CURRENT RESEARCH
Urban Epidemiology
Urban Infectious Disease Preparedness: Infrastructure Assessment and Investment Framework for Global Cities
Work in Progress, Expected Late 2026
Acute infectious disease outbreaks in recent decades—including severe acute respiratory syndrome (SARS), measles resurgences in cities with prior elimination status, monkeypox transmission concentrated in urban networks, and antimicrobial resistance emerging from healthcare-dense metropolitan areas—have exposed persistent gaps in municipal preparedness infrastructure. Yet most cities lack evidence-based frameworks for assessing surveillance capacity, healthcare surge readiness, workforce sustainability, budget resilience, and accountability mechanisms. Budgetary realities can compound these challenges: funding is often oriented toward chronic disease management rather than acute outbreak response, and fiscal mechanisms rarely incentivize sustained investment between crises.
This research evaluates urban infectious disease preparedness for acute outbreaks across four to five global cities representing diverse income levels, governance structures, and epidemiological contexts. The study combines secondary analysis of published reports, municipal health assessments, and budget documents with key informant interviews involving municipal and national health officials, hospital system administrators, multilateral and foundation representatives, and academic researchers. Deliverables include a standardized assessment instrument spanning seven infrastructure domains, tiered investment recommendations calibrated to three resource levels, and a budget sustainability guide identifying fiscal mechanisms resilient to inter-crisis funding erosion. The framework addresses a fundamental incentive misalignment: jurisdictions that invest effectively in preparedness generate benefits—averted outbreaks—that are inherently difficult to measure and politically unrewarding, while underinvesting jurisdictions may free-ride on regional capacity without bearing proportionate costs.
Infectious Diseases
Is a Single Dose of JYNNEOS Modified Vaccinia Ankara Associated With Lower Incidence of Mpox Disease: A Review of Observational Studies
Last Updated January 2023
A severe shortage in the supply of the modified vaccinia Ankara (MVA; Jynneos), the primary vaccine approved for the prevention of mpox disease, resulted in rationing of available doses in the United States during a global outbreak in mid-2022. While the protocol and standard of care indicate two doses of the vaccine spaced approximately one month apart, health departments in major cities across the country began to prioritize first doses. At the time of the outbreak, the effectiveness of Jynneos for the prevention of monkeypox disease was only inferred from antibody responses in smallpox clinical trials and from studies in non-human primates. There were no observational or randomized control trial studies in humans demonstrating the efficacy of either a single dose or two doses.
Over the last year, a small number of observational studies have shown that a single dose of MVA confers a protective benefit in reducing the incidence of mpox disease in humans. For the single-dose intervention, the primary outcome measured is vaccine effectiveness, which ranged between Following guidelines from the Cochrane Collaboration and PRISMA, searches of databases including PubMed and Google Scholar identified 544 articles. Following screening against inclusion and exclusion criteria and for duplicates and quality, five studies with 19,333 subjects were selected for review. At least two of the studies likely have substantial overlap in the study subjects. This review summarizes the findings from these studies, including subgroup analysis of men who have sex with men (MSM), the population most impacted during the 2022 outbreak.
Should the Centers for Disease Control and Prevention (CDC) Recommend Voluntary Medical Male Circumcision (VMMC) for HIV Prevention Among Men Who Have Sex With Men (MSM)
Last Updated December 2022
The protective effect of voluntary male medical circumcision (VMMC) on HIV infection in men was first suggested in the mid- to late-1980s, with evidence of significant efficacy emerging in the subsequent years and decades. As a primary intervention in Sub-Saharan Africa (SSA) and many low- and middle-income countries (LMIC), VMMC has gained considerable support during this time, principally targeted to men engaging in penetrative vaginal intercourse. Based on the strength and consistency of findings from LMIC studies, the World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended routine VMMC in certain settings since 2007. The President’s Emergency Plan for AIDS Relief (PEPFAR) includes VMMC as a primary intervention and had facilitated more than 15 million circumcisions between 2007 and 2017 in 14 countries with an otherwise low prevalence of circumcision and high prevalence of HIV infection.
