Introduction and Definition Definition: Modes of transmission Examples of CDs Common Infectious diseases Neglected diseases History of Communicable Diseases Burden of Disease Global burden of disease and communicable diseases, by region, gender and income levels Importance of CDs Sheer Burden Economic impact Rate of spread Recurrence of diseases Security and CDs Interventions Why intervene? Why should policy makers care about CDs? History of interventions and policy issues What is needed for effective control of CDs Global Approaches Global responsibility International law Partnerships and collaboration Financial support World Bank’s role and involvement Total lending in health Special programs the Bank is involved in. Conclusions and Way forward
Even with the projected rise in the burden of NCDs, CDs are expected to account for 26% of the BoD in 2015 globally, and 56% in Africa. (Global Burden of Disease
In Sierra Leone most deaths occur in the U5 age group, whereas in Denmark it is among those over 65.
Global importance of Communicable Diseases Enormous burden and impact globally Economic impact Constrain health and development of infants and children and affect their schooling Stigma and discrimination against people with certain communicable diseases such as HIV/AIDS, TB. Leprosy Disruption of social networks and family structure e.g. with Orphans and other vulnerable children who have lost their parents or other care gives due to HIV/AIDS TB- Malaria HIV/AIDS etc
Reduction in revenue for the country India example during the bubonic plague outbreak Substantial loss in productivity and income In Tanzania, men with AIDS lost an average of 197 days of work over an 18 month period. Catastrophic costs of treating illness
In history, attempts at stopping communicable diseases from entering a country often proved ineffective
Two billion people – one third of the world’s total population–are infected with the microbes that cause TB. Of these, 10% will become sick with active TB in their lifetime. Risks are higher in those with HIV infection. A total of 1.6 million people died from TB in 2005, equal to about 4400 deaths a day. TB is a disease of poverty, affecting mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world, with more than half occurring in Asia TB/HIV- About 200 000 people with HIV die from TB every year, most of them in Africa. TB is a worldwide pandemic. Although the highest rates per capita are in Africa (28% of all TB cases), half of all new cases are in six Asian countries (Bangladesh, China, India, Indonesia, Pakistan and the Philippines). Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to the standard treatments using first-line drugs. MDR-TB is present in virtually all countries recently surveyed by WHO and its partners. About 450 000 new MDR-TB cases are estimated to occur every year. The highest occurrence rates of MDR-TB are in China and the countries of the former Soviet Union. Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is extremely difficult to treat and cases have been confirmed in South Africa and worldwide. WHO’s Stop TB Strategy aims to reach all patients and achieve the target under the Millennium Development Goals (MDG): to reduce by 2015 the prevalence of and deaths due to TB by 50% relative to 1990 and reverse the trend in incidence. The Global Plan to Stop TB 2006-2015, launched January 2006, aims to achieve the MDG target with an investment of US$ 56 billion. This represents a three-fold increase in investment from 2005. The estimated funding gap is US$ 31 billion.
Most cases of XDR-TB were in HIV infected individuals.
With full LLITN coverage, child mortality from all causes is reduced by 18%
One of the most devastating conditions of the 21 st century An estimated 38.6 million [33.4 million–46.0 million] people worldwide were living with HIV in 2005. An estimated 4.1 million [3.4 million–6.2 million] became newly infected with HIV and an estimated 2.8 million [2.4 million–3.3 million] lost their lives to AIDS.
Growing body of evidence on the interactions between both conditions Both are diseases of poverty
Limited evidence suggests that some antiviral drugs, notably oseltamivir (commercially known as Tamiflu), can reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset.
Improved hygiene and sanitation Hand washing, proper waste disposal, sewage system, cooking methods and boiling water Information, education and behavior change including household practices Livestock handling, knowledge about contagion, Cultural norms Poultry and farming methods, ….. Self reporting of illnesses and compliance with interventions and treatment Unexplained fevers, ARI symptoms, etc Compliance with medications to reduce potential for drug resistance. – hasn’t always worked - DOTS
Utilitarian Approaches – “Greatest good for the greatest number” – Sort of cost benefit analyses, where the benefits of the intervention such as the lives saved or years of live gained, etc, exceed the costs which could range from just the prick of a needle to a minority developing side effects of the vaccine. Social Isolation and Quarantine measures Home treatment Isolation Mass Vaccination programs Polio in Nigeira
Regulations and Laws- Challenge of enforceability, as it often relies on international cooperation and pressure
Notification - The IHR (2005) require States to notify WHO of all events that may constitute a public health emergency of international concern and to respond to requests for verification of information regarding such events. Under the WHO Constitution, all WHO Member States are automatically bound by the new IHR (2005) unless they affirmatively opt out within a limited time period, namely by 15 December 2006. No WHO Member State has completely opted out, and only a very small number made reservations.
Effectiveness of global response is based on the principle of collaboration The Global Outbreak Alert and Response Network (GOARN) is a technical collaboration of existing institutions and networks who pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance.
The need to move beyond charity-model. Non-rival –The benefits from the Interventions can be enjoyed simultaneously by all in the community. Lack of access to TB drugs may fuel resistance and the development of MDR-TB
Therefore by the percentage of the global population susceptible to CDs will increase significantly.
Respect for the value of each life – Behind the numbers of those affected by CDs are individuals, with hopes dashed and who make complex decisions, the context of which we are not very familiar with. The person who refuses an HIV test, against the background of stigma The mother in northern Nigeria who prevents her child from accessing polio vaccines because of the outbreak of vaccine-derived polio
more than 21 million LLINs and over 42 million doses of ACT will be distributed under projects in the Booster Program’s first phase ending in 2008.
The World Bank has committed more than $430 million to Booster projects. A nine-fold increase in IDA funding for malaria control in Africa.