Priorities for action
The report identifies priorities for action in three categories. These are "old diseases - old problems"; "old diseases - new problems" and "new diseases - new problems". It says that by applying existing technology and expertise, many infectious diseases can be controlled, eliminated or eradicated. What is required is the political and professional commitment to finance and sustain well-planned, cost-effective disease control measures.
In the "old diseases - old problems" category, cost-effective interventions already exist, the report says. These include:
- Immunization of children against diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles and tuberculosis, with the addition of hepatitis B and yellow fever vaccine for selected countries, and vitamin A and iodine supplements in others. The cost: about $14.60 per child.
- An integrated approach to the management of sick children to prevent them dying from acute respiratory infections and diarrhoeal diseases. The cost: about $1.60 per capita in low-income countries.
- Provision of adequate and clean drinking-water, basic sanitation and waste disposal, together with simple personal hygiene measures can prevent diseases ranging from poliomyelitis and hepatitis to cholera and typhoid.
- School health programmes to treat worm infections and micronutrient deficiencies, and school health education programmes. The cost: about 50 cents per capita in poor countries.
- Simple standard procedures for improved diagnosis and treatment of sexually transmitted diseases. The cost: $11 per case in poor countries.
- In the second category of "old diseases - new problems", are tuberculosis and insect-borne diseases including malaria and dengue. The report says the strategy for controlling them largely involves cost-effective interventions, which also exist for many of them. But the development of antimicrobial drug resistance or of pesticide resistance, poses a greater threat to public health.
- The main components of WHO's global malaria strategy are providing early diagnosis and prompt treatment, prevention measures including vector control, and the early detection, containment or prevention of epidemics.
- Tuberculosis control depends on DOTS - directly observed treatment, short-course, which is already showing itself to be a successful and cost-effective intervention.
- New research initiatives are needed in treatment and improved diagnostics, drugs and vaccines related to all diseases in this group.
- Strengthened epidemiological surveillance systems nationally and internationally are required to detect and combat all diseases in this category, particularly their drug-resistant forms .
The "new diseases - new problems" category is probably the most frightening, says the report. The natural history of diseases such as Ebola and other viral haemorrhagic fevers is unknown, and there is incomplete understanding of the factors behind their emergence. The need therefore is for expanding research on the agents of such diseases, their evolution, the vectors that spread them, methods of controlling them, and vaccines and drug development. The report points out that much of this approach has already been applied to HIV/AIDS, one of the most serious diseases to emerge in recent decades.
The priority requirements in this category of diseases are:
- Improving national and international epidemiological surveillance.
- Developing prevention strategies to fight new and re-emerging infectious diseases.
- Responding more rapidly to outbreaks and epidemics.
- Integrating laboratory science and epidemiology to optimize public health practice.
In confronting infectious diseases as a whole, the first priority is to complete "unfinished business" of eradicating or eliminating certain targeted diseases - poliomyelitis, guinea-worm infection, leprosy, neonatal tetanus and Chagas disease, to be closely followed by measles and onchocerciasis - while simultaneously addressing other major diseases. "Relatively small financial resources are needed for this final stage. If they cannot be found, eradication or elimination will not be achieved; these diseases will exploit any easing of the campaign against them, and return with a vengeance," the report says.
"The eradication of smallpox shows the way forward. The lessons of malaria and tuberculosis must not be ignored, or the efforts and resources already invested will have been wasted. This must not be allowed to happen."