges and ways to

mediate them

Interpret and outline the key questions and findings of scholarly journal articles from different

academic fields

Simulate global disease transmission scenarios using online modules

Solve an epidemiological case study utilizing strategies discussed in class

Critique and defend arguments determining the most critical steps necessary to control global

infectious diseases

Synthesize information from primary sources to write a critical research essay examining and

analyzing the factors involved in an emerging infectious disease and propose/design possible

intervention solutions.

Assignments and Grading

Class Participation (25%): There will be many ways to participate throughout the course. Students are

expected to attend all class sessions, come prepared by having completed reading assignments, and

participate fully in discussions. Students will be assessed in the following ways:

Preparation: Students will be asked to submit a reading response or question on an online

graded discussion board through Canvas prior to each class period.

Leadership: Student groups of 3-4 will be responsible for opening discussion during one class

session – a sign-up sheet will be circulated early in the quarter. Requirements of the discussion

are the following:

o Present a brief summary of required readings

o Identify and point out one or two passages from the readings that are central to the

main argument

o Pose questions from the articles/passages

o Present a relevant news article from the past six months that relates to the topic at

hand

o Turn-in a one-page self-reflection one week following the discussion

In-class participation: Students will be asked to participate in weekly discussions and take part in

in-class activities, such as the group-led debate during the 10th week of class.

Active Reading Exercises/Reflections (5% each; 3 total): Students will individually choose three articles

during the quarter for additional analysis. Deadlines for each article selection are noted in the syllabus.

Students will be asked to create a “reverse outline” for two academic journal articles they find on their

own. In this, they will assess the pre-existing findings which led the researchers to engage in their study

and will subsequently break-down and summarize the major points and conclusions of the study. For a

third article, students will be asked to reflect on the importance of the article and relate it to class

material.

Mid-term exam (20%): Students will take an in-class, short answer essay midterm covering topics

discussed during the first half of the quarter.

Term research paper (40%): In a 10-15 double-spaced page, well-structured research paper, students

will analyze their own case study of a contemporary infectious disease (other than the ones explored in

class) and health policy. Using readings discussed in the class as well as external primary sources,

students will pose their own public health question and analyze the situation at present, going into

detail what kind of cultural, political, environmental, and economic forces are at play in the

manifestation of the disease and what public health difficulties arise as a consequence of these factors.

Additionally, the student will present their own assessment as to what kinds of specific behavioral

change strategies can be employed and why, citing previous case studies and examples. We will have

two workshop days throughout the quarter to allow students time to brainstorm ideas and discuss with

other students. An outline will be due by the end of week 5, with the final version due on the date of the

final by midnight.

Course Policies and Values

Respect: The goal of this class is to gain a better understanding of medical anthropology and the

globalization of infectious disease through class discussion and analysis of varying perspectives on the

roles of physicians and public health experts. As a result much of this class will be graded on students’

abilities to actively engage in insightful discussion and contribute to how we understand these concepts.

Students are required at all time to engage in a respectful manner toward the thoughts and opinions of

other students and as best as possible use reasoning and evidence as support for their thoughts and

opinions.

Access and Accommodations: Your experience in this class is important to me. If you have already

established accommodations with Disability Resources for Students (DRS), please communicate your

approved accommodations to me at your earliest convenience so we can discuss your needs in this

course.

Required Texts and Readings:

In addition to the reader packet provided that contains necessary articles, the following books are

required and may be purchased from the UW Bookstore:

Mayer, Kenneth, and Hank Pizer. The Social Ecology of Infectious Diseases. Oxford: Academic, 2008.

Weekly Course Schedule

Week 1: Introduction to Infectious Disease and Epidemiology

During this first week, we will review and discuss how globalization has affected the spread of infectious

disease. We will examine the concepts of medical anthropology and epidemiology in the scope of a

global health perspective and how the two disciplines are learning to interact and apply each others’

knowledge to address the spread and treatment of infectious disease. We will begin to understand why

it is so important to examine different perspectives to treat international maladies and set the

foundation for what we mean by infectious disease throughout the course, exploring the differences

between epidemic, endemic, and pandemic diseases, using examples. We will also work together to

dissect a primary literature article as a class in preparation for readings throughout the course.

