Epidemics by Ruth Peaden

Zika Virus - Epidemic

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Ebola - West Africa 2014 - Pandemic

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Ebola is a virus that involves vomiting, diarrhoea, rashes as well as internal and external bleeding (Lekone & Finkenstädt, 2006).

Human to human transmission happens through contact of bodily fluids (Gostin et al, 2014).

EPIDEMICS

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The spread of disease with a sudden increase in the number of cases. Higher than expected in that population in that area (Centers for Disease Control and Prevention, 2012.

SARS - Pandemic

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Japan 2003

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SARS Outbreak - China

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SARS was categorised as a Pandemic due to the disease reaching from Southeast Asia all the way over to the USA (Zhong, et al., 2003)

Root Cause

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The outbreak came from an American businessman travelling from China via Hong Kong to Vietnam (Wilder-Smith, 2006).

Time

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SARS became prevalent in mainland China in November 2002.

The outbreak to other countries occurred on the 23 February 2003 (Wilder-Smith, 2006).

Gravity

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8,098 people worldwide contracted SARS, 774 died (National Center for Immunization and Respiratory Disease, 2017).
China had more than 75% of the cases (Dombrey, 2003).

Dimensions

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The SARS outbreak was on a global scale after the World Health Organisation on the 12th March 2003 issued a global alert (Zhong, et al., 2003).

References Ruth:

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Baran, M. (2016, February 22). Brazilian tourism board outlines measures for Zika control. Retrieved from Travel Weekly: http://www.travelweekly.com/South-America-Travel/Brazilian-tourism-board-outlines-measures-for-Zika-control

Baran, M. (2016, May 03). Lack of reporting standards blurs Zika travel safety data. Retrieved from Travel Weekly : http://www.travelweekly.com/Caribbean-Travel/Lack-of-reporting-standards-blurs-Zika-travel-safety-data

Benxiang Zeng , Rodney William Carter & Terry De Lacy (2005) Short-term Perturbations and Tourism Effects: The Case of SARS in China, Current Issues in Tourism, 8:4, 306-322

Biesiada, J. (2016, July 27). Air sales spike for Brazil Olympics, but World Cup surge was bigger. Retrieved from Travel Weekly: http://www.travelweekly.com/Travel-News/Airline-News/Air-sales-spike-for-Brazil-Olympics-but-World-Cup-surge-was-bigger

Brazil. (2018). Key information. Retrieved from Visit Brazil: http://visitbrasil.com/en/informacoes-essenciais/health.html

Centers for Disease Control and Prevention. (2012, May 18). Lesson 1: Introduction to Epidemiology . Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html

CDC. (2017, November 15). REporting and Surveillance. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/zika/reporting/index.html

Cooper, M. (2005 ). Japanese Tourism and the SARS Epidemic of 2003. Journal of Travel & Tourism Marketing, 171-131

Daniels, J. (2016, February 1). Zika virus worries weigh on the travel industry. Retrieved from CNBC: https://www.cnbc.com/2016/02/01/zika-virus-worries-weigh-on-the-travel-industry.html

Euronews. (2016, February 3). The threat of the Zika virus to tourism in Brazil in Olympic year. Retrieved from euronews: http://www.euronews.com/2016/02/03/the-treat-of-the-zika-virus-to-tourism-in-brazil-in-olympic-year

Kiernan, P., & Jelmayer, R. (2016, February 3). Zika Fears Imperil Brazil’s Tourism Push. Retrieved from The Wall Street Journal: https://www.wsj.com/articles/zika-fears-imperil-brazils-tourism-push-1454461138

Martel, F. (2016, February 11). Breitbart. Retrieved from Zika Begins to Hit Brazil’s Tourism Industry, Months Before Olympics: http://www.breitbart.com/national-security/2016/02/11/brazils-tourism-industry-hit-hard-by-zika/

Pinghui, Z. (2013, February 20). How the Sars outbreak changed mainland China. Retrieved from South China Morning Post: http://www.scmp.com/news/china/article/1154190/how-sars-outbreak-changed-mainland-china

Pinheiro de Oliveira, A. (2016). Brazil’s Militarized War on Zika. Global Societies Journal, 88-89.

ShiNa Li , Adam Blake & Chris Cooper (2010) China's tourism in a global financial crisis: a computable general equilibrium approach, Current Issues in Tourism, 13:5, 435-453

Vora, S. (2016, January 28). How the Zika Virus is Affecting Travel. Retrieved from New York Times: https://www.nytimes.com/2016/01/29/travel/how-the-zika-virus-is-affecting-travel.html

World Health Organization . (2017, February 6). The Zika Virus outbreak continues one year after the global emergency. Retrieved from Pan American Health Orginization: http://www.paho.org/hq/index.php?option=com_content&view=article&id=12944%3Azika-virus-outbreak-continues-one-year-after-global-emergency&catid=740%3Apress-releases&Itemid=1926&lang=en

WHO. (2003, April 16). The operational response to SARS. Retrieved from World Health Organisation: http://www.who.int/csr/sars/goarn2003_4_16/en/

WHO. (2016, September 6). Zika Virus. Retrieved from World Health Organization: http://www.who.int/mediacentre/factsheets/zika/en/

Impact at Destination Level

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- The China National Tourism Administration stated up to 130,000 international travellers cancelled trips to Beijing, Shanghai and Guangdong in May 2003 (Dombrey, 2003).

