World Bank Seminar Series: Global Issues Facing Humanity

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World Bank Seminar Series Global Issues Facing
Humanity

• Diseases without borders
• PART I

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Slide 1 Presentation Summary

• Profile of Major Communicable Diseases
• Factors Driving the Spread of Communicable
  Diseases
• What makes Communicable Diseases a Global Issue?

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Slide 2 Profile of Communicable Diseases

• Steady Progress during the 20th Century in
  controlling communicable diseases
• Immunization
• Eradication of smallpox, containment of polio
• Widespread use of drugs including antibiotics
• Impressive advances in medicine

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Slide 3 Yet infectious diseases remain a
leading cause of death worldwide

• Annually, more than 10 million deaths worldwide
  are caused by communicable diseases
• More than half of all deaths due to communicable
  diseases are attributed to HIV/AIDS,TB and malaria

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Slide 4 Magnitude of the Problem

• HIV has infected more than 60 million people
  worldwide, more than 20 million of whom have died
• TB causes 8.8 million new infections each year
  and is responsible for an annual mortality of 1.7
  million
• HIV-TB co-infection about a third of HIV
  positive people also suffer from TB
• Malaria endemic areas cover a third of the
  worlds population and the estimated annual
  mortality is 1.2 million

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Slide 5 Emerging Infectious Diseases

• Zoonotics (diseases caused by infectious agents
  that can be transmitted between animals and
  humans)
• Characteristics include mutation during
  transmission, leading to highly contagious
  (superspreader) or deadly forms
• Examples - Severe Acute Respiratory Syndrome
  (SARS), Avian Flu, Ebola, Lyme Disease

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Slide 6 Factors driving the spread of
communicable diseases

• Changes in human demographics and behavior
• Economic development
• Dramatic increase in volume of international
  travel and commerce people, animals, food,
  commodities
• Microbial adaptation and change
• Breakdown of public health capacity at all levels
• (Source Institute of Medicine)

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Slide 7 What Makes Communicable Diseases a
Global Issue?

• First, the sheer global magnitude of the problem
• - a substantial threat to people everywhere
• - an obstacle to a nations social and economic
  development
• - worst affected include the poorest households
• further impoverish the already poor loss of
  productivity, treatment costs
• The poor have a greater share of the burden of
  disease and have less access to affordable and
  quality care

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Slide 8 What Makes Communicable Diseases a
Global Issue?

• Second, diseases do not recognize international
  boundaries or sovereign states
• Diseases can emerge anywhere on the globe and
  spread quickly to other regions
• Examples West Nile virus, SARS, Avian Flu

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Slide 9 Transmission Routes of SARS virus during
the 2003 outbreak
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Slide 10 Avian Flu- Bird Migratory Pattern
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Slide 11 What makes Communicable Diseases a
Global Issue?

• Third, globalization has resulted in a close link
  between international economics and public
  health.
• Local outbreaks have global implications because
  of disruption of travel and trade
• - Examples, outbreak of plague in India
• - Impact of SARS on East Asian economies

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Slide 12 What makes Communicable Diseases a
Global Issue?

• Fourth, communicable diseases affect other global
  issues discussed in this seminar series
• Climate change
• Malnutrition
• Biodiversity
• Access to safe water
• Migration

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Slide 13 What makes Communicable Diseases a
Global Issue?

• Finally, global action is needed to
• Identify, control and prevent diseases
• Obtain adequate and predictable funding for the
  above
• promote awareness and changes in behavior and
• accrue global benefits from RD

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World Bank Seminar Series Global Issues Facing
Humanity

• Diseases without borders
• PART II

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Slide 14 Presentation Summary

• International Cooperation Against Diseases
  without Borders
• Key Elements of a Global Disease Response Plan
• The Role of the World Bank
• Conclusion

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Slide 15 International Cooperation Against
Diseases Without Borders

• International Sanitary Regulations (1851)
  following cholera epidemic in Europe
• WHO International Sanitary Regulations (1951)
• WHO International Health Regulations (1969)
• Revised WHO International Health Regulations
  (2005)

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Slide 16 International Cooperation Against
Diseases without Borders

• Various forms of Voluntary cooperation amound
  international agencies
• Roll Back Malaria
• Stop TB Campaign
• UN Millennium Development Goals

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Slide 17 International Cooperation Against
Diseases without Borders

• Millennium Development Goal 6
• Have halted by 2015 and begun to reverse the
  spread of HIV/AIDS
• Have halted by 2015 and begun to reverse the
  incidence of malaria and other major diseases

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Slide 18 International Cooperation Against
Diseases without Borders

• An estimated 70 other Global Health Initiatives
• Global Fund to Fight AIDS, TB and Malaria
• Bill and Melinda Gates Foundation
• Global Alliance for Vaccination and Immunization
  (GAVI)
• Multi Country AIDS Program for Africa (MAPS)
• US Emergency Plan for AIDS Relief

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Slide 19 Key Elements of a Global Disease
Response Plan

• WHO and the Center for Diseases Control (CDC)
  plans for global diseases outbreaks
• Outbreak Management
• Disease Surveillance
• National and Local Public Health Services
• Health Workforce
• Research and Development
• International Legal and Regulatory Framework
• Disease Prevention and Control

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Slide 20 The Role of the World Bank

•   The Banks first Health, Nutrition and
  Population (HNP) strategy in 1997, currently
  under revision.
• Typical activities include
• Health policy reform
• Strengthening of primary health care systems
• Health workforce development
• Strengthening surveillance systems
• Pharmaceutical procurement and planning

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Slide 21 The Role of the World Bank

• The World Bank is one of the largest financiers
  of disease control programs
• About 150 million since 2000 in the fight
  against malaria
• 560 million for TB prevention and control in
  current portfolio in 30 countries
• 2.5 billion committed for 106 projects for
  HIV/AIDS projects or components for HIV
  prevention in health, education, transport
  projects

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Slide 22The Role of the World Bank

• Strong Partnerships now central to Bank work
• Commitment to MDGs
• Partnership for Maternal, Neonatal and Child
  Health
• Safe Injection Global Network
• Global Alliance for Vaccines and Immunization
• Global Alliance for Improved Nutrition

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Slide 23 Role of the World Bank

• Different instruments available to finance
  initiatives
• Investment loans
• Adjustment (policy reform) loans
• Grants for pilot or research activities
• Poverty Reduction Strategy Credits
• Avian Flu Fund

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Slide 24 The Role of the World Bank

• Investments in health through other sectors or
  cross-cutting themes
• Infrastructure projects
• Slum upgrading
• Electrification
• Governance
• Human rights

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Slide 25 The Role of the World Bank

• Bank evaluations of its health projects/portfolio
• Bank support has been successful in
• Expanding health care coverage
• Training health personnel
• Supplying basic inputs
• Influencing health policy
• The Bank has been less successful in
• Sustained, systemic service quality improvement
• Institutional change

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Slide 26 Conclusion

• High risk that a major pandemic will occur
  sometime during the 21st century
• Factors that contribute to spread of diseases
  will continue to be at work
• If we truly want to end the threat of infectious
  diseases, we must ..inject into global gatherings
  the urgency of working together to defeat
  infectious diseases .. Continue to invest in
  vaccine research and development.. Work to ensure
  that drugs, vaccines and tests are available
  during an emergency.. Pool our greatest resources
  our imagination and intellect to fight this
  collective fight
• - James Hughes, Director, CDC