Despite highly advanced medicines and a sophisticated understanding of infection, the modern disease challenge is as serious ever. However, the debate about what priorities
the international community should have in their approach to global health
threats is as contentious as ever.
Determining
which disease to prioritize requires a careful analysis balancing infection
numbers, death tolls and the debilitating effects on the community and
infrastructure.
We are inviting you to vote for what you
consider the most pressing disease challenge as a launch-pad for a discussion
about the global health agenda. Below is
an overview of the challenges each of the diseases poses on the global
scale:
- Swine and Avian Flu
With the recent outbreak of the Swine Flu in Mexico -- which contains genetic materials from the virus that usually affects birds and pigs -- international concern about the international virus epidemics are rising. Indeed, when one considers European history, a prospect of an influenza pandemic on a scale which would dwarf the 1918 Spanish Flu is a frightening scenario. If the strains of the Swine or Avian flu mutate in the right way, it will be able to spread by human-to-human at an alarming rate. If such transmissions begin, a pandemic could occur which could affect between 2 million and 7.4 million people around the world. Such scenarios underline the seriousness of the threats.
The WHO has provided recommended action plans to deal with an eventual pandemic and has a stockpile of 3 million antiretroviral treatments which it is hoped will delay the spread. Better surveillance, detection capacity, early-warning systems, investment in vaccine research and the ability to enforce movement restriction need to be put in place now on a national level if this strategy is to have any success. However, not enough countries have implemented the necessary protective measures against an influenza epidemic.
- Diseases of Poverty:
a) Cholera
Cholera, caused by bacteria residing in infected water, takes hold in areas with poor sanitation and inadequate access to safe drinking water. It causes profuse vomiting and diarrhea and is transmitted through contaminated food and drinks or contact with cholera patients. Immediate and constant hydration of the patient is required to prevent a death of dehydration.
The disease could be contained and prevented with proper sanitation practices and a stronger health infrastructure in the developing world. Zimbabwe is a recent example. As political instability, collapse of the health infrastructure, obstacles to foreign aid combined in a tragic Cholera outbreak, which according to the WHO has surpassed 80,000 cases and caused over 3000 deaths.
The immediate reaction necessitates a control of the outbreak regions and hydration treatments. In the long-term the fight against cholera necessitates the development of proper sanitation practices, and an emphasis on preventative measures in development and aid programs. The failure to address cholera poses a threat to millions of lives and to the development prospects of countries across the globe.
b) Tuberculosis
Tuberculosis currently kills 2 million people a year and infects another 5 million. It is an infectious bacterial disease which spreads to the lungs and is fatal if left untreated. Developing countries are worst affected, and HIV/AIDS sufferers' poor immune systems put them at even greater risk: 30% of people living with HIV also have TB. The most deadly strains of the virus are those such as extremely drug-resistant Tuberculosis (XDR-TB), which are resistant to antibiotics. International action to improve TB control is urgently required.
Access and equity are the key challenges: treatment plans are time consuming and cumbersome and thus particularly difficult for people in post-conflict regions to follow correctly. Self-administered treatment models and community observation schemes adapted to suit rural and nomadic patients have been launched by Doctors Without Borders. In addition, research into antibiotic resistance is needed. Grassroots activism such as the XDRTB.org initiative, which works to improve funding for TB diagnostics, combined with international backing for new research, such as the WHO DOTS strategy, need greater international backing.
c) Malaria
500 million people are affected by Malaria every year, 2 million are killed. In fact, one child dies from form Malaria every 80 seconds and it costs Africa $12 billion annually. In spite of this, it reminds neglected because it is not immediately threatening worldwide and does not receive the kind of "celebrity disease" status which HIV/AIDS does. Just 35 countries account for 98 percent of global malaria deaths, many of which are among the poorest in the world.
Lack of political will and financial investment remain obstacles to the containment of the disease. Since the means to reduce malaria are already available, what is needed is concerted, coordinated global action. The Roll Back Malaria Partnership seeks to tackle malaria through a combination of prevention and cure: mosquito control strategies (insecticidal nets, residual sprays and clean water) preventative treatment during pregnancy, prompt diagnosis and anti-malarial treatment if necessary. Doctors Without Borders has had commendable success in overcoming cost barriers to obtaining diagnosis and treatment through training community malaria volunteers who can reach isolated areas and by providing free health care for those most at risk.
- HIV/AIDS
HIV/AIDS has swept the globe with alarming speed and devastating consequences. Nearly 40 million people live with the virus worldwide and 2 million die from AIDS-related causes each year. It is a chronic infection which gradually debilitates the immune system; while death from AIDS can currently be stalled with antiretroviral drugs (ARVs), the disease cannot be cured. Despite the prominence of HIV/ Aids in the media, the battle persists to tackle the disease at all levels: diagnosis, prevention, drug therapy, counseling and vaccine research.
Drug availability and affordability is one of the biggest obstacles to treatment in the developing world: whilst campaigns to lower prices of ARVS have had considerable success, newer drugs remain costly and subject to bureaucratic patent laws. UNITAID advocates tackling these barriers through the use of a "patent pool" and such innovative initiatives need international backing if they are to be successful. The sexual stigma attached to the disease poses a host of problems that other diseases do not face. The preventative approach, which in the absence of much progress towards a vaccine is the priority, is bound up with addressing cultural attitudes to sexuality and contraception. Resources should be put into simultaneously increasing reproductive education, particularly among females, and providing people with access to affordable antiretroviral treatment.
- Diseases of the Wealthy: Obesity and Some Kinds of Diabetes
Western aid for diseases in the developing world will not even be available if the current obesity epidemic seizing Europe and North America is not addressed. The prevalence of obesity has tripled in many western countries since the 1980s and in the US, 61% of adults are overweight or obese; in the UK, 1 in 3. While the scale of the problem is slowly being acknowledged, governments are being too slow to act. Nothing short of a revolution in food culture is needed in conjunction with the promotion of free, safe, accessible exercise facilities.
Heart disease and diabetes are the most severe obesity-related diseases, and worldwide numbers of the latter are set to increase from 192 million to 333 million by 2025. Lower socioeconomic groups are worst affected and long-term obesity not only increases morbidity but also puts an enormous burden on the economy's health service. Tackling this epidemic should take precedence over investing in diseases in the developing world; a national emergency is at hand and it is imperative that governments address this crisis.
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April 29, 2009
Jennifer L. Amariya, University of Helsinki, (7)
Clearly the fight against Malaria needs to be prioritized, as this is the lowest-hanging fruit in this list of diseases. As the medical technology already exists to fight this disease, it is simply a question of incentivizing distribution and investment. With sufficient political will, rapid progress could be made.