- Foreign governments banned travel to and from china (MoFAC, 2003 cited in Zeng, Carter, & De Lacy, 2005).
- Bookings for Chinese commercial airlines dropped by around 10%. Other airlines dropped by about 20% in bookings in the month of April 2003 (Zeng, Carter & De Lacy, 2005).
- Many airlines suspended around 50% of their flights and reduced staff salaries by approximately 20% and cancelled or delayed investment projects (Dombrey, 2003) .
- Hotels were given directives by the government to make sure hygiene and sanitation procedures are up to scratch and in place (Dombrey, 2003)
- 'Elevator drivers' were employed in some hotels to save guests from button contamination (Dombrey, 2003).

- Destinations with no cases of SARS were also affected by the epidemic, such as Japan.
.

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_{Cited in Breda, Z. and Costa, C (2005)}

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Source: Zeng, Carter, & De Lacy, 2005

Faulkner's Conceptual Framework

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Pre event phase - There was no preparation for the SARS virus, or the scale of the epidemic.
Prodromal phase - The identification of the virus, once it is confirmed by the laboratory. This allows warnings to be issued from WHO - On the 12th March they issued a global alert of SARS. On April 2nd 2003, WHO also declared Guangzhou and Hong Kong as high risk tourists destinations (Zeng, Carter, & De Lacy, 2005).
Emergency phase - The Government responded by closing businesses and tourist attractions, and cancelling or postponing events to contain the contamination (Zeng, Carter, & De Lacy, 2005).

China’s National Tourism Administration and Ministry of Health issued guidelines for all travel agencies to help prevent the virus and put in place the emergency procedures to combat contamination (Li, Blake & Cooper, 2010).

Recovery:
The State Council's general office started to develop a contingency plan in July of 2003. In 2006 many departments have plans in case of emergencies

(Pinghui, 2013).

.
In January 2006 China published the first state-level plan. It considered the general principles for handling natural disasters, industrial and traffic accidents, public health problems and terrorist attacks (Pinghui, 2013).

References Cassie:

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Aldrick P. 2001. Cinemas benefit from foot and mouth. The Daily Telegraph 2 April: 27.

Baxter, E. & Bowen. D., 2004. Anatomy of Tourism Crisis: Explaining the Effects on Tourism of the UK Foot and Mouth Disease Epidemics of 1967-68 and 2001 with Special Reference to Media Portrayal. International Journal of Tourism Research, 6, pp. 263-273.

BBC News | UK | FMD report: Outbreak’s economic impact. 2018. BBC News | UK | FMD report: Outbreak’s economic impact. [ONLINE] Available at :http://news.bbc.co.uk/1/hi/uk/1515327.atm. [Accessed 14 March 2018].

BBC News. 2018. Ebola: Mapping the outbreak – BBC News. [ONLINE] Available at: http://www.bbc.co.uk/news/world-africa-28755033. [Accessed 14 March 2018].

Centre for Public Impact. (2016, April 5). The WHO's Ebola Virus Disease Outbreak Response Plan. Retrieved from Centre for Public Impact.https://www.centreforpublicimpact.org/case-study/ebola-crisis-response-in-west-africa/#legitimacySubtitle1

Comptroller and Auditor General. (2002). The 2001 Outbreak of Foot and Mouth Disease. National Audit Office.

CMSC (2001) Tourism – the Hidden Giant – and Foot and Mouth. Culture, Media and Sport Committee, Fourth Report, Vol. 1. London: Stationery Office.

DAERA. 2018. Foot and Mouth disease | Department of Agriculture, Environment and Rural Affairs. [ONLINE] Available at: https://www.daera-ni-gov.uk/articles/foot-and-mouth-disease. [Accessed 14 March 2018].

Farrar, J.J. & Piot, P., 2014. The Ebola Emergency – Immediate Action, Ongoing Strategy. The New England Journal of Medicine, 371, pp. 1545-1546.

Ferguson, M.N., Donnelly, C.A. & Anderson, R.M. 2001. The Foot-and-Mouth Epidemic in Great Britain: Pattern of Spread and Impact of Interventions. Science, 292, pp. 1155-1160.

Gostin, L.O., Lucey, D. and Phelan, A., 2014. The Ebola epidemic: a global health emergency. Jama, 312(11), pp. 1095-1096.

Government of Sierra Leone, 2015. National Ebola Recovery Strategy For Sierra Leone. National Ebola Recovery Strategy For Sierra Leone, pp. 1-55.

HMSO. 2001. Tourism — The Hidden Giant — and Foot and Mouth. Report and Proceedings Vol. 1 Fourth Report. Her Majesty Stationary Office (retrieved on 18 September 2001 from http://www.parliament.the-stationary-office. co.uk/pa/cm/cmcumeds.htm)

HMSO. 2002. Foot and Mouth Disease 2001: Lessons to be Learned Inquiry Report HC 888. Her Majesty Stationary Office: London

Lekone, P.E. and Finkenstädt, B.F., 2006. Statistical inference in a stochastic epidemic SEIR model with control intervention: Ebola as a case study. Biometrics, 62(4), pp. 1170 -1177.

