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Progress in Public Health in the Year of the Goat

We welcome the Year of the Goat, or Sheep, depending on which version of the Chinese almanac you read. Either way, tradition tells us that it will be a calmer, more gentle year. Those born in the Year of the Goat are said to be mild-mannered and gentle, tending to be romantic about life and preferring to work in groups rather than as individuals. Of course teamwork is most important in public health and many branches of modern medicine, so perhaps it is good to be a goat to work in our field. We can expect a slower, more caring year following the energetic Year of the Horse. But unfortunately in public health, this seems rather unlikely, as we continue to face challenges for public health that remain from last year. The Ebola epidemic of 2014 reminded us that public health will continue to be challenged by infectious diseases, both traditional public health problems and newly emerging diseases. In our region, the increasing public health challenges of infections are driven by pressures of urbanisation, growing populations and climate change. It is said that the Year of the Horse brings dramatic action and surprises, and this is what happened with the Ebola epidemic in West Africa. Ebola damaged the reputation of the World Health Organisation as its response faltered in the face of an epidemic with rapid onset, high case fatality rates and the poor health infrastructure available in the West African countries. The public health community responded quickly with volunteers joining its workforce and support for the WHO and its policies1. Ebola is but one of a number of dangerous infectious diseases that if they emerge or re-emerge in Asia, will challenge all of our resources. While Ebola has recently grabbed headlines, SARS, MERS and Lassa fever, to name but a few, are examples of other potentially deadly outbreaks. While having a much lower case fatality, epidemics of dengue and the lesser known chikungunya are major public health issues in the Asia-Pacific region2,3. WHO estimates there may be 50-100 million dengue infections worldwide every year, with a high (and increasing proportion) in the Asia-Pacific region 4,5. Before 1970 only nine countries had experienced severe dengue epidemics, but now it has spread to more than 100 countries. In our region it is found in Korea in the north, Australia in the south, and into many of the Pacific Islands. Work continues on the development of vaccines and there is some hope that the Year of the Goat will bring success. The development of all new vaccines is very expensive and initial costs of any new dengue vaccine will be high, and reminiscent of early experiences with the Hepatitis B vaccine, and will require extensive public health advocacy to make it available to at-risk populations. As populations continue to increase and urbanisation proceeds at an even greater rate, more pressure is placed on existing public health services and the challenge of providing food, water