Planning for Emerging Infectious Disease Pandemics

How can planners help curtail future infectious disease pandemics? In "Planning for Emerging Infectious Disease Pandemics" (Journal of the American Planning Association Vol. 88, No. 1) James Nguyen H. Spencer, David Marasco, and Michelle Eichinger conceptualize the benefits of planners' involvement in disease mitigation.

Nearly three-fourths of emerging infectious diseases (EIDs) result from zoonotic conditions, or animal-to-human transmissions, in which the disease switches host species. Spencer et al. begin by defining two types of interventions: "upstream" or preventative and "downstream" or reactive.

Planning Upstream is Essential for Preventing Diseases

While most interventions have occurred downstream after the virus is within human populations, optimal EID prevention occurs as far upstream as possible. Invasive medical and public health interventions, like pre-outbreak vaccinations and large-scale culling, are not as politically viable as upstream intervention alternatives. Therefore, ideal EID mitigation complements medical downstream interventions with upstream planning prevention.

To make their case, the authors examined the 2004-2005 avian influenza outbreak that caused 52 human deaths and two human-to-human contact cases. Vietnam's response exemplified a downstream approach that largely ignored the opportunity for preparative planning. Such short-term responses like vaccinating and culling poultry undermined the long-term efficacy. Spencer et al. contend that had preemptive measures been considered, land use planners would have been more involved in policymaking.

In response, Spencer et al. use the avian flu to help understand the COVID-19 pandemic. Their comparison emphasizes how today's vaccine distribution, as the seemingly "most effective solution," still has many long-term limitations.

Planning, in particular infrastructure and land use planning, is well situated to address zoonotic diseases. Public health officials may be versed in "testing, treating, and vaccination," but planners are well-equipped to broaden our understanding of threats.

For instance, improving water and sewer systems or designing local food markets that promote safe livestock-to-human interactions are examples of preventative measures where planning can help. Community-level planning can motivate action towards anticipated, rather than existing, threats. Figure 1 outlines policy mechanisms categorized by the timing and invasiveness of interventions.

Table 1. Current policy alternatives and objectives.

Planning Key in Health Crisis Prevention

Spencer et al's piece concludes with actionable recommendations for planning pedagogy and practice. They suggest managing density in urbanizing areas, promoting food systems planning, and encouraging planning associations to develop land management policy positions for human health and disease control.

Planning and public health have been inextricably linked since Dr. John Snow used spatial mapping to identify the cause of cholera outbreaks in the mid-1800s. Today, amidst threats like COVID-19 and monkeypox, planners must continue to "assert the utility of their perspectives" to improve disease mitigation through multidisciplinary collaboration.

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