Mintel Leisure Intelligence. 2001a. Inbound Tourism. Mintel International Group: London

National Audit Office. 2018. The 2001 Outbreak of Food and Mouth Disease – National Audit Office (NAO). [ONLINE] Available at: https://www.nao.org.uk/report/the-2001-outbreak-of-foot-and-mouth-disease/. [Accessed 14 March 2018].

Osborne A. 2001. Fewer passengers fly BA. The Daily Telegraph 19 April: 37

Poletto, C., Gomes, M.F., y Piontti, A.P., Rossi, L., Bioglio, L., Chao, D.L., Longini, I.M., Halloran, M.E., Colizza, V. and Vespignani, A., 2014. Assessing the impact of travel restrictions on international spread of the 2014 West African Ebola epidemic. Euro surveillance: bulletin Europeen sur les maladies transmissibles= European communicable disease bulletin, 19(42).

Ritchie. B.W., Dorrell, H., Miller, D. & Miller, G.A. 2004. Crisis Communication and Recovery for the Tourism Industry. Journal of Travel and Tourism Marketing. 15(2-3), pp. 199-216.

Rivers, C.M., Lofgren, E.T., Marathe, M., Eubank, S. and Lewis, B.L., 2014. Modeling the impact of interventions on an epidemic of Ebola in Sierra Leone and Liberia. PLoS currents, 6.

Saéz, A.M., Weiss, S., Nowak, K., Lapeyre, V., Zimmermann, F., Düx, A., Kühl, H.S., Kaba, M., Regnaut, S., Merkel, K. and Sachse, A., 2014. Investigating the zoonotic origin of the West African Ebola epidemic. EMBO molecular medicine, p.e201404792.

The Countryside Agency. 2001. The Impact of the Outbreak Foot and Mouth Disease: the State of the Countryside. (Retrieved on the 15 September 2001 from http://www.countryside.gov. uk/information/report/pdf/fmd%20August% 20report%20Pages%206-10.pdf)

WHO Ebola Response Team, 2014. Ebola Virus Disease in West Africa – The First 9 Months of the Epidemic and Forward Projections. The New England Journal of Medicine, 371(16), pp. 1481- 1495.

https://en.wikipedia.org/wiki/2001_United_Kingdom_foot-and-mouth_outbreak

Root Cause

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The index case of this outbreak was a zoonotic transmission to a 2 year old boy in a village called Meliandou, in Guinea (Saéz et al, 2014).

From here, the virus spread to other areas of Guinea and into nearby countries such as Sierra Leone and Liberia (Saéz et al, 2014).

Stakeholders

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- Centers for Disease Control and Prevention partnered up with WHO to globally address the SARS outbreak. Their Emergency Operations Center was activated to provide 24/7 response, with extensive lab testing specimens of SARS patients to identify a cause (CDC, 2017.

- World Health Organisation aided countries on a international scale by providing them with an alert and response system which tracks the spread of outbreaks. The had a SARS operational team which provided information to uninfected destinations to protect the health of travellers and contain the disease (WHO, 2003).

- The Chinese Government took issues into their hands by closing businesses and tourist attractions, and cancelling or postponing events to contain the contamination (Zeng, Carter & De Lacy, 2015).

- Ministry of Health
- China National Tourism Administration

- China Travel Serivce
- Tourism businesses
- Chinese commercial airlines, foreign and regional airlines

Time

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The most severe Ebola epidemic outbreak began in December 2013 and happened in West Africa (Rivers et al, 2014)..

On 23rd March 2014, the World Health Organization announced an outbreak of Ebola in Guinea through the Global Alert and Response Network (Rivers et al, 2014).

Gravity

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Almost two years on from the first confirmed case in March 2014, there were 11,315 reported deaths (BBC News, 2016).

Total number of cases reported is estimated at 28,637 (BBC News, 2016). .

It was estimated that the case fatality rate was 70.8% (WHO Ebola Response Team, 2014).

Dimension

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- Nearly affected the entire territory of three countries (Farrar & Piot, 2014) .

https://www.cdc.gov/vhf/ebola/images/west-africa-distribution-map.jpg

Faulkner's Conceptual Framework

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Pre event phase

- Farrar and Piot (2014) say that it is unlikely that it is the characteristics of the virus that caused the severity of the epidemic, but it was the unpreparedness of the countries effected. The countries effected such as Sierra Leone have dysfunctional health systems, densely populated cities as well as a lack of trust due to the previous civil war in 2002.

Prodromal phase

- It took more than 3 months to diagnose Ebola as the cause of the epidemic and the public health emergency declaration came after 5 months (Farrar & Piot, 2014).

- It took nearly 2 months before a humanitarian response began to be put in place (Farrar & Piot, 2014).

- This epidemic was declared to be a Public Health Emergency of International Concern in August 2014 (Gostin et al, 2014).

Emergency phase

- As a response to the concerns about the spread of Ebola, several countries as well as airlines put in place travel restrictions to and from affected areas (Poletto et al, 2014).

- These restrictions included suspension of visa issuance and closure of borders (Poletto et al, 2014).

- Social distancing was implemented which involves the closure of schools and and bans on public gatherings whcih includes sporting, shopping and entertainment (Gostin et al, 2014).

- By May 5th, World Health Organization had deployed 112 experts to the affected areas to assist in the response (Gostin et al, 2014).

