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Stop Epidemics

Pills for antiretroviral treatment of HIV/AIDS in the hand of an infected woman in Botswana
Pie chart: 4.5% of world population affected (294 millions) Bar chart: 4.3 million deaths per year, over 100 million lives at risk Steady/negative trend

Human health is largely affected by epidemics. Malnutrition increases the risk of diseases and deaths that are caused by them. Epidemics constrain workforce and development.

Affected people and foundations of life: About 33 million (30-36 million) people suffered from HIV (Human Immunodeficiency Virus)/AIDS (Acquired Immune Deficiency Syndrome) in 2007, most of them in sub-Saharan Africa. The portion of women has remained stable at 50% worldwide for the last years. Circa 15 million children have lost one or both parents to AIDS. (UNAIDS [Joint United Nations Programme on HIV/AIDS] 2008, 16, 35, 214 and 218.)
  About 14.4 million people were ill from tuberculosis in 2006, 9.16 million of them were new cases (WHO [World Health Organization] 2008b, 19).
  Additionally there were 247 million (189-327 million) occurrences of malaria in 2006 (WHO 2008c, 10). Africa is affected the most.
  Furthermore, there are risks to be contained, like resistant bacteria or viruses and new diseases like SARS (Sudden Acute Respiratory Syndrome) and avian influenza. These global risks are characterized by a very large potential of damage as well as uncertainty about the probabilities of occurrence (WBGU [German Advisory Council on Global Change] 1998, 62).

Deaths:

  • The three worst epidemics of the present − AIDS, tuberculosis and malaria − combined kill around 4.3 million people per year:
    • AIDS: 2.0 million (1.8-2.3 million) in 2007 (UNAIDS 2008, 15 and 217).
    • Tuberculosis: 1.66 million in 2006, of which 231 000 were HIV-positive people (WHO 2008b, 19 and 33)
    • Malaria: 881 000 (610 000 to 1.21 million) in 2006, 85% of children under 5 years (WHO 2008c, 10 and 12).
  • New risks: An event similar to the 1918 Spanish flu pandemic, which is thought to have killed 20-40 million people worldwide, could now result in over 100 million deaths within a single year. Such a catastrophic event, the possibility of which is being seriously considered by the epidemiological community, would probably lead to severe economic disruption and possibly even rapid collapse in a world economy dependent on fast global exchange of goods and services. (MA [Millennium Assessment] 2005, 89.)

Loss of healthy life-years:

  • HIV/AIDS: 58.5 million of healthy life-years (DALYs [Disability-adjusted life years]) in 2004
  • Tuberculosis: 34.2 million DALYs in 2004
  • Malaria: 34.0 million DALYs in 2004 (WHO 2008, 60)
Targets/goals: Trends: 0/−
AIDS, Malaria (and TB [tuberculosis]), with regard to 2015: To have, by then, halted, and begun to reverse, the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity (Millennium Target: UN [United Nations] 2000, § 19.4) The increase of people affected by HIV/AIDS has been slowed down by huge efforts, but is still not halted. However, the numbers of new infections and deaths have already been declining since 2001. (UNAIDS 2008, 32 and 35.)
TB prevalence rate (cases per population) is on the decline, already meeting the Millennium target. But the number of new cases still continued to rise in 2006. (WHO 2008b, 1, 3 and 33; UN 2008, 34.).
Regarding malaria no summarizing trend data available, but some data may suggest a decline in recent years (WHO 2008c, vii [roman 7], x [roman 10]).
TB (more ambitious target): to halve prevalence and deaths from 1990 to 2015 (Stop TB Partnership 2008) TB prevalence and death rates have started to fall, but are not on track yet to reach these targets (WHO 2008b, 1, 3 and 34; UN 2008, 34).
TB (additional target): by 2050, to eliminate TB as a global public health problem (global incidence less than 1 per million population; Stop TB Partnership 2008) -
Malaria (more ambitious targets): reducing malaria cases and deaths per capita by at least 50% between 2000 and 2010, and by at least 75% between 2005 and 2015 (adopted by the WHO Assembly 2005: WHO 2008c, viii [roman 8]) In some countries malaria cases have halved until 2007, but at the global level trends are not on track (WHO 2008c, vii, x).

Targets on treatment see under measures below.

Measures:

  • On HIV/AIDS: information and antiretroviral therapy. The UN targets to scale up ... responses ... towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010 (UN 2006, § 20). As achievements of basically three years, 31% of the population with advanced HIV infection in low and middle income countries (3 of 9.7 million in need) have received access to affordable essential drugs for antiretroviral therapy at the end of 2007 (UN 2008, 30). Ten billion US (United States) dollars were available in 2007 to constrain HIV/AIDS. In 2009 at least US$ 20 billion will be needed and in 2010 at least US$ 25 billion to meet the 2010 target of universal access to prevention and treatment. (UNAIDS 2008, 185.)
  • TB: case detection and new treatments. WHO had targeted to detect 70% and to cure 85% of the cases by 2005 (Stop TB Partnership 2008). These targets are still narrowly missed: case detection has reached 61% in 2006, and cure 84.7% in 2005 (UN 2008, 33f. [and following page]; WHO 2008b, 1). Treatment success is lower than expected for patients infected by HIV or carrying multidrug-resistant TB. Hence, efforts are needed to step up cooperation between TB and HIV programmes and to deal with drug-resistancy. (WHO 2007, 18.) Available funding for TB control in 2008 was US$ 3.3 billion, while an additional US$ 1 billion was needed (WHO 2008b, 1).
  • Malaria: prevention through anti-malaria bed nets, insecticide use, larval control or environmental management, intermittent preventive treatment in pregnancy (IPTp); new treatments (artemisinin-based combination therapy, ACT; WHO 2008c, 3). WHO member states target to reach, by 2010, at least 80% coverage with insecticide-treated bed nets for people at risk; appropriate antimalarial drugs for patients with probable or confirmed malaria; indoor residual spraying of insecticide for households at risk; and IPTp (adopted by the WHO Assembly 2005: WHO 2008c, viii). Supplies with insecticide-treated bed nets were sufficient to protect 26% of people in 37 of 45 African countries in 2006. Other targets are not on track as well, despite of increasing efforts. (WHO 2008c, ix [roman 9].) Funding to fight malaria has increased to at least US$ 688 million for the African Region in 2006 (WHO 2008b, 22f.).
  • New risks: Epidemiologic monitoring of new or unknown phenomena is indepensable (WBGU 1998, 91). In June 2007, revised International Health Regulations came into effect. Adopted by 192 WHO member states, public health emergencies of international concern have to be notified, national capacities and contact points are to be provided, recommended measures and external advice are embodied. (WHO 2006, 2007b.) Up to now, measures to constrain the spread of SARS were successful.
  • The G8 (Group of Eight industrialized countries) has pledged to work towards the goals of providing at least a projected US$ 60billion over 5 years, to fight infectious diseases and strengthen health (G8 [Group of Eight] 2008, § 46a).

Annotations

For numeric names the short scale is used:
1 billion = one thousand million = 109 = 1 000 000 000

DALYs: Disability-adjusted life years.
One DALY represents the loss of one year of equivalent full health. DALYs are the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition. (WHO 2004, 95f.)

Sources

Draft (2008)

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Photo credit: © WHO/Eric Miller

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