Questions to Consider: What constitutes the social ecology of infectious disease? How are

emerging diseases different now than a few centuries ago? What factors are involved in the

emergence and reemergence of new infectious diseases?

Activity: As a class, we will engage in a workshop to learn how to dissect and interpret primary

literature. Students will be given a short ~2 page primary literature research paper to dissect with a

partner, aiming to answer guiding questions I will provide regarding the hypothesis being tested,

previous evidence, and conclusions. We will then work through it together as a class, making

annotations to the paper on an overhead projector to identify critical components and findings.

Textbook Readings:

EID: Introduction: What constitutes the social ecology of infectious diseases

Possible Supplemental Readings:

Dobson and Carper. “ Infectious Diseases and Human Population History”

Weiss and McMichael. “Social and environmental risk factors in the emergence of infectious

diseases.”

Morens, et al. "The Challenge of Emerging and Re-emerging Infectious Diseases."

Harper and Armelagos. "The Changing Disease-Scape in the Third Epidemiological Transition."

Smith, et al. "Global Rise in Human Infectious Disease Outbreaks."

Week 2: Biology of Infectious Disease

In the second week of class, we will begin to explore the biological factors that contribute to the

emergence and reemergence of infectious diseases, new and old. We will also discuss the basic biology

of how viruses and bacterium can switch hosts/vectors, the life cycles of many of these diseases, and

how they are able to target the host immune system.

Questions to Consider: What biological factors determine the susceptibility of an individual to a

disease? What kinds of vectors are most common in the transmission of zoonotic diseases and

why are they optimal? How do various bacterial/viral life cycles improve their ability to be

infectious?

Activity: West Nile Virus – Vectors and Hosts Game: In this activity adapted by HHMI, students play a

game in which they are assigned roles as either a host or a vector during a West Nile virus outbreak.

Using properties of these hosts/vectors/diseases as discussed in class, students will be required to take

the appropriate action of spreading or squandering the disease.

http://www.hhmi.org/biointeractive/infectious-disease

Possible Supplemental Readings:

Wolfe, et al. “Origins of Major Human Infectious Diseases”

Brierley, et al. "Quantifying Global Drivers of Zoonotic Bat Viruses: A Process-Based Perspective”

Lipsitch and Moxon. "Virulence and Transmissibility of Pathogens: What Is the Relationship?"

Hubálek and Zdenek. "Emerging Human Infectious Diseases: Anthroponoses, Zoonoses, and

Sapronoses."

Week 3: Global Climate Change and the Emergence of Infectious Disease

Global warming due to globalization brings about environmental changes that are conducive to the

spread of infectious diseases and their vectors, particularly mosquitoes. Warmer temperatures and

increased rainfall have increased the geographic ranges of diseases such as dengue fever and malaria

throughout Africa and Latin America, while normal seasonal changes can bring about increased

incidences of more widespread pathogens, such as Salmonella. In this unit, we will discuss how climatic

changes, even at a seasonal level, influence the pathogen, vector, and host, leading to increased

incidence of disease. Primary literature from the fields of climatology and epidemiology will promote an

interdisciplinary understanding of how these two fields influence public health, with a case study

focusing on dengue fever.

Questions to Consider: In what ways has climate change influenced the spread of disease?

Which pathogens are most likely to become an emerging threat as a result of global warming?

What seasonal variations should be considered when thinking about preventative measures for

pathogen transmission?

Textbook Readings:

Chapter 14 EID: Climate change and Infectious Disease

Possible Supplemental Readings:

Patz, et al. “Global Climate Change and Emerging Infectious Diseases.”

Rogers and Packer. "Vector-borne Diseases, Models, and Global Change."

Cazelles, et al. "Nonstationary Influence of El Niño on the Synchronous Dengue Epidemics in

Thailand."

Hales, et al. "Potential Effect of Population and Climate Changes on Global Distribution of

Dengue Fever: An Empirical Model."

Hopp and Foley. "Worldwide Fluctuations in Dengue Fever Cases Related to Climate Variability."

**Active Reading Exercise/Reflection 1 Due by Friday

**Term Paper Workshop I on Friday

Week 4: Political/Economical Contexts affecting Disease Spread

In this unit, we explore the kinds of political and economical contexts that may affect the spread of

infectious disease and conversely, how infectious disease shapes the development of political systems.