Recovery

- Sierra Leone implemented a 24 month Recovery Strategy which focused on 3 sequential steps

1. Eliminating the disease completely.
2. Restoration of basic healthcare and agriculture and the opening of schools.
3. Transition back into their Agenda for Prosperity plan.

This plan was estimated to cost the country US$1.3 billion (Government of Sierra Leone, 2015).

Brazil - Zika Virus

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The Zika Virus started in Brazil and reached to many destinations in the Americas. Since the disease was contained in one geographical area it can be categorised as an Epidemic

Root Cause

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The government suspect the virus was brought by a visitor from Africa or Oceania during the 2014 football World Cup where Zika is endemic (Euronews, 2016).

Time

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February 2015 investigation began into an unknown disease.

On the 1st of February 2016 WHO declared a 'Public Health Emergency of International Concern (World Health Organization, 2017)

Gravity

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Between 20,000 and 25,000 Zika cases were estimated in Brazil in 2015 (WHO, 2017).

Dimensions

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The Zika virus has been 75 transmitted to overall 3 countries (World Health Organization, 2017)

Impact at Destination Level

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-The CDC has said that pregnant women should consider postponing travel.
- With the Zika virus spreading it was seen as a potential threat to the attendees of the 2016 Rio Olympics (World Health Organisation, 2017).
- Some athletes have publicly pulled out of the games, citing Zika as the cause (Biesiada, 2016)
- Many tour operators in Brazil have received several “cancellation requests or travel postponements from foreign tourists, mostly pregnant women and caregivers.” (Martel, 2016)
- There are reports of an increase in people taking out insurance should they cancel or postpone their trip (Euronews., 2016).

Faulkners Conceptual Framework

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Pre event phase: Brazil was not prepared for the outbreak of the Zika Virus. There were no contingency plans in place.
Prodromal phase:
The president announced 3 main actions:

1) Community support in fighting the mosquito;

2) Develop a vaccine;

3) Using the Armed Forces to combat the spread of the virus
(Pinheiro de Oliveira, 2016).
The Brazilian Army supported the community health agents in mosquito control measures (Baran, 2016).
Emergency phase:
- The Brazilian tourism board released a statement on the precautions and measures to control the virus (Baran, 2016).
- Removing water from reservoirs to prevent mosquito larvae from hatching (Baran, 2016).

- Health officials state that they will increase the frequency of inspections of Olympic venues and fumigate before the games occur (Kiernan & Jelmayer, 2016).
Recovery:
- $465 million to combat Zika and has assembled a task force of more than 300,000 people (Baran, 2016).
- The recovery started 2 years after the first case.

In 2017 a group of experts on Public Health Entomology provided guidance on the control of mosquitoes. Their aim:
Improve surveillance, prevention and management to control and eliminate the disease (World Health Organization , 2017).
- Brazil has outlined a National Plan to combat and prevent the disease (Brazil, 2018).

Foot and Mouth Disease - Epidemic

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An acute infectious disease which is caused by a virus (Department of Agriculture, Environment and Rural Affairs, n.d)

Root Cause

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Foot and Mouth Disease came from a herd of pigs in Northumberland in early February 2001. From here it rapidly spread locally and widely throughout the United Kingdom (Ferguson et al, 2001).

Impact at Destination Level

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- This outbreak cost the public sector over £3 billion and over £5 billion for the private sector (National Audit Office, 2002).

- The tourism sector was one of the most hard hit financially. Animal, rural and farm based attractions were the most severely affected (ETC, 2002).

- The Office of National Statistics said that for the period of April - June in 2001 that there was a decrease of 5% in foreign visitors numbers in comparison to the previous 3 months (BBC News, 2001).

- The English Tourism Council found that 46% of respondents said that they were put off visiting the countryside due to the sight of the destruction and disposal of animals (Sharpley & Craven, 2001).

- Several inbound tourists cancelled their holidays to Britain and this included trips to cities such as London. For March 2001, London hoteliers reported a 10% decrease in reservations from inbound tourists (Mintel Leisure Intelligence, 2001a).

- British Airways stated that their economy class traffic fell by 10.1% in March 2001 (Osborne, 2001).

- For the first 6 months of 2001, visitor numbers were lower than the previous year and it has been suggested that Foot and Mouth Disease was partly responsible for this (Baxter & Bowen, 2004).

- Cumbria was one of the worst affected areas and accommodation bookings in this area were down by 58% in March in comparison with numbers of March 2000 (HMSO, 2001).

- The employment sector in Cumbria was severely affected, and by mid April 2001, 1000 jobs had been lost (Baxter & Bowen, 2004). Nationally, a sixth of outdoor leisure retailers had laid off staff (CMSC, 2001).

- Some tourism businesses were not affected and a few even had positive effects. Eg. The leisure industry saw an increase in ticket sales as a growing number of people chose the cinema over countryside activities (Aldrick, 2001 in Baxter).

- The Economist (2001b) estimated that tourism revenue losses were at approximately £125 million a week (Baxter & Bowen, 2004).

CASE STUDY: Foot and Mouth Disease, United Kingdom, 2001.

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- Largest crisis that the UK tourism industry endured for several years (Baxter & Bowen, 2004).

Time

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- The outbreak took place between February and September 2001.

- The United Kingdom was announced free from Foot and Mouth Disease on 22 January 2002 (Baxter & Bowen, 2004).

