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Stop Epidemics

Pills for antiretroviral treatment of HIV/AIDS in the hand of an infected woman in Botswana

This is the 2007 draft on epidemics. You will get the newest version here.

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

Affected people and foundations of life: 33.2 million (30.6-36.1 million) people suffer from HIV (Human Immunodeficiency Virus)/AIDS (Acquired Immune Deficiency Syndrome), most of them in sub-Saharan Africa. The portion of women is stagnating at 50% worldwide. (UNAIDS [Joint United Nations Programme on HIV/AIDS] 2007, 1, 4; revised data.) Around 15.2 million children have lost one or both parents to AIDS, 80% of them in sub-Saharan Africa. In 2005 only 11% of pregnant women in low- and middle-income countries who were HIV-positive were receiving services to prevent the transmission of the virus to their newborns. (UN [United Nations] 2007, 20.)

8.8 million people are newly infected by tuberculosis per year (WHO [World Health Organization] 2007, 18), and 350-500 million by malaria. Africa is affected the most.

As well as their substantial benefits especially in prevention and treatment of epidemics, injection practices in medical settings can harm the recipients because of overuse or reuse of injection equipment (resp. [respectively] the lack of new injection equipment), mainly in South-East Asia (WHO 2002, 78).

Furthermore, there are new risks of resistant viruses and diseases like SARS (Sudden Acute Respiratory Syndrome) and avian influenza to be contained. 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:

  • AIDS, tuberculosis and malaria combined kill 5 million people per year.
    • AIDS: 2.1 million (1.9-2.4 million), estimated for 2007 (UNAIDS 2007, 1).
    • Tuberculosis: 1.6 million per year (WHO 2007, 18)
    • Malaria: about 1.27 million per year, mostly children (WHO 2004, 120)
  • Unsafe injection practices in medical settings: 0.501 million per year (WHO 2002, 226).
  • 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:

  • AIDS: 84.5 million of healthy life-years annually (DALYs [Disability-adjusted life years]; WHO 2004, 126; according to a 2007 revision of estimates on numbers of infected people probably over-estimated, UNAIDS 2007)
  • Tuberculosis: 34.7 million DALYs annually
  • Malaria: 46.5 million DALYs annually (WHO 2004, 126)
  • Unsafe injection practices in medical settings: 10.5 million DALYs annually (WHO 2002, 78).
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 2000, § 19.4) The rise of HIV/AIDS has been slowed down by huge efforts, but still is not halted (UN 2007, 18; UNAIDS 2007, 4).
TB appears to be on the threshold of decline globally, while rising in sub-Saharan Africa (WHO 2007, 18).
Available data for malaria do not allow a trend analysis (UN 2007c).
It is still possible to meet the Millennium Target by continuing the successful extension of measures (UN 2007, 18-21).
TB (more ambitious target): to halve prevalence and death rates from 1990 to 2015 (Stop TB Partnership: UN 2007, 21) TB prevalence and death rates are stagnating (UN 2007, 21), meeting this target is less likely (WHO 2007, 18).
TB (additonal target): by 2005, 70% case detection and 85% cure (Stop TB Partnership: UN 2007, 21) Targets were narrowly missed: for case detection reaching 60%, and for cure 84% (WHO 2007, 18).
Malaria (additonal target): 60% coverage with insecticide-treated bed nets until 2005, and 80% until 2010 (adopted by the African Summit on Roll Back Malaria in 2000: UN 2007, 20) Some countries have reached more than 20% coverage with insecticide-treated bed nets (UN 2007, 20).
Unsafe injection practices in medical settings: no international goal or target. No trend data available.

Measures:

  • On HIV/AIDS: information and antiretroviral therapy. Mainly achieved within the last two years, it has been achieved, that 28% of the population with advanced HIV infection in low and middle income countries (2 of 7.1 million in need) have received access to affordable essential drugs for antiretroviral therapy (UN 2007b, Indicator 46).
  • TB: case detection and new treatments. 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.)
  • Malaria: anti-malaria bed nets and insecticide use, new treatments (artemisinin-based combination therapy, ACT; UN 2007, 20f.).
  • 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.

In 2008 financial support of 22.1 billion US (United States) dollars will be needed to constrain HIV/AIDS (UNAIDS [Joint United Nations Programme on HIV/AIDS] 2005). The G8 (Group of Eight) summit announced US$ 60 billion for the Global Fund on AIDS, Tuberculosis and Malaria.

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 (2007)

Photo credit: © WHO/Eric Miller

Address of this page (URI, URL): http://global2015.net/challenges/epidemics_draft2007.html