It is difficult to predict how infectious diseases will respond to an economic crisis. The response depends on the presence of foci of infection and the means of transmission (such as insect vectors) in a population, as well as the extent to which investment in public health surveillance and control is maintained. Well-documented outbreaks in some of the countries that have experienced the deepest austerity measures include the re-emergence of malaria and transmission of dengue fever (Bonovas et al. 2012). Greece has seen a major upsurge in HIV infections among intravenous drug users, coinciding with substantial reductions in funding for needle exchange programmes (ECDC 2012)


Publications

Arinaminpathy N, Dye C. Health in financial crises: economic recession and tuberculosis in Central and Eastern Europe. J R Soc Interface. 2010 Nov 6;7(52):1559-69.

Atun R, Knaul FM, Akachi Y, Frenk J. Innovative financing for health: what is truly innovative? Lancet. 2012 Dec 8;380(9858):2044-9. doi: 10.1016/S0140-6736(12)61460-3.

Bonovas S, Nikolopoulos G. High-burden epidemics in Greece in the era of economic crisis. Early signs of a public health tragedy. J Prev Med Hyg. 2012 Sep;53(3):169-71. 

Castano J, Ospina JE, Caylà JA, Greer SL. Restricting Access to Health Care to Immigrants in Barcelona: A Mixed-Methods Study With Immigrants Who Have Experienced an Infectious Disease. Int J Health Serv. 2016;46(2):241-61..

Catania JA, Dolcini MM, Gandelman AA, Narayanan V, McKay VR. Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity. Transl Behav Med. 2014 Mar;4(1):34-45. 

Christofidou M, Bartzavali C, Militsopoulou M, Anastassiou ED. The economiccrisis in Greece affects HCVRNA RTPCR determination. Dig Liver Dis. 2016Jan;48(1):98.

Danis K, Lenglet A, Tseroni M, Baka A, Tsiodras S, Bonovas S. Malaria in Greece: historical and current reflections on a re-emerging vector borne disease. Travel Med Infect Dis. 2013 Jan-Feb;11(1):8-14 

Danno K, Komukai J, Yoshida H, Matsumoto K, Koda S, Terakawa K, Iso H. Influence of the 2009 financial crisis on detection of advanced pulmonary tuberculosis in Osaka city, Japan: a cross-sectional study. BMJ Open. 2013 Apr 3;3(4).

Dowdy D, Vassall A, Cobelens F. Tuberculosis control in crisis: economic honesty and comparative effectiveness. Int J Tuberc Lung Dis. 2012 Aug;16(8):1131-2.

ECDC. Risk assessment on HIV in Greece. Technical report. Stockholm: European Centre for Disease Prevention and Control, 2012.

Economic crisis threatens AIDS fight. AIDS Read. 2009 Jun-Jul;19(6):229.

Fineberg FV. Public Health in a time of government austerity. Am J Public Health. 2013 Jan;103(1):47-9.

Fortes PA, Carvalho RR, Louvison MC. Economic crisis and counter-reform of universal health care systems: Spanish case. RevSaude Publica. 2015;49:10-2

Georgakopoulou T, Menegas D, Katsioulis A, Theodoridou M, Kremastinou J, Hadjichristodoulou C. A cross-sectional vaccination coverage study in preschool children attending nurseries-kindergartens. Implications on economic crisis effect. Hum Vaccin Immunother. 2016 Sep 26:0. [Epub ahead of print]

Gray RT, Heymer KJ, Hoare A, Kwon JA, Thein HH, Lote N, Siba P, Saramony S, Saphonn V, Worth H, Kaldor JM, Wilson DP. What impact might the economic crisis have on HIV epidemics in Southeast Asia? Curr HIV Res. 2009 Nov;7(6):656-65.

Hernando V, Alvárez-Del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, Pharris A, Del Amo J. HIV infection in migrant populations in the European Union and European Economic Area in 2007-2012; an epidemic on the move. J Acquir Immune DeficSyndr. 2015 Jun 11. [Epub ahead of print]

Holland DP, Person AK, Stout JE. Did the 'Great Recession' produce a depression in tuberculosis incidence? Int J Tuberc Lung Dis. 2011 May;15(5):700-2.

