Diseases, dilemmas, decisions-Converting epidemiological dilemmas into successful disease control decisions

This paper describes 50 years of personal experience in dealing with a range of animal and zoonotic diseases at national and global level, using a series of selected examples to illustrate both the nature of the various dilemmas and difficulties faced, and the way in which they were solved using the tools and techniques that were available at the particular time. A major theme throughout has been the dependence on advancing computer technology, which initially allowed only simple analyses and modelling activities to be undertaken, but as computers have grown increasingly powerful, techniques such as Bayesian spatial regression have become available to the epidemiologist, making possible forms of analysis and disease modelling which had been mere dreams in earlier decades. There is now a need to integrate these tools and techniques into a toolbox which allows both epidemiological and economic analysis to be applied to virtually any type of disease, thereby further extending the capacity of epidemiologists to solve even more difficult problems in the future.