[Ip-health] WHO report: "Scaling up the Response to Infectious Diseases"

[Paul Davis]

See article below: "NEW HEALTH PARADIGM URGES WIDER USE OF DRUGS"

The "Scaling up the Response to Infectious Diseases" report is online:
http://www.who.int/infectious-disease-report/2002/framesintro.html

The report cite's Brazil as a model for improving health service delivery:
<snip>
Drug-price reductions can be achieved through the production or
importation of generic alternatives. For example, the Government of
Brazil has a policy of universal access to antiretroviral drugs,
which benefits nearly all AIDS patients in the country. From 1996 to
1999, thanks to antiretroviral therapy, the number of AIDS deaths was
nearly halved in Brazil and the incidence of opportunistic infections
was cut by 60% - 80%. Without significant decreases in the cost of
antiretrovirals, however, Brazil's universal access programme would
not have been possible. The Government achieved these price
reductions through the local manufacture of drugs that were not
patent-protected, combined with bulk purchases of imported
antiretrovirals and price negotiations with the producers. Between
1997 and 1999, many AIDS-related hospitalizations were averted,
resulting in savings of nearly US$ 290 million. During this period,
condom sales also doubled. Brazil allocates US$ 450 million each year
to providing free antiretroviral treatment.
</snip>

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HEALTH: NEW HEALTH PARADIGM URGES WIDER USE OF DRUGS
By Gustavo Capdevila

01/31/2002
Inter Press Service

GENEVA, Jan. 31 (IPS) -- Health strategies that up to now have
focused mainly on disease prevention must incorporate treatment with
drugs, according to a new report released by the World Health
Organization (WHO).

"Today as opposed to five years ago, the paradigm for the control of
infectious disease is not only prevention," said David Heymann,
executive director of communicable disease programs in the WHO.
If applied, the new policy could cut the number of deaths caused by
malaria and tuberculosis in half and the number of AIDS deaths by 25
percent by 2010, according to the United Nations agency.

WHO officials pointed out that the agency traditionally dedicated
most of its efforts to prevention, but that things changed with the
advent of AIDS.

HIV, which is transmitted to 15,000 people a day worldwide, forced
the WHO, under pressure from patients and U.N. member countries, to
reconsider its position and put a greater focus on treating the ill.

Heymann said the new strategy represented "an important shift in
thinking" among the international health community, and added that
greater access to medicine can prevent deaths, improve health and
help pull people out of poverty.

Heymann presented the new WHO report, "Scaling up the Response to
Infectious Diseases: A Way out of Poverty," in Geneva today.

The study will be distributed on Jan. 2 in New York at the World
Economic Forum, an annual gathering that brings together CEOs of
transnational corporations, neo-liberal thinkers, and leaders of
developing countries, and which has been held until now in the Swiss
ski resort town of Davos.

The WHO document states that "Today, perhaps for the first time in
history, it is possible to launch a truly global response to the
major infectious diseases that keep people in poverty."

The report offers a road map of how countries and the international
community can "scale up" successful interventions against infectious
diseases, especially the leading killers like AIDS, tuberculosis and
malaria.

It highlights successful efforts in various countries. For example,
the number of cases of tuberculosis fell 50 percent in Peru from 1991
to 1995, thanks to the application of a strategy recommended by WHO,
based on the timely and regular provision of medicine to patients.

And between 1992 and 1997, Vietnam drastically reduced the number of
deaths caused by malaria, by a full 97 percent, by distributing
mosquito screens treated with insecticides and high-quality
antimalarial drugs, and by carrying out indoor spraying with
insecticides.

In Uganda, meanwhile, which had one of the highest rates of HIV-AIDS
in the world in the 1980s, the spread of the disease among pregnant
women and young people was reduced by 50 percent.

Until five years ago, international development agencies turned down
requests for funds for medicine to treat malaria, tuberculosis, and
AIDS, on the argument that spending on drugs was neither socially nor
economically sustainable, said Heymann.

The new paradigm was strengthened by the results of the Commission on
Macroeconomics and Health, set up by the WHO and presided over by
prominent U.S. economist Jeffrey D. Sachs, to study the link between
health and economic development.

In its report, released last December, the commission said that in
developing countries, health spending not only saved lives, but
provided an essential boost to economic development.

Taking up that idea, the WHO pointed out in its new report that the
tools for fighting infectious disease, which account for half of all
deaths in developing countries, already exist.

For the biggest killers, there are drugs that can cure the disease or
prevent transmission and prolong life, as in the case of AIDS,
Heymann noted.

However, one of the report's authors, Jose Esparza with WHO's
department of policy, strategy and research on vaccines, warned of
the risks of excessive optimism.

"Excessive confidence could lead us to believe that all of the tools
needed to prevent and control diseases are already available, and
must simply be applied on a larger scale," said Esparza.

"But the number of people infected with HIV every day shows that we
do not yet have the necessary resources," he underlined.

On the contrary, smallpox was eradicated due to the existence of an
effective vaccine, and polio is on its way out for the same reason,
while inroads have been made against dysentery due to the widespread
application of the simple oral rehydration technique.

On the other hand, in the case of AIDS we cannot say antiretroviral
drugs are ideal, said Esparza, because they are toxic, expensive and
difficult to administer.

The WHO official said that what was needed was a balance between
prevention and treatment. He also called for greater efforts to
develop new tools for fighting malaria, tuberculosis and AIDS, which
together claim 5.7 million lives a year.




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