We will examine how government-implemented systems as well as political policies resulted in a mass

boycott of polio vaccinations in central Nigeria and Pakistan, leading to the resurgence of a nearly

eradicated disease. We will discuss how censorship and denial in many countries has led to delayed

treatment efforts.

Questions to Consider: How have governments across the world shaped the spread of infectious

disease, both positively and negatively? What steps can political systems make to take

accountability for disease in their respective nations?

Textbook Readings:

Chapter 11 EID: Infectious diseases in the context of war, civil strife and social dislocation

Chapter 15 EID: Governance, Human Rights, and Infectious Disease

Possible Supplemental Readings:

Mcneil, Donald G. "C.I.A. Vaccine Ruse May Have Harmed the War on Polio." The New York

Times.

Mcpake, et al. “Ebola in the Context of Conflict Affected States and Health Systems: Case Studies

of Northern Uganda and Sierra Leone."

Hill, et al. "The “empty Void” Is a Crowded Space: Health Service Provision at the Margins of

Fragile and Conflict Affected States."

Ghinai, et al. "Listening to the Rumours: What the Northern Nigeria Polio Vaccine Boycott Can

Tell Us Ten Years on."

Jegede, AS. "What Led to the Nigerian Boycott of the Polio Vaccination Campaign?"

Week 5: Social/Cultural Contexts:

Throughout the world, time-honored cultural traditions and practices have revealed themselves to be a

source for facilitating the spread of infectious disease, and social beliefs have created resistance toward

vaccination/eradication programs. Medical anthropologists seek to incorporate these social and cultural

norms into what is now understood about disease transmission as a way to more effectively educate at-

risk populations. In this unit, we will explore the roles social and cultural practices have on the

transmission and treatment of disease through the exploration of three case studies, religious practices

promoting the spread, and the halt, of infectious diseases, sexual practices and STIs, and burial practices

and Ebola. Additionally, we will consider the kinds of behavioral communication change (BCC) practices

in place that experts utilize to accommodate and modify these practices.

Questions to Consider: What kinds of social and cultural practices contribute to the spread of

infectious disease? What kinds of social and cultural practices are used to treat disease and how

effective are they? How might current disease-education programs in existence be modified to

better accommodate existing cultural practices while prompting health changes?

Textbook Readings:

Chapter 2 EID: Changing Sexual Mores and Disease Transmission

Possible Readings - Religion and the Spread of Infectious Disease:

Pennisi, Elizabeth. "Faith Goes Viral." Utne. ScienceNOW, 2012.

Gautret, P. "Religious Mass Gatherings: Connecting People and Infectious Agents."

Fincher, C. L., and R. Thornhill. "Assortative Sociality, Limited Dispersal, Infectious Disease and

the Genesis of the Global Pattern of Religion Diversity."

Drain, P. K. et al. "Male Circumcision, Religion, and Infectious Diseases: An Ecologic Analysis of

118 Developing Countries."

Possible Readings – Sexual Stigmas/Practices and HIV Transmission:

Hrdy, D. B. "Cultural Practices Contributing to the Transmission of Human Immunodeficiency

Virus in Africa."

Coates, Thomas J., Linda Richter, and Carlos Caceres. "Behavioural Strategies to Reduce HIV

Transmission: How to Make Them Work Better."

Possible Readings – Burial Practices in rural Africa and the Ebola Epidemic:

Maxmen, Amy: How the Fight Against Ebola Tested a Culture’s Traditions

Hewlett, Barry S., and Richard P. Amola. "Cultural Contexts of Ebola in Northern Uganda."

Alexander, K A et al. "What Factors Might Have Led to the Emergence of Ebola in West Africa?"

**Term Research Paper Outline Due

Week 6: Globalization, Travel, and Trade

When the European settlers first set foot in North America in 1492, they brought along many new

technologies and lifestyles. However, they also brought with them a slew of infectious diseases, most

notably smallpox, but also measles, typhoid, tuberculosis, and others. With no natural immunity to

these new pathogens, roughly 25-50% of the populations of native tribes succumbed. This example

begins to highlight how increased globalization, travel, and trade have cultivated the spread of

epidemics throughout the world. During this week, we will begin to take a closer look at infectious

diseases affecting the Western world and how trade and travel in particular have broadened the range

of disease vectors and pathogens.

