The fight against disease is far from over. Dr Hiroshi Nakajima,
Director-General, the World Health Organisation, argues that we face a
global health crisis unless the international community takes action
Until relatively recently, the long struggle for control over infectious
diseases seemed almost over. Smallpox was eradicated and half a dozen
other diseases were targeted for eradication or elimination. Vaccines
protected about eight out of ten of the world's children against six
killer diseases. Antimicrobial drugs were effectively suppressing
countless infections. However, in the path of these successes, cautious
optimism has been overtaken by a fatal complacency that is costing
millions of lives a year. Infectious diseases are the world's leading
cause of death, killing at least 17 million people - most of them
children - every year. Up to half the 5.72 billion people on earth are
at risk of many endemic diseases.
Far from being over, the struggle to control infectious diseases has
become increasingly difficult. Diseases that seemed to be subdued, such
as tuberculosis and malaria, are fighting back with renewed ferocity.
Some, such as cholera and yellow fever, are striking in regions once
thought safe from them. Other infections are now so resistant to drugs
that they are virtually untreatable. In addition, deadly new diseases
such as Ebola haemorrhagic fever, for which there is no cure or vaccine, are
emerging in many parts of the world. At the same time, the sinister role
of hepatitis viruses and other infectious agents in the development of
many types of cancer is becoming increasingly evident.
The result amounts to a global crisis: no country is safe from
infectious diseases. The socio-economic development of many countries is
being crippled by the burden of these diseases. Much of the progress
achieved in recent decades towards improving human health is now at
A global challenge
Poverty exposes hundreds of millions of people to the hazard of
infectious diseases in their everyday lives. More than 1 billion people
live in extreme poverty. Half of the world's population lacks regular
access to the most needed essential drugs.
Continuing global population growth and rapid urbanisation force many
millions of city dwellers to live in overcrowded and unhygienic
conditions, where lack of clean water and adequate sanitation are
breeding grounds for infectious disease.
Migration and mass movements of millions of refugees or displaced people
from one country to another as a result of wars, civil turmoil or
natural disasters, also contribute to the spread of infectious diseases.
As a result of the economic and social crises still affecting many
countries, health systems which should offer protection against disease
have, in extreme cases, either collapsed or not even been built. The
result is a resurgence of diseases that were once under control or
should be controllable, given adequate resources. Disabled by these
diseases, some societies are unable to get themselves back on their
Increasing international air travel, trade and tourism result in
disease-producing organisms being transported rapidly from one continent
to another. Reporting of infectious diseases now poses serious economic
threats to trade and tourism. Some countries impose unjustified
restrictions on travellers coming from infected countries; others are
tempted to conceal information about infections within their own
borders. The result is a fragmented, unco-ordinated approach to
infectious disease control and inadequate global information to allow
Changes in the global food trade create new opportunities for infections
to flourish. They include the shipment of livestock, new methods of food
production, storage and marketing and altered eating habits.
The effects of climate change may allow some diseases to spread to new
geographical areas. Microbes continue to evolve and adapt to their
environment, adding antimicrobial resistance to their evolutionary
A global response
For all these reasons, controlling infectious diseases is an imperative
global challenge that requires a global response. There is an
international consensus that priorities have to be set and activities
initiated speedily. This favourable environment for action needs to be
exploited, and in WHO's view there are three priorities for
international action over the next five years.
The first priority is to complete unfinished business, namely the
eradication and elimination of diseases such as poliomyelitis,
dracunculiosis, leprosy and Chagas disease. This does not require a huge
expenditure, and if the resources are not found, these diseases will
return with a vengeance and previous efforts will be lost.
The second priority is to tackle old diseases such as tuberculosis and
malaria which present new problems of drug and insecticide resistance.
Here there is a need to remove infectious sources in the community and
cure a high proportion of infectious cases, establish appropriate
national and international epidemiological surveillance and undertake
research on treatment regimens and improved diagnostics, drugs and
vaccines. Work is needed on developing new and improved vaccines against
neonatal tetanus, bacterial meningitis, tuberculosis and other diseases.
The third priority is to take short-term and long-term action to combat
newly emerging diseases. A speedy response is needed to outbreaks of
important new infections, wherever they occur. At the same time there is
a need for intensive research on the natural history of new diseases and
on possibilities for preventing, treating and controlling them. A
global surveillance programme is also essential.
The world has lost sight of its priority to reduce poverty through
better health and foster development by fighting disease. Today,
infectious diseases are not only a health issue; they have become a
social problem with tremendous consequences for the well-being of the
individual and the world we live in. We need to recognise them as a
common threat that has been ignored, at great cost, for too long, and to
build the global solidarity to confront them. What is required is the
commitment of the international community to helping countries most at
risk to help themselves. By helping each other, nations united protect
the world and protect themselves. To TopTo Archive IndexTo Contents
©Kensington Publications 1996