A Newsletter for WHO and its partners - No1 December 1999

Editorial by Dr David L. Heymann, Executive Director, Communicable Diseases, WHO, Geneva

For some time now, we have felt a pressing need to create an informal forum for discussion and communication among all those who, worldwide, are committed to taking immediate action against infectious diseases. It is an idea which has met with widespread support from many of you.

What WHO can do is to provide technical guidance and leadership, and foster essential alliances, to ensure that all forces for progress can come together and maximize their individual strengths and advantages -governments, public institutions, international and nongovernmental organizations, private enterprises and concerned individuals.

The timing for the launch of this new forum for exchanging information is auspicious - when together we are crossing the threshold of a new millenium. One which we hope will see the world becoming increasingly free of the burden of infectious diseases.

There is no time to lose. Millions continue to suffer while help is often at hand. Low-cost tools exist and their use must be extended. The search for new solutions must be intensified.

The elimination of infectious diseases as a public health threat may seem like a distant dream. But battles can be and have been won. Over the past 50 years, smallpox has been eradicated, and river blindness eliminated as a problem of public health importance in 11 African countries - thanks to strategic alliances. Polio and guinea-worm disease should be next, with leprosy and lymphatic filariasis not far behind. All thanks to pioneering partnerships that are models for the future. New movements for the even more awesome fight against malaria and tuberculosis, launched in 1999, can build on this success. Meanwhile, other innovative alliances will continue to be explored to help ease the suffering.

We live in changing times, in a world that is impatient for effective development - characterized by justice and equity. Rhetoric and empty promises are no longer acceptable. The commitment of support and compassion from donors and foundations is reaching unprecedented heights. The World Health Organization invites everyone to join together in a cohesive effort so that we can make full use of all opportunities to contribute to a better deal for world health - and poverty reduction - in the decades to come. 

We would like to know how readers have reacted to the first issue of Action Against Infection. If it is well received, the plan is to issue it three times a year. Let us know your views by writing to the Editor:
Mary Vallanjon, Communicable Diseases Cluster, World Health Organization, 1211 Geneva 27, Switzerland.
Fax: (+41) 22 791 4285, E-mail: vallanjonm@who.int

River blindness successfully controlled

Commemorative statue unveiled in Geneva

On 6 October 1999, a statue of an adult blinded by onchocerciasis (river blindness) and guided by a child was unveiled by Dr Gro Harlem Brundtland, Director- General of WHO, in the presence of President Jimmy Carter (Carter Center), Mr James Wolfensohn (President, World Bank), Mrs Eveline Herfkens (Minister for Development Cooperation, the Netherlands), Dr Ebrahim Samba (WHO Regional Director for Africa), Dr Hussein Gezairy (WHO Regional Director for the Eastern Mediterranean), Mr Raymond Gilmartin (CEO, Merck & Co.), and representatives of participating countries, donors, nongovernmental development organizations and the scientific community.

The ceremony was followed by a roundtable discussion on the subject of partnership for health. The discussion was frank, broad and lively. The meeting was indicative of a new environment for dealing with world health problems, in which international momentum is being created.

Next steps

• Separate roundtables of partners should be set up systematically to tackle specific disease problems without further delay, since technical know-how exists.

• Clear objectives and well structured outcome-oriented agendas should be prepared by the partners in order to attract available funding.

• More sophisticated processes and mechanisms should be devised to meet the upcoming flow of transnational policy challenges and to enable all partners to participate.

• The efforts of all partners should focus on building up a solid infrastructure which can sustain all disease-specific needs.

In West Africa, where the Onchocerciasis Control Programme has operated for 25 years, 25 million hectares of fertile land (previously deserted for fear of the disease) have become available for cultivation, enough to feed 17 million people per year; and when the programme comes to an end in 2002, 12 million children born since the beginning of control activities will have grown up without the risk of infection.

"This statue serves as a symbol of the shared goal of preventing millions of people in the developing world from contracting river blindness, while reminding all of us that strong partnerships are often the very foundation upon which world-shaping accomplishments are based" (President Jimmy Carter). The statue shown above stands in front of the WHO headquarters building in Geneva. Other identical statues can be seen in Ouagadougou (Burkina Faso), at the World Bank, at the headquarters of Merck & Co. and at the Carter Center.

Lymphatic filariasis

First country programme launched in Samoa

On 24 October 1999, the government of Samoa began the once-yearly, single-dose, two-drug treatment of the nation's entire population. The antifilarial drug combination comprised albendazole (donated by SmithKline Beecham) and diethylcarbamazine (DEC). This mass administration is the very first step of an integrated programme which aims to reach the entire global at-risk population (up to 1 billion people) over the next 20 years.

Armed with safe and effective drugs, the global programme to eliminate lymphatic filariasis (GPELF) aims to meet the goal set by the 1997 World Health Assembly, which called for the elimination of lymphatic filariasis, one of the world's leading causes of disability, as a public health problem. Initiated by WHO and SmithKline Beecham, the programme is an exceptional collaboration involving multilateral institutions, national governments, international aid agencies, the private sector, nongovern-mental organizations and various sectors of civil society. Other partners include the World Bank, Merck & Co. and the Carter Center, who have already worked with WHO to combat onchocerciasis.

"We have the willingness to share our expertise and to participate in sustainable solutions"

Raymond V. Gilmartin, CEO, Merck & Co.

In Africa, programmes for elimination of lymphatic filariasis could become integrated with those already ongoing for the control of onchocerciasis. The two diseases have much in common, particularly when it comes to strategies for control.