Hoyos J, Fernández-Balbuena S, de la Fuente L, Sordo L, Ruiz M, Barrio G, Belza MJ; Madrid Rapid HIV Testing Group. Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers. J Int AIDS Soc. 2013 May 9;16:18560

Jackson Y, Varcher Herrera M, Gascon J. Economic crisis and increased immigrant mobility: new challenges in managing Chagas disease in Europe. Bull World Health Organ. 2014 Oct 1;92(10):771-2. 

Kakalou E, Papastamopoulos V, Ioannidis P, Papanikolaou K, Georgiou O, Skoutelis A. Early HIV diagnosis through use of rapid diagnosis test (RDT) in the community and direct link to HIV care: a pilot project for vulnerable populations in Athens, Greece. J Int AIDS Soc. 2014;17(4 Suppl 3):19619.

Kentikelenis A, Karanikolos M, Reeves A, McKee M, Stuckler D. Greece's health crisis: from austerity to denialism. Lancet. 2014 Feb 22;383(9918):748-53.

Kentikelenis A, Karanikolos M, Williams G, Mladovsky P, King L, Pharris A, Suk JE, Hatzakis A, McKee M, Noori T, Stuckler D. How do economic crises affect migrants' risk of infectious disease? A systematic-narrative reviewmigrants' risk of infectious disease? A systematic-narrative review. Eur J Public Health. 2015 Aug 28.  [Epub ahead of print] 

Lytras T, Spala G, Bonovas S, Panagiotopoulos T. Evaluation of tuberculosis underreporting in Greece through comparison with anti-tuberculosis drug consumption. PLoS One. 2012;7(11):e50033

Maher D. Implications of the global financial crisis for the response to diseases of poverty within overall health sector development: the case of tuberculosis. Trop Med Int Health. 2010 Jan;15(1):11-7.

Maltezou HC, Lionis C. The financial crisis and the expected effects on vaccinations in Europe: a literature review. Infect Dis (Lond). 2015 Mar 5:1-10. [Epub ahead of print]

Maruthappu M, Da Zhou C, Williams C, Zeltner T, Atun R. Unemployment, public-sector health care expenditure and HIV mortality: An analysis of 74 countries, 1981-2009. J Glob Health. 2015 Jun;5(1):010403.

Meletis G, Chatzidimitriou D. Long-lasting austerity in the Greek health care system: Could it influence the efforts to limit the spread of carbapenem-resistance in Europe?carbapenem-resistance in Europe? Hippokratia. 2015;19(4):291-2.

Morris K. Global tuberculosis control amid the world economic crisis. Lancet Infect Dis. 2009 Mar;9(3):144-5.

Nikolopoulos GK, Sypsa V, Bonovas S, Paraskevis D, Malliori-Minerva M, Hatzakis A, Friedman SR Big Events in Greece and HIV Infection Among People Who Inject Drugs. Subst Use Misuse. 2015 Feb 27:1-14. [Epub ahead of print]

Odone A, Signorelli C, Rodrigues LC. Tuberculosis and the economic crisis: an old threat for the new European agenda. Scand J Public Health. 2014 Oct 28. [Epub ahead of print]

Papamichail D, Petraki I, Arkoudis C, Terzidis A, Smyrnakis E, Benos A, Panagiotopoulos T. Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling. Eur J Public Health. 2016 Oct 2. [Epub ahead of print]

Papatheodoridis G, Thomas HC, Golna C, Bernardi M, Carballo M, Cornberg M,Dalekos G, Degertekin B, Dourakis S, Flisiak R, Goldberg D, Gore C, Goulis I,Hadziyannis S, Kalamitsis G, Kanavos P, Kautz A, Koskinas I, Leite BR, Malliori M, Manolakopoulos S, Matičič M, Papaevangelou V, Pirona A, Prati D, Raptopoulou-Gigi M, Reic T, Robaeys G, Schatz E, Souliotis K, Tountas Y, WiktorS, Wilson D, Yfantopoulos J, Hatzakis A. Addressingbarriers to the prevention,diagnosis and treatment of hepatitisB and C in the face of persisting fiscal constraints in Europe: report from a high levelconference. J Viral Hepat. 2016Feb;23 Suppl 1:1-12.

Paraskevis D, Nikolopoulos G, Fotiou A, Tsiara C, Paraskeva D, Sypsa V, Lazanas M, Gargalianos P, Psichogiou M, Skoutelis A, Wiessing L, Friedman SR, Jarlais DC, Terzidou M, Kremastinou J, Malliori M, Hatzakis A. Economic Recession and Emergence of an HIV-1 Outbreak among Drug Injectors in Athens Metropolitan Area: A Longitudinal Study. PLoS One. 2013 Nov 12;8(11):e78941.