Gravity

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By the end of September 2001, over 6 million sheep, cattle and pigs had been slaughtered (BBC News, 2016).

Dimensions

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References Pasquale:

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BBC News (2009) Mexico Imposes Swine Flu Measures [Online]. BBC News. Available from: <http://news.bbc.co.uk/1/hi/world/americas/8023820.stm> [Accessed 14^th March 2018].

Bernstein, J, Z. (2016) Mexico sees spike in H1N1 swine flu cases, 68 people dead [Online]. Reuters. Available from: <https://www.reuters.com/article/us-mexico-flu/mexico-sees-spike-in-h1n1-swine-flu-cases-68-people-dead-idUSKCN0W50PR> [Accessed 14^th March 2018].

Gibbs, S. (2009) Swine flu strikes Mexican tourism [Online]. Mexico City: BBC News. Available from: <http://news.bbc.co.uk/1/hi/8099100.stm> [Accessed 13^th March 2018].

Inbound visitors to South Korea (n.d.) [Online Image]. Available from: <https://www-statista-com.ezproxy.leedsbeckett.ac.uk/statistics/709116/south-korea-inbound-visitors/> [Accessed 14^th March 2018].

Jack, A., 2015. Why the panic? South Korea's MERS response questioned. BMJ: British Medical Journal (Online), 350.

McGreal, C. and Carroll, R. (2009) WHO urges governments to prepare for swine flu pandemic [Online]. The Guardian. Available from: <www.theguardian.com/world/2009/apr/28/swine-flu-who-pandemic-usa-mexico> [Accessed 14^th March 2018].

Mers-CoV Map (2015) [Online Image]. Available from: <https://www.researchgate.net/figure/Global-distribution-map-of-Middle-East-respiratory-syndrome-coronavirus-MERS-CoV_fig1_281293335>[Accessed 14^th March 2018].

NBC News (2009) Swine Flu reshapes Mexican tourism [Online]. NBC News. Available from: <http://www.nbcnews.com/id/30522749/ns/travel-destination_travel/t/swine-flu-reshapes-mexican-tourism/#.WqZbXWacagQ> [Accessed 13^th March 2018].

NHS (2016) Swine flu [Online]. NHS. Available from: <https://www.nhs.uk/conditions/swine-flu/> [Accessed 12^th March 2018].

Oh, M.D., Park, W.B., Park, S.W., Choe, P.G., Bang, J.H., Song, K.H., Kim, E.S., Kim, H.B. and Kim, N.J. (2018) Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea. The Korean Journal of Internal Medicine, 33(2), p. 233.

Rassy, D. and Smith, R. (2012) The Economic Impact of H1N1 on Mexico’s Tourist and Pork Sectors. Health Economics 22(7), pp. 824-834.

Seong, M.W., Kim, S.Y., Corman, V.M., Kim, T.S., Im Cho, S., Kim, M.J., Lee, S.J., Lee, J.S., Seo, S.H., Ahn, J.S. and Yu, B.S. (2016) Microevolution of outbreak-associated Middle East respiratory syndrome coronavirus, South Korea, 2015. Emerging Infectious Diseases, 22(2), p. 327.

Swine Flu Map (2009) [Online Image]. Available from: <http://www.who.int/csr/don/2009_08_04/en/> [Accessed 14^th March 2018].

The Straits Times (2015) S. Korea may lose nearly $14b in tourism revenue to Mers [Online]. The Straits Times. Available from: <http://www.straitstimes.com/asia/s-korea-may-lose-nearly-14b-in-tourism-revenue-to-mers> [Accessed 14th March 2018].

Wilson TD. (2008) Economic and Social Impacts of Tourism in Mexico. Latin American Perspectives 35(3), pp. 37–52.

World Health Organization (2010) What is the pandemic 2009 virus? [Online]. World Health Organization. Available from: <http://www.who.int/csr/disease/swineflu/frequently_asked_questions/about_disease/en/ > [Accessed 12^th March 2018].

World Health Organization. (2015) Middle East respiratory syndrome coronavirus (MERS-CoV): summary of current situation, literature update and risk assessment.

World Health Organization. (2017) WHO MERS-CoV global summary and assessment of risk.

World Health Organization (2018) Middle East respiratory syndrome coronavirus [Online]. World Health Organization. Available from: <http://www.who.int/mediacentre/factsheets/mers-cov/en/> [Accessed 14th March 2018].

World Travel & Tourism Council (2015) Tourism and the Spread of Disease [Online]. World Travel & Tourism Council. Available from: <https://medium.com/@WTTC/tourism-and-the-spread-of-disease-cc73e5ed3471> [Accessed 09^th March 2018].

Scale

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Sporadic - Infrequent/Irregularly
Endemic - Constant presence of an infectious agent
Hyperendemic - High levels of disease occurence
Epidemic - Increased or Sudden number of cases of diseases.
Outbreak - Often used for a limited geographic area
Cluster - Many cases grouped in place and time that are suspected to be greater
Pandemic - An epidemic that has spread over several countries/continents.

(Centers for Disease Control and Prevention, 2012)

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Sourced: Milka Ivanova, 2018

Impact at Destination Level - Sierra Leone

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- Civil war ended in 2002 and the improvements of international transport were impressive, which aided in the revitalisation of their tourism sector. These positive improvements were reversed by the impact of the Ebola outbreak (Government of Sierra Leone, 2015).