Though the Centers for Disease Control and Prevention (CDC) has a clear policy of promoting and facilitating VMMC in LMIC settings, it currently has no comparable guidance or interventions for high-risk populations domestically. The objective of this analysis is to review evidence on the effectiveness of VMMC in MSM, with particular emphasis on countries with similar social, cultural, and development profiles to the United States; and, to evaluate whether the evidence supports a decision by the CDC to recommend VMMC among MSM in the United States as a protective intervention to reduce HIV infection risk.
Clear guidance on the efficacy of VMMC in this setting offers another potentially valuable tool for domestic public health officials and clinicians, alongside safer sex education, condom use, and PreP. The increasing availability, declining cost, and proven efficacy of pre-exposure prophylaxis (PreP) in the United States must be weighed in this evaluation as circumcision may have a statistically insignificant impact on seroconversion for high-risk individuals adhering strictly to a PreP protocol. As PreP is a significantly more effective than circumcision at reducing HIV transmission when the two have been evaluated independently, circumcision may offer no additive benefit when combined.
Economics, Urban Economics, and Real Estate
Reimagining Real Estate: A Framework for the Future
World Economic Forum, December 2024. Sam Chandan and Kalin Bracken. Forward by Christian Ulbrich
https://www.weforum.org/publications/reimagining-real-estate-a-framework-for-the-future/
Published by the World Economic Forum, Reimagining Real Estate: A Framework for the Future advances a framework organized around four pillars — liveability, sustainability, resilience, and affordability — through which the real estate industry and the public sector can collaborate to deliver a more effective built environment. Liveability addresses healthy, human-centric spaces that support the occupant experience. Sustainability focuses on energy efficiency and resource utilization aimed at reducing whole-life-cycle carbon emissions. Resilience extends beyond physical climate risks to encompass functional and competitive obsolescence, public health shocks, and local fiscal imbalances. Affordability reflects the pervasiveness of housing shortages and the impact of high housing costs across global markets. The framework emphasizes that progress on these objectives requires investments that attract capital and deliver competitive market returns, and offers calls to action for both public and private sector stakeholders, including regulatory clarity, infrastructure investment, technology adoption, and diversified capital structures. Case studies across economies at varying stages of development illustrate the necessity and feasibility of cross-sector collaboration in an increasingly complex global landscape.
Housing as a Determinant of Health: The Relationship Between Market-Rate Housing and Public Health Outcomes
Last Updated February 2023
The quality, location, and security of housing have critical roles in shaping individual, household, and public health outcomes. In this narrative review, we identify several broad mechanisms through which housing impacts health, including internal characteristics such as density and the physical features of the residential dwelling; proximity to external amenities and disamenities, such as public parks and the public transportation network; and, housing security, broadly encompassing access to and stability of housing opportunity. The relationship between housing and health is mediated by income and affordability. Valued housing features are capitalized into rents and prices; undesirable housing features reduce value. Access to housing that promotes desired health outcome is mediated by affordability. Recent years’ sharp deterioration in market-rate housing affordability, both in the rental and ownership markets, and the COVID-19 pandemic, have reinforced this relationship between house prices and their health-related amenities, related disparities in health outcomes, and the absence of a robust framework for advancing public health goals through market-rate housing policy at the national and local levels.
Development, Cities, and the Public Health
Published April 2022
Symposium on Built Up: An Historical Perspective on the Contemporary Principles and Practices of Real Estate Development, by Patrice Derrington. Environment and Planning: Economy and Space, 54(5), 1022-1066. https://doi.org/10.1177/0308518X221083682
In devastating fashion, the COVID-19 pandemic has reintroduced the notion that unmediated density, and crowding in particular, can be a driver of unwanted health outcomes. Glaeser (2013) tells us that “ideas spread more easily in denser places.” The last two years have reminded the world that the same can be true for infectious diseases.