Rechel B, Suhrcke M, Tsolova S, Suk JE, Desai M, McKee M, Stuckler D, Abubakar I, Hunter P, Senek M, Semenza JC. Economic crisis and communicable disease control in Europe: a scoping study among national experts. Health Policy. 2011 Dec;103(2-3):168-75 

Reeves A, Karanikolos M, Mackenbach J, McKee M, Stuckler D. Do employment protection policies reduce the relative disadvantage in the labour market experienced by unhealthy people? A natural experiment created by the Great Recession in Europe. Soc Sci Med. 2014 Nov;121:98-108.

Reeves A, Basu S, McKee M, Sandgren A, Stuckler D, Semenza JC. Tuberculosis control and economic recession: longitudinal study of data from 21 European countries, 1991-2012control and economic recession: longitudinal study of data from 21 European countries, 1991-2012. Bull World Health Organ. 2015 Jun 1;93(6):369-79. 

Regidor E, Barrio G, Bravo MJ, de la Fuente L. Has health in Spain been declining since the economic crisis? J Epidemiol Community Health. J Epidemiol Community Health 2013 Oct 23. [Epub ahead of print]

Roure S, Pérez-Quílez O, Vallès X, Martínez-Cuevas O, Sabrià M, Valerio L. Has the economic crisis led to a new risk profile for international travellers?the economic crisis led to a new risk profile for international travellers? Rev Clin Esp. 2015 Jul 16.

Semenza JC, Tsolova S, Lim TA. Economic crisis and infectious disease control: a public health predicament. Eur J Public Health. 2012 Feb;22(1):5-6 

Shivaji T, Cortes Martins H. Improving data management practices in thePortuguese HIV/AIDS surveillance system during a time of public sector austerity.BMJ QualImprov Rep. 2015 Sep 2;4(1). 

Sotiropoulou P, Gourgoulianis K, Konstantinou K, Petinaki E, Roupa Z. Retrospective study of measuring tuberculosis therapy compliance: greece as ahost country for vulnerable populations before and during the financial crisis.Mater Sociomed. 2015 Oct;27(5):328-32.

Souliotis K, Agapidaki E, Papageorgiou M, Voudouri N, Contiades X. Access to treatment for Hepatitis C among injection drug users: results from the cross-sectional HOPE IV study. Int J Equity Health 2017 Jun 14;16(1):101. doi: 10.1186/s12939-017-0601-3.

Suhrcke M, Stuckler D, Suk JE, Desai M, Senek M, McKee M, Tsolova S, Basu S, Abubakar I, Hunter P, Rechel B, Semenza JC. The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One. 2011;6(6):e20724.

Tarján A, Dudás M, Gyarmathy VA, Rusvai E, Tresó B, Csohán Ã. Emerging Risks Due to New Injecting Patterns in Hungary During Austerity Times. Subst Use Misuse. 2015 Mar 16:1-11. [Epub ahead of print]

Tsang MA, Schneider JA, Sypsa V, Schumm P, Nikolopoulos GK, Paraskevis D, Friedman SR, Malliori M, Hatzakis A. Network Characteristics of People Who Inject Drugs Within a New HIV Epidemic Following Austerity in Athens, Greece. J Acquir Immune DeficSyndr. 2015 Aug 1;69(4):499-508

Van der Werf M, Giesecke J, Sprenger M. Can the economic crisis have an impact on tuberculosis in the EU/EEA? Euro Surveill. 2012 Mar 22;17(12) 

Voelker R. One casualty of global economic crisis: uncertain finances for HIV/AIDS programs. JAMA. 2010 Jul 21;304(3):259-61. 

Wada K, Higuchi Y, Smith DR. Socioeconomic status and self-reported health among middle-aged Japanese men: results from a nationwide longitudinal study. BMJ Open. 2015 Jun 24;5(6):e008178.

Winston CA, Navin TR, Becerra JE, Chen MP, Armstrong LR, Jeffries C, Yelk Woodruff RS, Wing J, Starks AM, Hales CM, Kammerer JS, Mac Kenzie WR, Mitruka K, Miner MC, Price S, Scavotto J, Cronin AM, Griffin P, LoBue PA, Castro KG. Unexpected decline in tuberculosis cases coincident with economic recession - United States, 2009. BMC Public Health. 2011 Nov 7;11:846.