DFID Burma (Courtesy of the UK Department for International Development)

WASHINGTON – Conflict and poverty are key factors in the emergence of disease worldwide according to Dr. Peter Hotez, who is President Barack Obama’s appointed science envoy focused on global health and vaccine development.

Hotez is one of four presidentially appointed scientists tasked with taking on a major scientific challenge on behalf of the United States.

“The forces of poverty and conflict are driving the emergence of disease,” said Hotez in a recent interview. He is finishing a book on the topic and has focused much of his work on the issue in his role as dean of the National School of Tropical Medicine at Baylor College in Houston and as the President of the Sabine Vaccine Institute in Washington.

He looks back and various instances of pandemics and disease outbreaks and points to either poverty or conflict – or often both – as the root cause for the impact on human life.

“One of the reasons Ebola came out of West Africa…was that those countries had emerged out of 10 years of devastating conflict with a complete breakdown in public health infrastructure, human migrations, deforestation,” said Hotez. All those forces combine to create the perfect storm that allowed Ebola to flourish. This is not new. This has been a recurring theme that we have seen since the 1970s.”

He believes the next Ebola will be the diseases coming out of areas occupied by ISIS. The Middle East and North Africa will be the next big wave of catastrophic epidemics “and it would be nice if we could be proactive about it for once,” said Hotez.

He went on to describe that there is a critical failure in the pathway toward vaccine development. The institutions that are responsible for strategic preparations are lacking the ability to make products. For instance, the Ebola vaccine was sitting with completed science for more than 10 years but with no manufacturer until it was too late said Hotez.

“That really was a terrible failure.”

Though the community still has a long, said Hotez, they are now working with the Saudis and the Malaysians to build vaccine infrastructure through public-private partnerships.

The refugee camps for those fleeing ISIS have become a hot bed of Leishmaniasis, a parasitic disease that causes scarring skin ulcers and can be fatal, said Hotez. The disease is transmitted through a bite from a sand fly and with the hastily set up refugee camps, piles of trash have made a home for the insects.

“There has been an explosion in cases coming out of the conflict zones,” he said.

The WHO Eastern Mediterranean Regional Office, based out of Cairo, is responsible for surveillance in the camps receiving refugees from the ISIS areas. The problem is they only get a glimpse of what is spilling out of the conflict zones and coming across the borders, said Hotez.

There have been more than 100,000 new cases of Leishmaniasis in the last 18 months and the locals call it “lepo evil,” said Hotez.

He said that the major driving force in disease is human behavior.

“Everyone is focusing on climate change right now but I think it’s actually social forces that are far more important,” said Hotez.

The most common psychological effect that can stem from coverage of traumatic events is Post-traumatic Stress Disorder, or PTSD.

“The more I learn and understand about PTSD speaking as a journalist, the more I feel that the mechanisms involved in PTSD have a particular relevance to us as journalists,”  said Bruce Shapiro, executive director of the Dart Center for Journalism and Trauma. The Dart Center, a project of the Columbia University Graduate School of Journalism, specializes in informed reporting on topics of violence, conflict and tragedy.

According to the National Center for PTSD, the condition is an anxiety disorder that usually occurs after one has been through a traumatic event.  During such an experience, the sufferer thinks their life or the lives of others are in danger. This can be coupled with feelings of fear or lack of control.

One of the hallmarks of PTSD is that sufferers can’t shake the memory of the traumatic event. It’s as if an amplification loop has been set up in the brain and the memory never fades, said Dr. Esther Sternberg, a medical researcher and author of Healing Spaces: The Science of Place and Well-Being.

That is particularly the case with journalists, who by the nature of their job are constantly re-exposing themselves to trauma through continued reporting. This makes it more difficult to escape traumatic memories, Shapiro and other experts say.

They add that many journalists ­may be ignoring the mental burden this carries, in many cases because they don’t realize how susceptible they are.­

Many if not most journalists suffering from PTSD don’t even know they have it because few in the medical community have spoken out about this hidden problem. It has become particularly common in journalists after the Sept. 11 2001 attacks, when so many journalists went to war or covered the story at Ground Zero and elsewhere in the United States.

PTSD is a real physiological phenomenon that is related to changes in brain stress hormones, said Sternberg, who adds that the macho image of a stiff upper lip, or that journalists are superheroes, can compound the problem. Such an attitude can prevent people from seeking the help they need.

“Do we [as journalists] perceive ourselves as invulnerable?” asked Shapiro. “Or, do we view ourselves as resilient skilled professionals who nonetheless are vulnerable to psychological injury?”

Certainly it is the latter, according to Shapiro and others.

Part of coping with PTSD is through recognition and understanding – though this is where journalism seems to be struggling, Shapiro said.

Training is important to consider. On the one hand, he suggests this can take the form of hazardous environment training to understand how to be safe under dangerous conditions. He also points out that training can give journalists a basic understanding of what symptoms to look for in themselves and others, as well as getting them to talk about PTSD.

The Dart Center is one organization that offers training to journalists. At the center of its approach is the idea of providing journalists with basic vocabulary to prepare them for covering trauma and addressing psychological injury. An emphasis is also placed on molding people into supportive colleagues, as well as getting sufferers to talk about their experiences.

But at an even more basic level, journalists need to remember that they are not super human. It’s important to resist self-isolation as social interaction is crucial. Social connection is key to moving past PTSD and other psychological injuries, said Shapiro.

“If you had an appendicitis it wouldn’t occur to you to take it out yourself,” Sternberg says. “You would see a surgeon.”