Statement to press conference
Honourable Minister Charity Ngilu,
Members of the media,
We have just visited the Kibera district, and the Mbagathi District Hospital, where I talked to staff in the TB/HIV clinic. In both these places some progress in health has been made by dedicated people. But the challenges people here are facing are also very obvious. One is the consequence of infectious disease. As an example, in this country, one child in every 10 does not reach their fifth birthday. Pneumonia, diarrhoeal diseases HIV/AIDS and malaria are the main infectious conditions that kill them, together accounting for two thirds of child deaths. In older age groups, progress continues in HIV, but there is more work to do to ensure universal access to prevention, treatment and care. The combination of HIV and tuberculosis remains deadly. Last September tuberculosis was declared a public health emergency in the African region, and much work is needed to detect and treat people who have TB.
The second challenge is to change the social conditions that foster and sustain these diseases.
In a slum like Kibera, people's health can depend on their access to education, to safe water and sanitation, to safe housing and clean neighbourhoods, to jobs, and gender equality. WHO is helping countries to improve health by focusing on these social determinants. We have to break the grim cycle of treating people's illnesses, then sending them back to the living and social conditions that made them sick in the first place.
The key driver of this effort is the Commission on Social Determinants of Health, which WHO launched one year ago.
Kenya is contributing to this through its prominent role in the Commission. The honourable Minister of Health Charity Ngilu is a distinguished member of the Commission. Kenya will host the Commission's next meeting in Nairobi this June. Dr Anna Tibaijuka, the Executive Director of the United Nations HABITAT Programme based in Nairobi, is also a distinguished member of the Commission on Social Determinants of Health.
Action on the social determinants of health complements WHO's work to expand treatment coverage for HIV/AIDS, TB, malaria and other illnesses. Research suggests, for example, that people with TB from poorer backgrounds are far less likely to successfully complete their treatment than patients from more privileged backgrounds.
We also know that some factors largely out of people's control, such as drought, will also affect the most vulnerable. In northern Kenya and in neighbouring countries, millions of people are facing one of the worst droughts in recent history. The drought is gravely impacting their access to food. It cripples their livelihoods as their livestock die or become almost worthless. It also impacts their access to clean water. In addition, stagnant pools can become ideal breeding grounds for mosquitoes, raising the risks of malaria and other vector-borne diseases. We must bring more attention and action to the drought-affected areas.
Disease prevention, control and treatment takes a lot of time and money. But it is worth the cost. As an example, I was in Mauritius earlier this week -a country which used to suffer a high toll of infectious disease. Through a longstanding policy of prioritizing health in the federal budget, infectious disease is now responsible for just 2 % of deaths there. Here in Kenya, I congratulate the Ministers of Health and Finance for the 30 % increase in the health budget, with further increase projected. They recognize that spending on health will result in a healthy and productive population, which is key to a prosperous nation. But now, every country, no matter its health standing, must prepare against the possibility of the advent of a potential new deadly threat - human pandemic influenza.
As you know, the avian influenza virus, H5N1, has spread in birds to two new continents in the last month: to Europe, and to Africa. Nigeria and Niger are now fighting outbreaks in poultry. Egypt has reported the disease in birds, and other countries are testing animals to determine if they too have avian flu. The spread of H5N1 to Africa is cause for great concern. H5N1 can wipe out entire flocks in 48 hours. It is deadly to birds.
At the moment H5N1 is rarely deadly to humans. Globally, 175 people have fallen ill, and 96 have died due to H5N1. In almost all those cases infection was caused by very close contact with sick or dead birds, such as children playing with them, or adults butchering them or taking off the feathers. People in every corner of every affected country must have information about the risks and the ways they can protect themselves and their children when handling sick or dead poultry. And, on this continent where poultry is a major source of protein, people must know that if poultry is thoroughly cooked, it is safe to eat. Where there are outbreaks of H5N1 in birds, the government, partners and the media play a crucial role in giving factual, relevant health messages to the population.
So, if so few people have died from this disease in birds, why are we worried? Because, the second, far greater concern is that this virus, H5N1, could change into a type that spreads easily from person to person. This would be a virus against which none of us is immune, and it could cause an influenza pandemic.
It is critical to limit the spread of H5N1 in animals, and the opportunities for this virus to be in contact with humans. Countries on this continent must be equipped to take many important actions.
One: they must be able to find, confirm and quickly report H5N1 in birds - whether wild or domestic. They must then take immediate action to stop the bird outbreaks. In Africa in particular, immediate "on-the-spot" cash compensation to backyard poultry owners is necessary, or they will have no incentive to cull.
Two: countries must be equipped to find, confirm and treat people who may be ill with this bird virus.
Three: countries must be able to collect, examine and share virus samples from these people, in order to determine whether the virus is changing in any way. Every country must have an avian influenza and human pandemic influenza preparedness plan. In practice these require surveillance and laboratory capacity for animals and for people; early warning systems and virus tracking; strong coordination between the animal and human health sectors; and very importantly, immediate and transparent reporting of animal outbreaks and of human cases.
I have discussed these issues with many heads of state. Now, before H5N1 spreads further here on the continent, I am talking to heads of state in this region; today with the President of Kenya, and earlier this week with the Presidents of Mauritius and Madagascar.
Kenya has already been very active. It was the only African country to participate in the WHO's November 2005 meeting in Geneva on avian and human influenza. Kenya was also the only African country at the Beijing meeting in January. It has developed a detailed national emergency plan and budget. There is an intersectoral avian influenza task force here, and I met with them yesterday afternoon. Kenya has also already spent money to implement its plans. The Minister of Health has made clear that the government will need assistance to fully fund the avian influenza and pandemic influenza plan. However, overall the African continent remains vulnerable. We do not know, for example, what kind of an impact a pandemic influenza virus would have on people who are already immunosuppressed as a result of HIV. The impact of an influenza pandemic on African countries' already overburdened health care systems could be extremely grave.
Generally, veterinary services are weaker here than in other parts of the world. Human health services also need to be strengthened. Almost two billion dollars were pledged at the Beijing meeting in January, and this funding is needed here, now, to strengthen health and veterinary services.
At the same time, African governments need to finalize avian influenza and pandemic influenza plans. They need to allocate their own resources to turn these plans into action. This includes simulation exercises, so that plans can be tested and improved. As part of this, it will be vitally important to have disease containment plans in place. These outline the actions that help to stop infection spreading.
I want to stress that there is no evidence of sustained human to human transmission of H5N1, or any other potential influenza pandemic virus at this time. We must use this time nature is giving us to prepare.