Questions to Consider: What are some examples of diseases that have attained globalization

primarily due to human travel or trade? What are some reasons why newly exposed populations

are particularly susceptible? What kinds of measures can be taken to prevent the human

carrying of infectious diseases across borders through travel or trade?

Textbook Reading:

EID: Chapter 1: Travel

Possible Supplementary Readings:

Section 1: Wilson, Mary E. "Travel, Conflict, Trade, and Disease." Infectious Disease Movement in

a Borderless World.

Bianchine and Russo. “The Role of Epidemic Infectious Diseases in the Discovery of America.”

Tatem, Hay, and Rogers. "Global Traffic and Disease Vector Dispersal."

Pindolia, et al. "The Demographics of Human and Malaria Movement and Migration Patterns in

East Africa."

Perrings, Charles. “Options for managing the infectious animal and plant disease risks of

international trade.”

**Active Reading Exercise/Reflection 2 Due by Friday

Week 7: Industrialization and Urbanization

With the advent of industrialization, large-scale production and distribution of food has become more

feasible and public water-delivery systems have been implemented. Commonly, infectious disease

issues have been of less concern in developed nations, yet as a result of urbanization and

industrialization, new microbial and viral threats have begun to emerge. In the U.S. alone, there are

approximately 76 million foodborne diseases per year, resulting in a $6.9 billion per year economic cost.

In this unit, we will investigate the kinds of new infectious disease concerns that arise due to

industrialization and urbanization.

Questions to Consider: What kind of technological advancements has industrialization provided

us to ameliorate infectious disease and what kinds of exacerbated it? What lessons can we bring

to developing nations in trying to prevent the emergence of these same diseases?

Activity: In response to the first epidemiological study performed by John Snow in 1880 Britain (review

here: https://www.youtube.com/watch?v=Pq32LB8j2K8), you will complete a module as though you are

public health investigators tracking down the source of a local food-poisoning outbreak, critically

examining data and utilizing deductive reasoning to solve the investigation as presented in the following

hand-out: http://www.jhsph.edu/research/centers-and-institutes/teaching-the-food-

system/curriculum/_pdf/Food_Safety-Handouts.pdf

Textbook Reading:

EID Chapter 8: Food Safety in the Industrialized World

EID: Chapter 5: Suburbanization in developed nations

EID: Chapter 4: Urbanization and the social ecology of emerging infectious diseases

Possible Supplemental Readings:

"CDC Update: Chipotle-Linked E. Coli Outbreak Case Count Now At 52." Food Safety News.

Graham et al. "The Animal-Human Interface and Infectious Disease in Industrial Food Animal

Production: Rethinking Biosecurity and Biocontainment."

Breiman, R. F. "Impact of Technology on the Emergence of Infectious Diseases."

Beisel and Morens. "Variant Creutzfeldt‐Jakob Disease and the Acquired and Transmissible

Spongiform Encephalopathies."

Neiderud, Carl-Johan. “How urbanization affects the epidemiology of emerging infectious

diseases.”

Week 8: Antibiotic Resistance and Vaccine Development

Antibiotic resistance has become the most immediate threat toward the reemergence of deadly

diseases. Once commonly treatable infections are now resistant to some or all known antibiotics, often

as a result of overprescription and inability of patients to adhere to medication regimens. These days,

scientists are scrambling in order to develop new forms of antibiotics, but the process is becoming ever

more and more difficult. This week, we will explore examples of the severity of the consequences that

results when pathogens become resistant to antibiotics, most notably, investigating MRSA in hospital

settings as well as drug-resistant tuberculosis. Additionally, we will look into strategies used in the US

and across the world to encourage and distribute vaccinations, and the reasons why individuals

sometimes refuse them.

Questions to Consider: What steps can be taken to minimize the risk of antibiotic resistance in

pathogens? Can antibiotic resistance be reversible? How can we identify new antibiotic

compounds? What are limitations to worldwide delivery of vaccines?

Textbook Reading:

EID Chapter 9: Antibiotic Resistance and nosocomial infections

Possible Supplemental Readings:

Cassell and Mekalanos. "Development of Antimicrobial Agents in the Era of New and

Reemerging Infectious Diseases and Increasing Antibiotic Resistance."