- As of August 2014, all airlines bar two suspended operation in fear of spreading the disease further (Government of Sierra Leone, 2015).

- The suspension of flights affected the governments efforts at fighting the disease as it inhibited the humanitarian assistance from abroad (Government of Sierra Leone, 2015).

- The National Tourist Board recorded that the tourist arrivals from abroad fell by 46.1% in 2014 in comparison to 2013 (Government of Sierra Leone, 2015).

- 50 of 70 hotels and 200 of 242 guest houses closed down due to fall in occupancy and all night clubs ceased operation completely (Government of Sierra Leone, 2015).

- The employment rate dropped by 75% in the tourism sector, from 4,207 before the outbreak to 1,051 after the outbreak (Government of Sierra Leone, 2015).

- The total revenue generated from tourism in 2013 was US$58.8 million but this dropped to US$31.8 million in 2014, a drop of US$27 million (Government of Sierra Leone, 2015).

MERS-CoV 2015 - Epidemic

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Mers-CoV was classed as an epidemic, this was because the majority of cases were reported within the Middle East (World Health Organization, 2018).

South Korea - MERS outbreak

p_buonanno2779 — 2018-03-14 16:55:02 UTC

Root Cause

p_buonanno2779 — 2018-03-14 17:12:28 UTC

The outbreak came from a 68-year-old Korean man who had travelled to the Middle East two weeks earlier (Seong et al., 2016).

Time

p_buonanno2779 — 2018-03-14 17:33:33 UTC

The Mers outbreak in Korea was first identified on May 20th 2015.

There were no new infections confirmed after 04^th July and the Korean prime minister Hwang Kyo-ahn declared an end to the outbreak on 28^th July (Seong et al., 2016).

Gravity

p_buonanno2779 — 2018-03-14 17:44:01 UTC

A total of 186 MERS-CoV cases, including 36 deaths, have been associated with the outbreak in the Republic of Korea (Oh et al., 2018)

Dimensions

p_buonanno2779 — 2018-03-14 17:48:46 UTC

Source: World Health Organization

Impacts at destination Level

p_buonanno2779 — 2018-03-14 18:03:17 UTC

- Within two weeks of the first case of the virus in the country, over 200,000 foreign travellers cancelled their planned trips to Korea (World Travel & Tourism Council, 2015).

- The World Health Organization (WHO) did not advise of any special screening at points of entry with regards to MERS-CoV nor did it recommend the application of any travel restrictions throughout the epidemic (World Health Organisation, 2015).

- Tourism in 2015 took a dip and was unable to reach the KTO’s target of 16.2million tourists.

Source: Korea Tourism Organization

p_buonanno2779 — 2018-03-14 18:23:02 UTC

Faulkner's (2001) Conceptual Framework

p_buonanno2779 — 2018-03-14 18:25:59 UTC

Pre-Event Phase - Korea had a lack of preparation for such an infection and a limited epidemiological expertise (World Health Organization, 2015).

Prodromal State - WHO stated that the outbreak in Korea occurred before adequate infection prevention and control procedures were applied and cases were isolated and managed, but it was not expected as MERS is a relatively rare disease and little known outside the Arabian Peninsula (World Health Organization, 2015).

Emergency Phase - After initial struggles, steps for controlling the outbreak were put into place by Jong-Koo Lee’s team, a medical doctor and public health expert who led the South Korean side of the crisis management team (Normile, 2015).

Recovery - After the epidemic was confirmed as over the immediate response was to prepare for a similar event.

- WHO along with ministries of health in all affected countries and individual partners have made significant improvements in surveillance of MERS, as well as transmission patterns.

Lessons Learned - International and local health experts recommended that strengthening infection control measures in health care facilities was of very high importance.

Stakeholders

c_tucker2638 — 2018-03-14 18:43:25 UTC

- World Health Organisation (Coordinating role).

- United Nations

- Medical NGO's eg. Centres for Disease Control and prevention (CDC) & Mécecins Sans Frontières.

- Financial NGO's eg. World Bank

- Aid organisations such as the Tony Blair Africa Governance Initiative (AGI).

- All the stakeholders shared a common interest in eradicating the Ebola virus.

(Centre for Public Impact, 2016)

Stakeholders

p_buonanno2779 — 2018-03-14 19:20:02 UTC

- Korean Government
- Korean ministry of health
- ASAN medical centre in Seoul
- World Health Organization
- Public Health Experts
- Medical Researchers
- International Health Experts
- Ministries of Health in all affected countries
All of these stakeholders worked together in order to minimise the impact of Mers-CoV and implement procedures to combat the virus (Jack, 2015), (World Health Organization, 2015), (World Health Organization, 2017).

- Korean Tourism Organization
Monitored the affect of Mers-Cov on South Korea's tourism industry, then created procedures in order to promote South Korea and entice tourists back to the country (The Straits Times, 2015).

- Major travel agencies in China
- K-pop industry
- The Mayor of Seoul
China and the K-pop industry were used by South Korea in order to attract tourists. The Mayor of Seoul sent officials visited China to explain about that there was no longer a health risk in South Korea. The K-pop industry was used to do promotional performances in South Korea and neighbouring countries (The Straits Times, 2015).

