Pacific Health Summit - Science, Innovation and the Future of Health
Plenary Session 2: The Impact on Public Health (Panel 3: Infectious Diseases)
Ladies and gentlemen,
I am convinced that it is both necessary and possible to get preventive care, including vaccines, and treatment to everyone who needs them.
When Bill Gates spoke to the World Health Assembly last month he was given a standing ovation. This was probably not just because he talked about contributing large amounts of money to health work, although that was warmly welcomed. The enthusiasm seemed to come mainly from his expression of this same conviction.
Universal access to effective health care is not a new idea. It is written into the Constitution of WHO, which entered into force in 1948. It is also the backbone of the Alma Ata Declaration on Primary Health Care from 1978. But every time this challenge is restated in clear terms, with due recognition of what it involves here and now, it inspires new energy and commitment.
This afternoon we are to look at how the promise of science relates to public health and infectious diseases. I will start the ball rolling with some comments on a current threat to global public health and some of the ways in which we are working to provide against such threats.
The greatest known health threat facing the world today is avian influenza. Numbers of people affected so far have been small. To date 97 human cases of avian influenza have been reported, and 53 of them have been fatal. But there is widespread agreement among experts that a flu pandemic will happen. Many of the conditions are already in place. They include human contact with birds infected with the influenza virus over a wide geographical area. This gives the virus more opportunities to combine with a human influenza strain and become easily transmissible. The question is not whether such a pandemic will happen but when.
We cannot accurately predict how many people would lose their lives in such an event, because the variables that influence mortality cannot be quantified at this stage. A commonly used reference point is the Spanish flu pandemic of 1918, which killed between 20 and 50 million people. Science has advanced almost beyond recognition since those days, so we can hope and work for a far more effective response than was possible then. But — and this is quite a big but — the speed and volume of human travel have also advanced almost beyond recognition. As we saw with the SARS outbreak in 2003, this means that a virus can travel worldwide, infecting many people in many places within a few hours, rather than the few weeks and months that used to be involved in the spread of epidemics.
This may be the first time we are watching the evolution of a pandemic. There has never before been such a sensitive surveillance system in place to detect cases and monitor events. This gives us an unprecedented opportunity to be prepared.
The World Health Assembly, which met the week before last, agreed on several things that must be done.
Overall, strong surveillance is the key, and at present national surveillance systems are nowhere near strong enough. Countries have to keep a careful watch over their avian flu situations. Human cases must be detected without delay and scientists must obtain samples to analyse the virus to see if it is mutating. Early warning is essential for a quick response.
This is part of the larger picture covered by the revised International Health Regulations, which the Health Assembly adopted on 23 May. The purpose of the Regulations is, in their own words: "to prevent, protect against, control and provide a public health response to the international spread of disease."
They stipulate that certain diseases must always be reported, namely smallpox, polio, SARS, and new subtypes of human influenza. The reporting of others depends on a series of questions:
Is the impact serious? Is the event unusual or expected? Is there a significant risk of international spread? Is there a significant risk of restrictions on international travel or trade?
The Regulations will help to bring the international response to disease outbreaks and other public health emergencies into the twenty-first century. We will be working with the governments of all our Member States to ensure that the new Regulations are put into practice. This will require significant investment both within countries and internationally but the result will be a safer world.
The adoption of the Regulations was an excellent decision not only for security but for strengthening health systems. The development of capacity needed to respond to emergencies will also support the day-to-day work of delivering preventive care and treatment. It is these same systems that make it possible to deliver the public health measures, vaccines and treatments that have existed for a long time and are known to be highly effective.
These are just two of the current developments in infectious disease threats and international cooperation, but they can provide important reference points for our discussion today.