Levy, S. “Antibiotic Household Products: Cause for Concern”

Günther, G. “Multidrug-resistant and extensively drug-resistant tuberculosis: a review of current

concepts and future challenges”

Widdus, R. “The potential to control or eradicate infectious diseases through immunization.”

Levine and Levine. “Influence of disease burden, public perception, and other factors on new

vaccine development, implementation, and continued use.”

**Active Reading Exercise/Reflection 3 Due by Friday

**Term Paper In-Class Workshop II on Friday

Week 9: Mathematical Modeling and Prediction in Infectious Disease

We will explore examples of epidemiological modeling used to predict infectious disease spread and

what kind of tools public health experts use to visualize and map disease outbreaks. We will spend a day

in the computer lab using the online simulator game Pandemic II. This game simulates global disease

transmission, and allows students to explore the factors that aid pandemics and foster the spread of

disease. Utilizing what they learn during the game and from class, they will attempt to create the most

virulent and infectious pathogen possible. Additionally, we will engage in in-class simulations of

epidemiological situations to better understand topics of disease spread, immunization, and herd

immunity.

Questions to Consider: Why might be prediction models be useful when considering the next

major outbreak? What do these prediction models empirically lack that makes them difficult as

tools? What do these prediction models suggest about the next big pandemic?

Activities:

1) Computer Simulation: We will utilize a computer lab to explore some of the many epidemiology

modeling games available on-line including Plague Inc.

(http://www.miniclip.com/games/plague-inc/en/), Pandemic II

(http://www.crazymonkeygames.com/fullscreen.php?game=pandemic-2), or Solve the

Outbreak (http://www.cdc.gov/mobile/applications/sto/web-app.html)

2) In-class: We will engage in an in-class simulation of how contact-dependent diseases are rapidly

spread. In a modified version of the following activity from the American Society of

Microbiologists (https://www.asm.org/images/Education/K-12/outbreakbwpdf.final.pdf),

students will have cups of water (a small portion containing a clear indicator). Students will over

the course of 2-3 rounds, pour water into each others’ cups. At the end, a dye can be used to

determine which cups now contain the indicator. Modified versions of the activity can

demonstrate concepts of herd immunity and immunization.

Possible Supplemental Readings:

Murray, et al. "Global Biogeography of Human Infectious Diseases."

Carrol, et al. "Visualization and Analytics Tools for Infectious Disease Epidemiology”

Pigott, et al. "Mapping the Zoonotic Niche of Ebola Virus Disease in Africa."

"See How a Pandemic Could Sweep the World: Scientists Develop Terrifying New Computer

Model." Mail Online. Associated Newspapers

Week 10: The Future of Global Medicine: Eradication and the Next Big Pandemics

To wrap up the class, we will analyze the current mechanisms in place to prevent the emergence of new

pandemics and facilitate eradication of old ones given all of the factors discussed throughout the course.

Students will form small groups and take knowledge from the course and additional sources to argue for

one of these mechanisms in a class presentation. We will also look at what diseases are on the radar as

causative agents for the next big pandemics, such as the Zika virus, and why they are likely to be a

threat.

Questions to Consider: Is eradication possible in today’s society? When, what, and where is the

next epidemic likely to be? What steps are most imminent to take in fighting the war on

infectious diseases?

Activity: You will be split into three groups in which you will make compelling arguments based on topics

based on one of the following three chapters from the book: Do Infectious Diseases Pose A Serious

Threat? You will be asked to formulate a persuasive argument as to why your cause is the most essential

toward the global fight against infectious diseases, utilizing your chapter as well as outside sources as

evidence, and present this to the class in a 15 minute presentation.

Chapter 13: Global Public Health Systems Must Be Improved to Combat Infectious Diseases

Chapter 14: Vaccine Development Is Vital to Controlling Infectious Diseases

Chapter 15: Technological Advances Are Key to Controlling Infectious Diseases

Possible Supplemental Readings:

Chapter 11 from Reimagining Global Health: Global Health Priorities for the Early 21st Century

Morse, et al. "Prediction and Prevention of the next Pandemic Zoonosis."

Brink, Susan. "Global Health Forecast For 2016: Which Diseases Will Rise ... Or Fall?" NPR.

"Virus Chequers – A newly Emerging Disease is Threatening the Americas." The Economist. Jan.

2016.

Gannon, John C. "The Global Infectious Disease Threat and Its Implications for the United

States." National Intelligence Council