- Foreign Travellers
- Hospitals
- Emergency Services

Swine Flu 2009 - Pandemic

p_buonanno2779 — 2018-03-14 20:02:22 UTC

"Swine flu" was the popular name for flu caused by a relatively new type of flu virus responsible for a global flu outbreak (or pandemic) in 2009-10. It's now just a normal type of seasonal flu and is included in the annual flu vaccine (NHS, 2016).

Swine flu was classed as a Pandemic as most countries in the world had confirmed cases of the virus (World Health Organization, 2010).

Mexico - Swine Flu outbreak

p_buonanno2779 — 2018-03-14 20:11:49 UTC

Faulkner's Conceptual Framework

c_tucker2638 — 2018-03-14 20:16:15 UTC

Pre event phase

- The farming industry had a contingency plan agreed for if a large scale outbreak was to occur, however there were severe gaps within the plan (HMSO, 2002).

- Limited knowledge within the government about changes in farming practices meant that there were gaps in the efficiency of plans and communication efforts (HMSO, 2002).

Prodromal phase

- The epidemic was initially treated as an agricultural issue and and the impact of the disease on tourism and the rural economy was not recognised (Baxter & Bowen, 2004)

Emergency phase

- Governments initial response was to place the British countryside under quarantine, despite the effects on the rural tourism industry (Sharpley & Craven, 2001).

- A significant amount of the countryside implemented access restrictions, and this happened not only in infected areas but throughout Britain (Ritchie et al, 2004).

- Sporting events were postponed, National Trust properties were closed and popular scenic routes were made inaccessible (Ritchie et al, 2004).

Recovery

- No tourism resources were damaged by Foot and Mouth disease, however the negative image of the UK needed to be repaired before tourists would return (Ritchie et al, 2004).

- Much of the recovery of the tourism industry was done through marketing campaigns that encouraged visitors that it was safe to go to the countryside (Ritchie et al, 2004).

- The ETC was given £3.8 million to promote tourism to a domestic audience in April 2001 which was used for marketing campaigns and the development of websites to inform potential visitors of where to visit and the safety of it (Ritchie et al, 2004).

- The ETC calculated that the financial aid recieved generated 766,000 additional visits to the United Kingdom (Ritchie et al, 2004).

Root Cause

p_buonanno2779 — 2018-03-14 20:16:47 UTC

The pandemic was caused by a variation in the usual virus (Mandal, 2012)

Time

p_buonanno2779 — 2018-03-14 20:20:29 UTC

The virus was first identified in Mexico in April 2009 and lasted until 10^th August 2010 when the World Health Organization (WHO) declared that swine flu had moved into the post-pandemic period. (NHS, 2010).

Gravity

p_buonanno2779 — 2018-03-14 20:33:07 UTC

The Mexican Secretary of Health confirmed that Mexico had received over 60,000 confirmed laboratory cases, and almost 400 deaths from swine flu (Secretaría de Salud de México, 2009)

Dimensions

p_buonanno2779 — 2018-03-14 20:33:17 UTC

Source: World Health Organization

Impacts at destination level

p_buonanno2779 — 2018-03-14 20:42:02 UTC

- Mexico's tourism industry was impacted massively, with travellers, airlines and cruise lines cancelling trips to Mexico (Rassy and Smith, 2012).

- Mexico reported that around a million people cancelled their holiday to during the swine flu epidemic, accumulating to a loss of around $US2.8b (Rassy and Smith, 2012).

- Luxury hotels in the capital said just 4% of their rooms were occupied at the height of the crisis, with Mexican authorities closing restaurants and bars (Gibbs, 2009).

- Cancun offered tourists 2-for-1 deals in order to entice them to Mexico. While Acapulco advised tourists to be sensible and not travel (NBC, 2009)

- WHO advised against Mexico imposing a travel ban, stating that such methods are not an effective way to deal with the issue (BBC News, 2009).

Faulkner’s (2001) Conceptual Framework

p_buonanno2779 — 2018-03-14 21:13:02 UTC

Pre-event Phase - There were no procedures in place before the outbreak.

Prodromal State - At the early stages of the disease Mexican authorities issued information in fragments and this unwillingness caused panic across Mexico and fuelled conspiracy theories (McGreal & Carroll, 2009).

Emergency Phase - Other measures were also put into place to ensure the spread of disease was kept to a minimum. Mexico City’s Mayor – Marcelo Ebrard ordered the closure of gyms, sports clubs and swimming pools, as well as banning restaurants and cafes from serving all food except takeaways in a bid to help prevent the spread of the virus (McGreal & Carroll, 2009).

Recovery - Mexico released a 1.2bn peso tourism campaign - 'Vive Mexico', in order to entice tourists back to the country (Hodgkinson, 2009).

- Officials were sent to China and Canada to see how their tourism industries recovered from the Bird flu outbreak (Hodgkinson, 2009).

Lessons Learned - Mexico had seemingly learned from the 2009 pandemic in identifying diseases early and treating them correctly. In 2015 Mexico had four cases of swine flu and no deaths. However, in 2016 Mexico had another case of Swine flu, with 945 cases and 68 deaths. This was due to shortages of the correct medication being available (Bernstein, 2016).

