We are the first generation ever to have the means of protecting itself from the most deadly and common infectious diseases. Today, we possess the knowledge to prevent or cure diseases such as malaria, tuberculosis, HIV, diarrhoeal diseases, pneumonia and measles.

Smallpox eradication and a reduction of deaths due to measles has been made possible by the introduction of widespread immunization campaigns. And while there are still no effective vaccines to prevent infection from other leading killers (tuberculosis, malaria, HIV, diarrhoeal diseases and pneumonia), control and containment using existing interventions is well within our reach. Within the past two decades, the scientific community has developed successful strategies and products to counter threats posed by infectious diseases in both wealthy and poorer nations.

In all countries, these diseases can be prevented or treated with tools and medicines that usually cost a few dollars – often mere cents. Because of advances in the use of anti-malarials and insecticide-treated bednets, malaria deaths are no longer common in Viet Nam. Mexico has achieved a five-fold reduction in diarrhoeal deaths through the use of oral rehydration. Increased condom use and health education have enabled Thailand and Uganda to reduce the spread of HIV. The effective use of antibiotics in parts of India has resulted in a seven-fold decrease in tuberculosis deaths.

Previous generations once prayed for these life-saving drugs, interventions and control strategies. But now that they are available, the world has been slow to put them to wide use. In disease endemic countries, global efforts have remained embarassingly modest. Only 3% of Africa's children have bednets. Effective anti-TB medicines and treatment strategies reach only 25% of the world's TB cases and only half of developing countries have adopted the effective Integrated Management of Childhood Illnesses (IMCI) package.

The underuse and misuse of recent health breakthroughs has been catastrophic for people living and working in developing countries. Two out of every three deaths among young people in the poorest countries of Africa and Asia continue to result from just a handful of illnesses. Each year worldwide, more than 11 million people die from these preventable or curable afflictions. Most deaths are among young parents and children.

The Threat of Antimicrobial Resistance is Growing

We are now beginning to pay for our neglect – a price over and above the tragedy and suffering infectious diseases inflict on millions of people annually. Our failure to make full use of recently discovered medicines and products means that many will slip through our grasp.

This is evident in wealthy countries which have exclusively focussed efforts on fighting disease within their own borders, while failing to help eliminate them globally. Proliferating elsewhere, many bacteria, viruses and parasites mutate, become drug resistant and venture back to wealthy countries via modern transportation.

Resistance is also seen where health workers have exclusively focussed on providing drugs for their patients while inadvertently failing to take time to ensure proper diagnosis, prescription and adherence to treatment.

Antimicrobial resistance is a natural biological phenomenon. But it becomes a significant public health problem where it is amplified many-fold owing to human misuse and neglect. Drug resistance is the most telling sign that we have failed to take the threat of infectious diseases seriously. It suggests that we have mishandled our precious arsenal of disease-fighting drugs, both by overusing them in developed nations and, paradoxically, both misusing and underusing them in developing nations. In all cases, half-hearted use of powerful antibiotics now will eventually result in less effective drugs later.

This report describes the growing threat of antimicrobial resistance. It documents how once life-saving medicines are increasingly having as little effect as a sugar pill. Microbial resistance to treatment could bring the world back to a pre-antibiotic age.

The Window of Opportunity is Closing

Before long, we may have forever missed our opportunity to control and eventually eliminate the most dangerous infectious diseases. Indeed, if we fail to make rapid progress during this decade, it may become very difficult and expensive – if not impossible – to do so later. We need to make effective use of the tools we have now.

The eradication of smallpox in 1980, for example, happened not a moment too soon. Just a few years' delay and the unforeseen emergence of HIV would have undermined safe smallpox vaccination in populations severely affected by HIV.

While many exciting research efforts are currently underway, there is no guarantee that they will yield new drugs or vaccines in the near future. Since 1970, no new classes of antibacterials have been developed to combat infectious diseases. On average, research and development of anti-infective drugs takes 10 to 20 years. Currently, there are no new drugs or vaccines ready to emerge from the research and development pipeline.

Moreover, for the major infectious killers, research and development funding continues to be woefully inadequate. A very small percentage of all global health research and development funding is currently devoted to finding new drugs or vaccines to stop AIDS, acute respiratory infections (ARI), diarrhoeal diseases, malaria and TB. The pharmaceutical industry reports that it costs them a minimum of US$ 500 million just to bring one drug to market. Combined funding for research and development into ARI, diarrhoeal diseases, malaria and TB last year was under that amount.

A Massive Effort is Required

Although prevention through vaccination continues to be the ultimate weapon against infection and drug resistance, no vaccines are available to prevent five of the six major infectious killers. Yet it is a needless tragedy that 11 million people perish each year awaiting the advent of newer miracle drugs and vaccines. Prevention and treatment strategies using tools available now can be provided to populations throughout the world to help eliminate high-burden diseases of poverty.

We need not stand by helplessly watching antimicrobial resistance increase and drug effectiveness decrease. As this report shows, resistance can be contained. When an infection is addressed in a comprehensive and timely manner, resistance rarely becomes a public health problem. The most effective strategy against antimicrobial resistance is to get the job done right the first time – to unequivocally destroy microbes – thereby defeating resistance before it starts.

Today - despite advances in science and technology - infectious disease poses a more deadly threat to human life than war. This year – at the onset of a new millennium – the international community is beginning to show its intent to turn back these microbial invaders through massive efforts against diseases of poverty – diseases which must be defeated now, before they become resistant. When diseases are fought wisely and widely, drug resistance can be controlled and lives saved.