AC/UNU Millennium Project
Global Challenges Facing Humanity
8. Health
How can the threat of new and reemerging diseases and immune microorganisms be reduced?

Avian flu has spread among birds in more than 50 countries. As of July 2006, WHO had confirmed 228 human cases of avian flu in nine countries, with 130 deaths. If genetic variations occur in the H5N1 avian flu virus that allows human-to-human transmission, then 25 million may die, with untold effects on airlines, tourism, and other economic sectors. Viet Nam has already lost $225 million due to the slaughter of millions of birds to prevent the spread of this flu.

About 30% of all deaths are caused by infectious diseases. More than 94% of deaths from diarrheal diseases and 40% of malaria deaths can be prevented through better environmental management. AIDS is the fourth leading cause of deaths in the world: 25 million people have died from AIDS, with 3.16 million deaths in 2005. Another 65 million people are living with HIV/AIDS, a number that increased by 4.9 million in 2005—the largest one-year increase. Although AIDS is the leading cause of death in sub-Saharan Africa, it is spreading more rapidly in Eastern Europe and in Central and South Asia. The annual cost of antiretroviral medicine in developing countries has fallen as low as $140 per person; however, 95% of those with HIV/AIDS do not yet get this treatment. Phase III AIDS vaccine trails have begun in Thailand, but their scientific validity is questioned. The cost of self-AIDS testing is beginning to fall to $15 per test.

The responses to avian flu and SARS have shown that even without a vaccine it is possible to control a disease by early detection and accurate reporting, prompt isolation, and quarantine as needed, plus ongoing global awareness and use of WHO international health regulations. WHO averages 200 outbreak investigations every year, and around 50 will require an international response. More than 30 new and highly infectious diseases have been identified in the last 20 years. Furthermore, 20 known strains of diseases such as tuberculosis and malaria have developed resistance to antibiotics, while old diseases have reappeared, such as cholera (in Angola, with 1,298 deaths), yellow fever (new cases recently reported in Guinea, Sudan, Mali, and Senegal), plague, dengue fever, meningitis, hemorrhagic fever, and diphtheria. Meanwhile, the demand for nurses is increasing, with fewer people enrolling in nursing schools and more retiring early, increasing shortages worldwide.

Diseases increase with poverty, migrations, trade, human encroachment in natural habits, environmental damage, deforestation, international air travel, armed conflicts, and urban concentrations of increasingly large numbers of people in unsanitary environments. In addition, bioterrorism is emerging as a threat on a par with nuclear war, triggering bio-sensor R&D for global deployment, general vaccines, and quarantine systems. Better trade security will be necessary to prevent increased food/animal-borne disease. Other problems may come from synthetic bacteria from gene laboratories and unknown nano-organisms.

Challenge 8 will be addressed seriously when life expectancy grows to 75 years with little disparity among and within nations, when there is effective global disease detection, when surveillance and therapy systems are in place, and when vaccines and medicines for new diseases are usually developed within one month. Donors have committed $27 billion over the next three years for HIV/AIDS, $18 billion less than requested. Financial and policy support should be given to WHO for implementing eHealth systems, new regulations to address SARS-like threats, immunization programs, and the Global Outbreak Alert and Response Network. The Global Fund to Fight AIDS, Tuberculosis and Malaria has contributed $4.9 billion to 131 countries to fight HIV/AIDS, tuberculosis, malaria, and other infectious diseases and has negotiated lowering the cost of drugs; it needs continuing support.

Asian poultry farmers should get incentives to replace their live-market businesses with frozen-products markets. Better understanding of the relationship among disease, ecology, behavior, and genetics is needed, as are increased applications of tele-medicine and tele-health, women's rights programs related to HIV/AIDS, safe water supply, advanced generations of antibiotics, and innovative health measures such as the "Miracle Tree" (Moringa) in Senegal. Widespread use of insecticide-treated bednets is a cost-effective way of reducing malaria. Scientists are working to develop a genetically modified mosquito that would not carry the malaria parasite. Adult stem cells have been regressed to act similarly to embryonic stem cells, opening the possibility of self-repair of organs and cellular malfunctions. In the future, genetic engineering, stem cell research, and nanotechnology may be used to improve our immune systems to prevent infection by known and unknown viruses and disease; one vaccination could become permanent and heritable to future generations.

Regional Considerations

Africa: Nearly 70% of all HIV/AIDS infected people—26 million people—reside in sub-Saharan Africa, reducing life expectancy from 62 years in 1990–95 to 48 in 2000–05 in Southern Africa, and it may fall to 43 years over the next decade. An estimated 2.4 million people died of HIV-related illnesses in this region in 2005, while a further 3.2 million became infected with HIV. Some 14 million children have lost parents due to AIDS, which could grow to 40 million by 2020. AIDS death rates among professionals are high enough to threaten development in many countries. Some 90% of the 1 million annual deaths from malaria occur in sub-Saharan Africa, costing the region $12 billion per year. Trials for an experimental vaccine for malaria are expected in Africa within two years. Chloroquine-resistant malaria is now being treated by artemisinin-based combination drugs, and insecticide-treated mosquito nets are having some impact.

Asia and Oceania: Promotion of hand washing among low-income children in Karachi, Pakistan, decreased impetigo by 34%, diarrhea by 53%, and pneumonia by 50%. The number of people in East Asia living with HIV increased 20% between 2003 and 2005. Pakistan and Indonesia could be on the verge of serious AIDS epidemics. There are 5 million people with HIV/AIDS in India and 2 million in China. Both countries could be in the early stages of the pandemic and could have more people with HIV/AIDS than Africa does by 2010. Malaria is endemic, outbreaks of dengue are common, and even in modern, sanitized Singapore there has been a resurgence of tuberculosis. Southeast Asia has the highest rate of tuberculosis infection in the world, with 3 million new cases annually.

 Europe: Transition economies' health systems are struggling at the same time that HIV/AIDS is accelerating: the number of people in Eastern Europe living with HIV has increased 25% (to 1.6 million) from 2003 to 2005, and the number of AIDS deaths almost doubled to 62,000 in the same period. TB is also on the rise in Eastern Europe.

 Latin America: Brazil began offering free combination antiretroviral therapy to all citizens with AIDS in 1996, which has saved the country an estimated $2.2 billion in hospital costs between 1996 and 2004 and has inspired similar efforts elsewhere. Treatment coverage in countries such as Argentina, Brazil, Chile, and Cuba now exceeds 80%. The bulk of the 1.8 million people living with HIV/AIDS in Latin America are in Argentina, Brazil, and Colombia.
North America: Over a million people in the U.S. are now HIV-positive, as are 58,000 people in Canada. Antiretroviral medications keep AIDS death rates low. Increased food imports raise vulnerability to infections from overseas. Society promotes the use and sale of antibiotics on scales that fuel growth of microbial resistance. How can pharmaceutical companies be encouraged to invest in R&D for disease eradication that might not be very profitable but important to the poor majority?

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