Stakeholders

p_buonanno2779 — 2018-03-14 22:40:01 UTC

- Mexican Health Authorities
- Mexican Government
- World Health Organization
These stakeholders all worked together in order to minimise the affect of swine flu (McGreal and Carroll, 2009)

- Mexico City Mayor
- Local Businesses
- Schools
Local Businesses and Schools were amongst some of the areas closed during the height of the pandemic The Mayor of Mexico City decided to close these areas in order to prevent spread of disease (BBC, 2009).

- Tour Operators
- Cruise Lines
- Airlines
These three stakeholders all cancelled trips to Mexico when swine flu broke out in Mexico (BBC, 2009).

- Chinese & Canadian tourist boards
Mexican tourism officials went to China & Canada to talk to the tourist boards to learn how they recovered from the bird flu outbreaks in their countries (NBC, 2009).

- Tourists
- Locals
- The media

Impacts on the destination level

r_peaden4332 — 2018-03-14 22:59:51 UTC

- The country had a short period of preparedness due to the publicity of the SARS outbreak in China.

- Japan's immediate reaction to the outbreak revolved around making sure travellers did not import the 'unknown disease' (Cooper, 2005 )

- Japan had no cases of SARS in 2003 (Cooper, 2005 )

- Many Japanese stopped overseas travel, around a 55% drop was likely to affect involved destinations (Cooper, 2005 ).
-Japanese sales results were influenced by the Ministry of Foreign affairs due to the travel advisory on SARS

(Cooper, 2005 ).

- When WHO called upon countries to take action, Japan responded:
1. Dispatched Disaster Relief Expert Teams to infected areas with the provision of medicines, equipment and operational funds.
2. Japan proposed to work alongside WHO to help control the spread of disease
3. They proposed to enhance international cooperation in order to reduce the negative impacts and support recovery (Cooper, 2005 ).

c_tucker2638 — 2018-03-14 23:36:57 UTC

r_peaden4332 — 2018-03-15 08:49:53 UTC

Similarities & Differences

p_buonanno2779 — 2018-03-15 12:42:23 UTC

Similarities

- Sierra Leone, Brazil, China, South Korea, Mexico
Didn't have any procedures in-place to deal with the virus before the outbreaks. However, the UK had a contingency plan in place, but this had major gaps in it and was unsuccessful.

- Sierra Leone, China, South Korea, Mexico
Due to this, all except Brazil, initially struggled in the prodromal phase as they are reacting to the virus as it happened, rather than containing it. However, Brazil reacted quickly to the Zika virus by using a number of campaigns.

- The UK, South Korea, Mexico
The UK, South Korea and Mexico are popular tourist destinations that were all hit by epidemics, which resulted in their tourism industries being affected badly. Due to this all three countries had to come up with a number of promotional strategies in order to entice tourists back.

Differences

- Brazil
Zika virus is different to other viruses as it really only applies to one segment of the community, which is pregnant women. However, there is still a great deal of fear surrounding the epidemic.

- The UK
Foot & Mouth was an animal epidemic, it didn't affect humans, but it still had a huge impact on tourism.

Stakeholders

c_tucker2638 — 2018-03-15 22:21:39 UTC

- The Department for Environment, Food and Rural Affairs took the lead in dealing with the outbreak.

- European Commission for the Control of Food-and-Mouth Disease.

- Dept. for Culture, Media and Sport played a big role in that they provided approximately £18 million to the British Tourist Authority and English Tourism Council for promotional and research work.

- Prime Minister was closely involved from the outset and he oversaw the development of the policy.

- State Veterinary Service - initially the operations were directed to the SVS, however this soon became too much for them to handle.

- Disease Control Centres

- The armed services were invovled from the beginning of the outbreak and they were involved in discussions with the Department. They went on to play a vital role, and assisted hugely in the organisational requirements of slaughter, disposal and transport of animals.

- Private contractors & voluntary stakeholders groups played significant roles . Eg. Royal Society for the Prevention of Cruelty to Animals and the National Farmers' Union.

- Scottish Ministers

- National Assembly for Wales

- Vets, key role in diagnosing the disease.

- Local authorities

- Representatives of farmers & contractors.

(Comptroller & Auditor General, 2002)

Stakeholders

r_peaden4332 — 2018-03-15 22:56:11 UTC

- World Health Organisation aided Zika affected areas by enhancing surveillance and work with health authorities to control the mosquito population (WHO, 2016).

- Center of Disease Control and Prevention activated surveillance systems to track the spread of Zika and improve the prevention of the virus (CDC 2017).

- Brazilian Government placed a mosquito eradication campaign and created a national plan to combat the disease.
- Brazilian Army aided the country's mosquito control measures.
- Brazilian tourism board provided information on the precautions to the eliminate/avoid contracting the disease.

- Tour operators
- Health officials

Media Coverage

r_peaden4332 — 2018-03-19 08:26:10 UTC

. McKercher (2003, cited in Pearson et al., 2005) stated the amount of coverage the SARS epidemic received and the way the outbreak was reported contributed to the overall ‘SARS effect’. During the outbreak, McKercher (2003, cited in Pearson et al., 2005) also suggested the media’s role was to escalate the problem because it was difficult to distinguish between fact and fake news. The media in the West started reporting on the SARS outbreak in a hostile manner, the international media caused a beneficial shift in the government’s agenda (Huang, 2004)