By Neena Bhandari
SYDNEY, 11.06.2010 (IPS) – While successful immunisation programmes worldwide have saved millions of lives, the threat of new infectious diseases and drug-resistant strains of existing diseases are posing a major challenge to governments, especially in developing regions like Asia, in meeting their commitment to the Millennium Development Goals (MDGs).
“We have two major problems in the context of emerging infectious diseases in the coming decade – outbreaks, which might develop into pandemics, and the continuing increase in anti-microbial resistance,” Professor Tanya Sorrell, director of the newly established Sydney Institute of Emerging Infectious Diseases and Biosecurity, based at University of Sydney, tells IPS.
This raises “the dual problems of preventing and managing outbreaks and treating infections which are not responsive to the drugs we have available,” she says.
Sorrell was among 350 scientists, academics and medical practitioners from across the world that discussed the issue at the Australasian Society for Infectious Diseases’ annual conference held in Darwin in northern Australia late last month.
HIV/AIDS, malaria and tuberculosis have been the three major infectious diseases inflicting a huge burden on developing countries, retarding economic and social development. For example, according to WHO, malaria can decrease Gross Domestic Product by as much as 1.3 percent in countries with high levels of transmission. As the world reviews progress on the MDGs and countries renew their financial commitments to the United Nations-backed Global Fund, 2010 is set to be a decisive year in the fight against these three diseases, experts say.
MDGs are eight time-bound goals tackling poverty and its various dimensions that member states of the United Nations and other international organisations have agreed to meet by 2015.
“We either win this fight or we lose it. There can be no let-up in the fight against the three diseases. If we ease up, these three diseases will re-emerge,” said UN Secretary-General Ban Ki-moon in a message last month, as he described the progress made by the Global Fund, which has been the main contributor to the health-related MDGs.
Professor Kevin Marsh, director of the Kenya Medical Research Institute Wellcome Trust programme in Kilifi, Kenya, cites the experience of Africa to stress the impact of efforts to fight one of the world’s killer diseases on meeting the MDGs.
“In Africa, if you control malaria, you can reduce childhood mortality down to the levels to achieve MDGs,” he says. In coastal Kenya, for instance, malaria has dropped by 90 percent in the last five years and infant childhood deaths have dropped from 115 deaths per 1,000 under-five children to 74 last year, he recounts.
Malaria causes 500 million episodes of illness, almost 40 percent of them in Asia, and according to the World Health Organisation, one million deaths annually, 90 per cent of them in Africa.
“The changing epidemiology of malaria in Southeast Asia, including the emergence and spread of drug-resistant strains of the parasite, are posing fresh challenges to regional elimination efforts,” says Professor Ric Price of the Menzies School of Health research in Darwin. “To achieve the ultimate goal of malaria control, we estimate that four to five billion U.S. dollars is needed per year, sustained over the next 20 to 30 years.”
Parts of South-east Asia are already witnessing the emergence of malarial strains that are resistant to ‘artemesinins’, drugs the world depends on to treat malaria. If such a situation is not controlled, “it will be a very serious global health issue,” warns Marsh, who is also a professor of Tropical Medicine at Oxford University.
There are five species of malaria that commonly infect humans, two of which pose the greatest health risks –‘Plasmodium falciparum’ and ‘P. vivax’. For Asia, the challenge is the `P. vivax’ in terms of numbers of cases and the difficulty in controlling it.
The emergence of another species of potentially fatal adult malaria, ‘Plasmodium knowlesi’, has also been noted in Asia, particularly in Malaysia. Pig-tailed and long-tailed macaques (monkeys), are the reservoirs of this parasite, says Timothy William, head of the Infectious Disease Unit at Queen Elizabeth Hospital in Sabah, Malaysia.
“It is difficult to treat or eradicate the reservoirs for obvious reasons. In our study, about 30 percent of the cases presented with severe disease. Therefore it is imperative that these cases are diagnosed early and treated,” he says.
Research has shown that more than 60 percent of emerging infectious diseases have been related to animal and human contact. “Of these, 70 percent are due to contact between humans and wildlife. In developing countries these issues are even more important with increasing land clearing, intensive farming of poultry, and infections passing from wild birds into domestic birds,” Sorrell. tells IPS.
Still another major challenge to the global health community is the growing drug resistance of certain diseases, particularly to antibiotics. These include tuberculosis, typhoid, malaria, and sexually transmitted diseases like gonorrhoea, amongst others. In recent years, there has been a renewed commitment to vaccine research to prevent and treat these infections and other preventable diseases of the developing world.
“The issue in the long term is affording the vaccines in routine use”, says Marsh, who adds that immunisation has been “one of the most successful international efforts to curb the spread of diseases. In the 1960s, less than five percent of the world’s children were immunised and now 80 percent or more are immunized”.
Immunisation is particularly crucial for children at risk for pneumococcal disease, says Dr Andrew Pollard, professor of paediatric infection and immunity and director of the Oxford Vaccine Group at University of Oxford. “Streptococcus pneumoniae is the leading cause of pneumonia in childhood and kills more children in South Asia and South East Asia than any other disease,” he says.
Nipping infections will be crucial to meeting health-related MDGs and Internet will play a major role as a tool of surveillance and educating communities.
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