Sleeping Sickness

Special project set up in central Africa

In December 1999, WHO will launch a project in Yaounde (Cameroon) to coordinate epidemiological surveillance activities against sleeping sickness. This forgotten disease is making a devastating come-back, and threatens an estimated population of 56 million people living in 36 countries of sub-Saharan Africa. Barely 10% of the population at risk is under surveillance, so that only 40 000 cases are reported each year, whereas the number affected is estimated at over 350 000.

The project has been set up thanks to the financing of a post of associate professional officer (APO) by the Ministry of Foreign Affairs (France) - which has been supporting WHO's control and surveillance activities against the disease for several years. Activities will be sustained by support from France

and Belgium. The WHO Regional Office for Africa will be closely associated in project development, and its location in the heart of the endemic area should ensure the most effective coordination between WHO offices and the field.

The location of the project in the region concerned follows the current trend in support to other countries: reduction in bilateral aid and strengthening of multilateral support. Ten countries will be covered: Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo, Gabon, Equatorial Guinea, Sudan and Uganda.

During the first year, priority will be given to reinforcing surveillance activities and to implementing a standardized mapping tool of endemic areas. The longer-term goal is to strengthen the project, especially with human resources, to make it an effective support platform for national programmes in central Africa.

Leprosy

Elimination in sight

On 15 November 1999, WHO announced the creation of a Global Alliance which will eliminate leprosy as a public health problem from every country. This partnership will be a powerful force in the work to complete the elimination of a disease from which humankind has suffered, physically and psychologically, for thousands of years.

Medecines for Malaria Venture

New public/private mechanism created

On 3 November 1999, public agencies and the private sector joined for the first time to create a unique mechanism for developing antimalarial drugs. MMV will be established as an independent not-for-profit foundation, operating from Geneva in close proximity to WHO.

Its goal is to develop and manage a portfolio of malaria drug discovery and development projects that will yield one new product every five years. Products will be targeted for appropriate and affordable use in disease-endemic countries. It is estimated that $30 million in cash will be needed every year, combined with gifts in kind and other resources and expertise from industrial partners. Three drug discovery projects have already been identified and will be funded for a total of $4 million through 2000. Funding will be focused on a limited number of projects and at a level adequate to get the job done. New products will be licensed out to companies for commercialization.

Tropical Disease Research

TDR Special Programme expands to include dengue and tuberculosis

At its 22^nd session on 24-25 June 1999, the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases (TDR) endorsed the proposal to include dengue and tuberculosis in the TDR disease portfolio - the first major modification of the Programme in its 24 years of existence.

At present, the only methods for controlling or preventing dengue and dengue haemorrhagic fever rely on controlling the mosquito vector. Research is to be initiated in the following areas: social, economic and behavioural sciences; vector studies; diagnosis; pathophysiology; vaccine discovery and development.

The lack of research capability in TB-endemic countries is a major stumbling block to the execution of the TB research agenda. It is expected that the addition of TB to the TDR portfolio will give added momentum to the drive to strengthen research capacity. The strategic plan for tuberculosis research is to include: functional genomics; tool discovery, development and evaluation; and economic and behavioural research.

TB and sustainable development

Ministerial Conference, Amsterdam, 22-24 March 2000

The TB epidemic is worsening, especially where the related HIV/AIDS epidemic also rages. Increasing reports of multidrug-resistant TB are alerting the world that health and development gains will be jeopardized if action is not accelerated immediately. The high-level ministerial conference which is being convened in March 2000, to which the governments of 20 key high-burden countries are being invited, will aim to better understand the social and economic impacts of TB; to assess how effective tuberculosis programmes can contain the epidemic and contribute to overall development; and to identify priority actions for the new millennium.

Challenges

• An outbreak of West Nile-like fever which caused 5 deaths in New York city in September 1999 was caused by transmission of the virus from birds to humans through mosquitos. It is the first time this virus has been isolated in the Americas, and how it got there remains a mystery.

• The number of reported cholera cases increased nearly 100% in 1998 as compared to 1997, on all continents.

• The total number of human plague cases reported to WHO in 1997 represented a significant increase over 1996 and considerably exceeded the average annual figure for the previous 10 years.

Progress

• Prepackaging improves compliance and helps stop resistance developing - A pilot study in 3 African countries is to test blister packages of antimalarials for babies, produced in partnership with local pharmaceutical companies.

• WHO and ASTA Medica, a pharmaceutical company based in Frankfurt (Germany) are running Phase III clinical trials in Bihar (India) of a new oral treatment against visceral leishmaniasis - miltefosine.

• The unified WHO intercluster vaccine research (IVR) initiative will allow more streamlined management of activities, avoiding duplication of effort, reducing the number of steering and advisory committees, and providing opportunities for joint projects.

CDS focal points meet in Geneva

WHO staff dealing with infectious diseases worlwide met on 11-12 November 1999 to prepare a joint workplan _ one that will be coherent throughout the Organization, from headquarters to regional offices to the field. Main items on the agenda were: working with partners; policies for working together; timeframes for implementation; monitoring progress and reporting results.

Notes

• WHO recently established a Global Health Leadership programme, designed to enable professionals who are potential leaders in health to experience the work of UN agencies and to contribute to it for up to two years. The programme is supported by the UN Foundation, the Rockefeller Foundation and WHO. Four fellows have been appointed to the Roll Back Malaria project, and an officer to the revision of the International Health Regulations.

• The WHO Communicable Diseases Cluster in Geneva is pleased to announce the creation of an Information Resource Centre, which will house in one place all information materials, in order to facilitate access by WHO's partners and the research community. For the first time, a catalogue has been compiled of information resources produced by the departments of the CDS cluster during 1998-1999. For further details, or to be placed on the mailing list for this newsletter, please contact:
  CDS Information Resource Centre, World Health Organization, 1211 Geneva 27, Switzerland; fax: (+ 41) 22 791 42 85; e-mail: cdsdoc@who.int.