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Chapter 5 of 16

Infectious diseases are controllable in any country

• Low-cost strategies make dramatic improvement
• Political commitment is essential

Graphs:

• ORT reduced diarrhoeal deaths among children in Mexico
• Sex education reduces HIV prevalence in Uganda
• Condom promotion reduces STIs among sex workers in India
• Free treatment reduces malarial deaths in Viet Nam
• Condom promotion reduces HIV among Thai army conscripts
• Global annual reported measles cases 1982-1997
  

Initiative: Towards a polio-free world

During the 1980s the success of mass campaigns against polio in the Americas showed what could be achieved against all the odds with strong political commitment. The WHO Regional Office for the Americas and its partner organizations worked with governments and civil society throughout the Americas to carry out a massive social mobilization campaign. Parents were educated about the need for immunization and millions of health workers and volunteers were mobilized.

In war-torn countries, negotiators worked with the warring factions to ensure that children's health would not become another casualty of the war. And the ceasefire for immunization worked. It worked in the poorest countries, in a densely populated country like Brazil, and even in countries where armed conflict was terrorizing populations and reducing health centres to rubble. Within six years a disease had been eliminated from the Americas. It could be done.

In Viet Nam, a four-year onslaught on malaria between 1992 and 1996 succeeded in reducing malaria deaths by over 90% and malaria cases by 40%. A decade earlier the situation was dire. An economic recession had dealt a body blow to health services, donations of insecticide had been stopped, resistance to antimalarial drugs was rising fast and migrant workers were carrying malaria into areas where it had once been eliminated. In 1991 alone, there were 144 epidemics of malaria.

Through government commitment, increased funding, and the widespread use of locally produced low-cost tools, health workers have today succeeded in turning the situation around. Locally produced high-quality drugs are now being used to treat cases of severe and multidrug-resistant malaria. Throughout Viet Nam, about 12 million people are protected by house spraying and insecticide-impregnated bednets. In areas where malaria is endemic, insecticide impregnation is provided as a public service - free of charge. The success of the programme has attracted international funding - allowing the government to give greater attention to the control of other diseases such as dengue.

In West Africa, a small low-income country - Guinea - has shown what can be done to control TB through government commitment to use the DOTS treatment strategy. Within four years of launching its TB control programme, the case detection rate had doubled and almost 80% of patients were being cured. The number of patients who failed to complete the treatment was halved as home visits were used to motivate patients to complete the course.

With three out of four people living in rural areas, the TB programme operates through primary health care clinics. It has grown from small beginnings, steadily increasing its reach every year. Today every prefecture is covered. Guinea has also established a network of laboratories for diagnosis and research. When the TB programme was launched in 1990 there were only 15 laboratories. Today there are 67.

In Mexico the success of efforts to reduce child deaths from diarrhoeal diseases has served as a model for other national programmes. Strong political commitment and leadership were key factors in achieving a 60% reduction in death rates within a decade.

Even more impressive, the dramatic reduction in death rates was achieved in the face of a nationwide epidemic of cholera during 1990-92. The strategy involved efforts to ensure correct home case management and the availability and use of oral rehydration solutions at home and in health centres.

Meanwhile in Senegal, a rapid broad-based response to the HIV/AIDS epidemic has succeeded in holding the spread of HIV at much lower levels than in many other African countries. The government acted swiftly - putting sex education on the timetable in primary and secondary schools, providing treatment for sexually transmitted infections, and actively promoting the use of condoms.

The results so far have been impressive. As HIV infection rates have risen steadily in other urban centres, the rate in the capital city, Dakar, has stayed below 2%. Over 60% of men and 40% of women aged 15-24 are now reported to be routinely using condoms with casual partners.

And, as a result of active condom promotion in Senegal, the condom distribution rate has soared - from 800 000 a year in 1987 to over seven million by 1998.