Anyone who has seen the Honolulu Star-Advertiser recently has read about the controversy over short-term rental regulations. Of course, it’s a big deal because tourism is so vital to our livelihoods.
What if tourism just abruptly dried up?
It could easily happen. We experienced it during 9/11, but there are other potential unpleasant scenarios. Back in Christmas 2014, my co-writer Rob Kay headed off to Tahiti to visit friends. He was warned that French Polynesia was in the grip of a chikungunya outbreak and that he should bring plenty of mosquito repellent.
Chikungunya is a mosquito-borne viral disease with symptoms such as fever and severe joint pain. The local population suffered, but the contagion didn’t inordinately affect Tahiti’s tourism economy. (Tahiti only gets about 200,000 visitors a year.)
If Hawaii were stricken with a similar scenario, it would be a different matter. Our tourist industry would fold overnight — not to mention the impact on local people. So, what is the likelihood that our state might succumb to an outbreak of infectious disease?
To answer that we consulted with Dr. Duane Gubler, one of the top infectious disease researchers in the nation and someone who knows Hawaii well. Formerly chief of the Centers for Disease Control and Prevention Dengue Branch and director of the Division of Vector-Borne Infectious Diseases, he is currently with Duke University-National University of Singapore Graduate Medical School. Prior to that, he was professor and chairman, Department of Tropical Medicine at John A. Burns School of Medicine.
Question: Dr. Gubler, is Hawaii vulnerable to an infectious disease outbreak?
Answer: Yes, Hawaii is the gateway to the U.S. from the Asia-Pacific region, where many newly emerging infectious diseases originate. With tourists stopping in Hawaii on their way to or from the U.S., the unprecedented economic and urban growth in Asia makes that region a very high-risk area for the emergence and spread of exotic infectious diseases. In fact, the dengue virus that caused the small outbreak of dengue fever in 2001 was introduced from Tahiti.
Q: We haven’t had any major outbreaks of dengue fever or chikungunya as in other Pacific islands such as Tahiti or Fiji. Have we just been lucky?
A: Hawaii is very lucky because the principal mosquito vector of dengue, chikungunya and Zika viruses (Aedes aegypti) is only found on the Big Island, and even there has only a very limited distribution. So, Hawaii is at low risk for those diseases. (Hawaii does have a species known as Aedes albopictus, which can transmit these viruses, but is an inefficient epidemic vector.) That said, the state of Hawaii must be vigilant. Hawaii is at high risk for epidemics of other infectious diseases that may emerge in Asia.
Q: What can be done to mitigate our vulnerabilities to an infectious disease outbreak?
A: With the extensive jet airplane travel to Hawaii, it is near impossible to prevent their introduction. The best alternative is to develop a good public health infrastructure, i.e., good laboratory-based surveillance for imported pathogens, emergency response plans in place, good vector control and adequate medical facilities for treatment as well as containment.
Q: Do rising global temperatures put Hawaii at greater risk?
A: The answer to this question is not a simple yes or no. In one respect Hawaii already has the ideal temperatures for transmission of many infectious diseases. As to whether rising global temperatures, say in Asia, may generate more disease which could impact Hawaii, I would say it is uncertain but unlikely. Rising temperatures are only one of many factors that may influence disease incidence in Asia. Many diseases are climate sensitive, but transmission dynamics are very complex. Environmental factors (temperature, rainfall, humidity, etc.), urbanization (human density, herd immunity, housing type, human behavior, human rural to urban migration, water, sewage and waste management systems, etc.), mosquito species, mosquito behavior, pathogen strain, etc., must all be considered and may be more important than temperature.
Thus, to say that increased temperature alone is responsible for increased disease transmission is flawed thinking.
