Ronald Waldman - Academia.edu (original) (raw)

Papers by Ronald Waldman

Governments, businesses, organizations, and communities looked upon the global health community f... more Governments, businesses, organizations, and communities looked upon the global health community for leadership and guidance for what to do in the event of a pandemic. WHO released the revised WHO Global Influenza Preparedness Plan: the role of WHO and recommendations for national measures before and during pandemics in March 2005 for this purpose in light of the ongoing pandemic threat. This document defined "the phases of increasing public health risk associated with the emergence of a new influenza virus subtype that may pose a pandemic threat," recommended actions for national authorities, outlined what measures WHO would take for each phase,

From a public health perspective, it is difficult to define exactly what a catastrophe is. Catast... more From a public health perspective, it is difficult to define exactly what a catastrophe is. Catastrophes can be of sudden onset or they can develop slowly; they can be the result of natural causes, such as hurricanes, droughts, or earthquakes, or they can be man-made, a consequence of war or of terrorist acts. Some would say that the distinction between these is not totally clear-even in earthquakes, for example, mortality rates are predictably higher among the poor, those who live in housing that does not conform to local construction standards. The Indian Ocean tsunami of December 2004 did not spare anyone on the basis of socioeconomic status, but those with means were able to rebuild, rehabilitate, and reconstruct their lives much more rapidly and more completely than those who had only minimal assets. Finally, the plight of the poor left behind in the wake of Hurricane Katrina, one of the world's most recent major catastrophes, was visible on televisions around the world. The blurriness of the lines between these categories, acute versus slow onset and natural versus man-made disaster, has led some to coin the term "complex emergency." The global response to complex emergencies has become a subject of relatively recent study and many of its medical, engineering, and even legal ramifications are still being refined. Dr. Waldman has a medical degree from the University of Geneva, Switzerland and a Master of Public Health degree from the Johns Hopkins School of Hygiene and Public Health. After beginning his career as a volunteer in the World Health Organization's Smallpox Eradication Program, he joined the Centers for Disease Control and Prevention ("CDC") in 1979. After having provided technical assistance to the Refugee Health Unit of the Ministry of Health of the Democratic Republic of Somalia, he, together with colleagues at the CDC, published a series of articles describing and analyzing the epidemiology of refugee health. He has worked for a variety of organizations, including the CDC, UN High Commissioner for Refugees, and World Health Organization in numerous emergency settings, including those in Iraq,

Conflict and Health, 2020

Background Armed conflict between the militant Islamist group Boko Haram, other insurgents, and t... more Background Armed conflict between the militant Islamist group Boko Haram, other insurgents, and the Nigerian military has principally affected three states of northeastern Nigeria (Borno, Adamawa, Yobe) since 2002. An intensification of the conflict in 2009 brought the situation to increased international visibility. However, full-scale humanitarian intervention did not occur until 2016. Even prior to this period of armed conflict, reproductive, maternal, neonatal, and child health indicators were extremely low in the region. The presence of local and international humanitarian actors, in the form of United Nations agencies and non-governmental organizations, working in concert with concerned federal, state, and local entities of the Government of Nigeria, were able to prioritize and devise strategies for the delivery of health services that resulted in marked improvement of health status in the subset of the population in which this could be measured. Prospects for the future remai...

Lancet (London, England), Jan 3, 2018

Chicago Journal of International Law, 2006

BMJ, 2016

In light of the recent Ebola epidemic, Francesco Checchi and colleagues argue that the World Heal... more In light of the recent Ebola epidemic, Francesco Checchi and colleagues argue that the World Health Organization's response to health emergencies is not fit for purpose and put forward six proposals to reform WHO's crisis response Francesco Checchi senior humanitarian health lead 1 2 , Ronald J Waldman president 3 4 , Leslie F Roberts professor

Bulletin of the World Health Organisation

Mortality rates among children and the absolute number of children dying annually in developing c... more Mortality rates among children and the absolute number of children dying annually in developing countries have declined considerably over the past few decades. However, the gains made have not been distributed evenly: childhood mortality remains higher among poorer people and the gap between rich and poor has grown. Several poor countries, and some poorer regions within countries, have experienced a levelling off of or even an increase in childhood mortality over the past few years. Until now, two types of programmes-short-term, disease-specific initiatives and more general programmes of primary health care-have contributed to the decline in mortality. Both types of programme can contribute substantially to the strengthening of health systems and in enabling households and communities to improve their health care. In order for them to do so, and in order to complete the unfinished agenda of improving child health globally, new strategies are needed. On the one hand, greater emphasis should be placed on promoting those household behaviours that are not dependent on the performance of health systems. On the other hand, more attention should be paid to interventions that affect health at other stages of the life cycle while efforts that have been made to develop interventions that can be used during childhood continue.

