WHO reinvigorates role to fight ‘big three’ diseases
Dr Jack C. Chow, 44, obtained his medical degree from the University of California in 1987 and trained at Stanford University Hospital. He has since held a number of senior public health posts in the US Government and worked as a management consultant with McKinsey & Company. Prior to joining WHO, Dr Chow was the Special Representative of the US Secretary of State for Global HIV/AIDS and became the first US diplomat of ambassador rank to be appointed to a public health mission. He led US diplomatic efforts to help establish the Global Fund To Fight AIDS, Tuberculosis, and Malaria in 2002 and in combating global infectious diseases, including SARS (severe acute respiratory syndrome).
Never has the combined toll of the ‘big three’ diseases been so high and the risk to global health so great. In 2004, an estimated three million people died of HIV/AIDS, two million of tuberculosis (TB) and one million of malaria, and the number of deaths is increasing in the poorest regions as each disease feeds off the other. In this Bulletin interview, Jack C. Chow, WHO’s Assistant Director-General for HIV/AIDS, Tuberculosis and Malaria, talks about the challenges in fighting the three diseases.
Q: HIV/AIDS and TB have drawn huge attention. Is malaria being neglected?
A: One of the themes of my stewardship has been to advance the concept of the compounding effect of the three diseases. I am particularly concerned about the confluence of these in resource-limited settings, their depletion of the health workforce and the economic cost to societies alike. More attention is being focused on malaria, on the practical low-cost and no-cost solutions that can reduce morbidity and mortality in malaria. The Roll Back Malaria Partnership and WHO’s Roll Back Malaria Department have been very proactive in promoting a number of critically needed interventions, like the long-lasting insecticide-treated bednets and the new generation of ACTs (artemisinin combination therapies) medicines which are transforming malaria treatment, and we are very encouraged by the response that we have seen. For example, the UK recently dedicated US$ 74 million (£40 million) for malaria bednet distribution, and at the World Economic Forum meeting in Davos in January a call for personal donations for malaria garnered about a million dollars.
Q: Donors are pledging a lot of funds for HIV/AIDS, but less for TB and malaria, how do you ensure each disease gets adequate resources?
A. We make clear that WHO’s role is in articulating public health strategies on how to support countries and implement programmes. We are very heartened that the Dutch Government has allocated a very significant extra-budgetary contribution to malaria and we also welcomed donations for HIV/AIDS and TB, particularly the Canadian ‘3 by 5’ contribution and their ongoing contribution to TB control. My mission is to make clear the benefit of investment in WHO. If we do our job right at country level for our Member States the resources will follow. Again, like all challenges, it’s an ongoing need because each of the three diseases is unfortunately rampaging.
Q: What are the challenges in the fight against TB?
A: Regrettably, TB infects nearly one-third of the world’s population generating nine million active cases per year and killing two million people every year. WHO’s technical support and operation of the Global Drug Facility has expanded the worldwide implementation of DOTS and contributed to solid progress in detection and treatment success goals. We are invigorating our TB work in collaboration with the Global Fund and by confronting the challenges of TB/HIV co-infection (see feature on pp.165–166) and multi-drug resistance. Of the six WHO regions, five have TB incidence that is falling or stable, but Africa has an incidence that keeps increasing at almost 10% per year, offsetting the gains in the rest of the world. There needs to be special focus on Africa, while maintaining TB control programmes in the rest of the world.
Q: Other organizations have taken up the cause of the ‘big three’: UNAIDS and the Global Fund To Fight AIDS, Tuberculosis and Malaria, to name two. Has WHO’s central role been undermined?
A: We have reinvigorated our mission to provide timely, accurate and robust advice for governments and civil society to implement the strategies of prevention, treatment and care. We welcome the advent of the Global Fund and the vigorous efforts of UNAIDS. I view the work in confronting the three diseases as a chain of concerted action with three links: finance, expertise and implementation. WHO and UNAIDS are in the middle link of providing the expertise, blueprints and strategies that can be financed by The World Bank, Global Fund and bilateral donors, and implemented at country and community levels through governments, NGOs, the private sector and individual citizens. We have always had this role.
Q: How have you reinvigorated WHO’s mission?
A: The ‘3 by 5’ is a fresh campaign. We have stronger partnerships, like the Stop TB Partnership and the Roll Back Malaria Partnership, we are finding ways to strengthen those and sharpen the vision and the mission. For TB, for example, there has been significant progress on the goal to detect 70% of existing cases and successfully treat 85% of those that get treatment. So far countries have reached a detection rate of about 43% and treatment success rate of 83%. We are also spotlighting new interventions: the long-lasting insecticide-treated nets and ACT medicines for malaria.