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But massive effort,’ political will are requisites
Two out of three deaths among children and adults (ages 0-44) in Africa and Southeast Asia are due to just a few diseases: TB, AIDS, malaria, childhood diseases, and reproductive conditions.
A new report issued jointly by six United Nations agencies on Dec. 19 shows that worsening epidemics of infectious disease and rising death rates are not inevitable. The report, titled "Health, A Key to Prosperity: Success Stories in Developing Countries," documents successful strategies for beating back TB, malaria, AIDS, childhood diseases, and maternal and perinatal conditions, even in some of the world’s poorest nations.
In India, for example, which accounts for 30% of the global TB burden and nearly half a million TB deaths each year, a massive expansion of TB treatment meant that by the end of last year, one-fourth of the population was covered by the five-pronged strategy known as directly observed treatment, short-course (DOTS), up from just 2% in 1998.
In Nepal, one of the poorest countries in the world, TB treatment success rates have more than doubled since 1994, and 75% of the population now has access to DOTS TB treatment.
Vietnam has reduced the death toll due to malaria by 97% in five years, through the use of locally produced high-quality drugs and the provision of insecticide-treated bednets.
Malawi, one of the world’s most impoverished nations, has boosted its measles immunization rate from 50% in 1980 to almost 90% today. A 1998 immunization campaign reached over 4 million children with measles vaccines and provided Vitamin A supplements for younger children at a cost of $.78 per child. Vitamin A given a few times a year can prevent 1 in 4 child deaths due to infectious disease. Globally, measles remains the greatest preventable killer of children, taking 900,000 young lives every year.
In the introduction to the report, the World Health Organization’s Director General Gro Brundtland says, "We know what works. A number of health interventions and tools can dramatically reduce deaths from the main killer diseases." The report is a call for taking these interventions to scale, making them available worldwide as a concrete, results-oriented, and measurable response to poverty and the global threat of infectious disease.
Combating infectious disease and protecting the lives and health of people in the world’s poor nations is not only the right thing to do; it is central to securing lives, the report argues. Diseases such as TB cannot be stopped at national borders, and they grow more dangerous and difficult to treat the longer the global community waits to put in place effective basic treatment programs, it says.
The report cites the fact that TB treatment using DOTS is one of the most cost-effective health interventions available (based on World Bank data), yet DOTS reaches fewer than 1 in 4 of those sick with TB.
If TB is improperly treated, it mutates into drug-resistant strains that are more costly to treat (and sometimes fatal). In the United States, a standard case of TB costs roughly $2,000 to treat, while multidrug-resistant TB can cost as much as $250,000, without a guarantee of success. In the world’s poorest nations, a full six months of drugs to cure a drug-sensitive case of TB costs as little as $10.
Infectious diseases are not only a threat to public health but also may predict or even contribute to the undermining of global stability, the report says. A 1995 CIA report commissioned by Vice President Al Gore looked at the reasons governments fall. In considering 600 factors associated with 113 cases of state failure, the CIA found the best predictor of state failure was a high infant death rate. Worldwide in 1999, almost 11 million children under age five died from mostly preventable diseases and malnutrition.