Global public health, 2014

The accuracy of the Content should not be relied upon and should be independently verified with p... more The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

Bulletin of the World Health Organization, 1998

Recent large epidemics of cholera with high incidence and associated mortality among refugees hav... more Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment co...

Bulletin of the World Health Organization, 1988

A review of mortality data from refugee camps in Thailand (1979-80), Somalia (1980-85), and Sudan... more A review of mortality data from refugee camps in Thailand (1979-80), Somalia (1980-85), and Sudan (1984-85) indicates that crude mortality rates (CMRs) were up to 40 times higher than those for the non-refugee populations in the host countries. In eastern Sudan, approximately 5% of the population of eight camps died in the first 3 months of the emergency and daily CMRs as high as 14 per 10 000 were reported. These rates dropped to values comparable with those of the host country within 6 weeks in the Thai camps; however, in Somalia and Sudan this process took 12 months. Mortality rates among under-5-year olds in the early phases, which were as high as 32.6 per 10 000 per day, are six times greater than those in the world's least developed countries during non-emergency times. Among severely undernourished children in one camp in Sudan, the death rate reached 114 per 10 000 per day. Acute respiratory infections, diarrhoeal diseases, malaria, measles, and undernutrition were the c...

New England Journal of Medicine, 2013

New England Journal of Medicine, 2006

New England Journal of Medicine, 2005

The Lancet, 2004

Major advances have been made during the past decade in the way the international community respo... more Major advances have been made during the past decade in the way the international community responds to the health and nutrition consequences of complex emergencies. The public health and clinical response to diseases of acute epidemic potential has improved, especially in camps. Case-fatality rates for severely malnourished children have plummeted because of better protocols and products. Renewed focus is required on the major causes of death in conflict-affected societies-particularly acute respiratory infections, diarrhoea, malaria, measles, neonatal causes, and malnutrition-outside camps and often across regions and even political boundaries. In emergencies in sub-Saharan Africa, particularly southern Africa, HIV/AIDS is also an important cause of morbidity and mortality. Stronger coordination, increased accountability, and a more strategic positioning of non-governmental organisations and UN agencies are crucial to achieving lower maternal and child morbidity and mortality rates in complex emergencies and therefore for reaching the UN's Millennium Development Goals. Search strategy and selection criteria Literature searches were done on the WHO website and the OVID database (which includes preMEDLINE and MEDLINE 1966 to May, 2004. Searches were not limited to English. The following combinations of search terms were used: mortality; mortality and emergencies; mortality and complex emergencies; complex emergencies; refugees; and humanitarian emergencies. All abstracts were reviewed for content consistent with the objectives of the paper. Papers fitting the content criteria were requested. 1992 matches were made on the WHO website and 6414 matches on OVID.

JAMA: The Journal of the American Medical Association, 1990

Health Policy and Planning, 1990

Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity a... more Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease.

Epidemiology and Infection, 1997

Between 23 August and 15 December 1990 an epidemic of cholera affected Mozambican refugees in Mal... more Between 23 August and 15 December 1990 an epidemic of cholera affected Mozambican refugees in Malawi causing 1931 cases (attack rate=2·4%); 86% of patients had arrived in Malawi <3 months before illness onset. There were 68 deaths (case-fatality rate=3·5%); most deaths (63%) occurred within 24 h of hospital admission which may have indicated delayed presentation to health facilities and inadequate early rehydration. Mortality was higher in children <4 years old and febrile deaths may have been associated with prolonged IV use. Significant risk factors for illness (P<0·05) in two case-control studies included drinking river water (odds ratio [OR]=3·0); placing hands into stored household drinking water (OR=6·0); and among those without adequate firewood to reheat food, eating leftover cooked peas (OR=8·0). Toxigenic V. cholerae O1, serotype Inaba, was isolated from patients and stored household water. The rapidity with which newly arrived refugees became infected precluded e...

Emerging Infectious Diseases, 1998

Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is fo... more Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. All material published in Emerging Infectious Diseases is in the public domain and may be used and reprinted without special permission; proper citation, however, is required.