World Bank Seminar World Bank Seminar Series: Global Issues Series: Global Issues

Facing HumanityFacing Humanity

Diseases without Diseases without bordersborders

PART IPART I

Slide 1: Presentation Slide 1: Presentation SummarySummary

Profile of Major Communicable Profile of Major Communicable DiseasesDiseases

Factors Driving the Spread of Factors Driving the Spread of Communicable DiseasesCommunicable Diseases

What makes Communicable Diseases What makes Communicable Diseases a Global Issue?a Global Issue?

Slide 2: Profile of Slide 2: Profile of Communicable Diseases Communicable Diseases

Steady Progress during the 20Steady Progress during the 20thth Century in Century in controlling communicable diseasescontrolling communicable diseases

ImmunizationImmunization Eradication of smallpox, containment of Eradication of smallpox, containment of

poliopolio Widespread use of drugs including Widespread use of drugs including

antibioticsantibiotics Impressive advances in medicine Impressive advances in medicine

Slide 3: Yet infectious Slide 3: Yet infectious diseases remain a leading diseases remain a leading cause of death worldwidecause of death worldwide

Annually, more than 10 million Annually, more than 10 million deaths worldwide are caused by deaths worldwide are caused by communicable diseases communicable diseases

More than half of all deaths due to More than half of all deaths due to communicable diseases are communicable diseases are attributed to HIV/AIDS,TB and attributed to HIV/AIDS,TB and malariamalaria

Slide 4: Magnitude of the Slide 4: Magnitude of the ProblemProblem

HIV has infected more than 60 million people HIV has infected more than 60 million people worldwide, more than 20 million of whom worldwide, more than 20 million of whom have diedhave died

TB causes 8.8 million new infections each TB causes 8.8 million new infections each year and is responsible for an annual year and is responsible for an annual mortality of 1.7 millionmortality of 1.7 million

HIV-TB co-infection: about a third of HIV HIV-TB co-infection: about a third of HIV positive people also suffer from TBpositive people also suffer from TB

Malaria endemic areas cover a third of the Malaria endemic areas cover a third of the world’s population and the estimated annual world’s population and the estimated annual mortality is 1.2 million mortality is 1.2 million

Slide 5: Emerging Slide 5: Emerging Infectious DiseasesInfectious Diseases

Zoonotics (diseases caused by infectious Zoonotics (diseases caused by infectious agents that can be transmitted between agents that can be transmitted between animals and humans)animals and humans)

Characteristics include mutation during Characteristics include mutation during transmission, leading to highly transmission, leading to highly contagious (“superspreader”) or deadly contagious (“superspreader”) or deadly formsforms

Examples - Severe Acute Respiratory Examples - Severe Acute Respiratory Syndrome (SARS), Avian Flu, Ebola, Syndrome (SARS), Avian Flu, Ebola, Lyme DiseaseLyme Disease

Slide 6: Factors driving the Slide 6: Factors driving the spread of communicable spread of communicable

diseasesdiseases Changes in human demographics and Changes in human demographics and

behaviorbehavior Economic developmentEconomic development Dramatic increase in volume of Dramatic increase in volume of

international travel and commerce – people, international travel and commerce – people, animals, food, commoditiesanimals, food, commodities

Microbial adaptation and changeMicrobial adaptation and change Breakdown of public health capacity at all Breakdown of public health capacity at all

levelslevels

(Source: Institute of Medicine)(Source: Institute of Medicine)

Slide 7: What Makes Slide 7: What Makes Communicable Diseases a Communicable Diseases a

Global Issue?Global Issue?First, the sheer global magnitude of the First, the sheer global magnitude of the

problem problem - a substantial threat to people everywhere- a substantial threat to people everywhere- an obstacle to a nation’s social and economic - an obstacle to a nation’s social and economic developmentdevelopment- worst affected include the poorest households- worst affected include the poorest households

further impoverish the already poor – loss further impoverish the already poor – loss of of productivity, treatment costsproductivity, treatment costs

The poor have a greater share of the The poor have a greater share of the burden of burden of disease and have less access to disease and have less access to affordable and affordable and quality carequality care

Slide 8: What Makes Slide 8: What Makes Communicable Diseases a Communicable Diseases a

Global Issue?Global Issue? Second, diseases do not recognize Second, diseases do not recognize

international boundaries or international boundaries or sovereign statessovereign states

Diseases can emerge anywhere on the Diseases can emerge anywhere on the globe and spread quickly to other globe and spread quickly to other regionsregions

Examples: West Nile virus, SARS, Avian Examples: West Nile virus, SARS, Avian FluFlu

Slide 9: Transmission Slide 9: Transmission Routes of SARS virus Routes of SARS virus

during the 2003 outbreakduring the 2003 outbreak

Slide 10: Avian Flu- Bird Slide 10: Avian Flu- Bird Migratory PatternMigratory Pattern

Slide 11: What makes Slide 11: What makes Communicable Diseases a Communicable Diseases a

Global Issue?Global Issue?Third, globalization has resulted in a Third, globalization has resulted in a

close link between international close link between international economics and public health.economics and public health.

Local outbreaks have global Local outbreaks have global implications because of disruption of implications because of disruption of travel and tradetravel and trade

- Examples, outbreak of plague in India - Examples, outbreak of plague in India

- Impact of SARS on East Asian - Impact of SARS on East Asian economieseconomies

Slide 12: What makes Slide 12: What makes Communicable Diseases a Communicable Diseases a

Global Issue?Global Issue?Fourth, communicable diseases Fourth, communicable diseases

affect other global issues affect other global issues discussed in this seminar seriesdiscussed in this seminar series::

Climate changeClimate change MalnutritionMalnutrition BiodiversityBiodiversity Access to safe water Access to safe water MigrationMigration

Slide 13: What makes Slide 13: What makes Communicable Diseases a Communicable Diseases a

Global Issue?Global Issue?

Finally, global action is needed toFinally, global action is needed to:: Identify, control and prevent diseasesIdentify, control and prevent diseases Obtain adeObtain adequate and predictable quate and predictable

funding for the abovefunding for the above promote awareness and changes in promote awareness and changes in

behavior and behavior and accrue global benefits from R&Daccrue global benefits from R&D

World Bank Seminar World Bank Seminar Series: Global Issues Series: Global Issues

Facing HumanityFacing Humanity

Diseases without Diseases without bordersborders

PART IIPART II

Slide 14: Presentation Slide 14: Presentation SummarySummary

International Cooperation Against International Cooperation Against Diseases without BordersDiseases without Borders

Key Elements of a Global Disease Key Elements of a Global Disease Response PlanResponse Plan

The Role of the World BankThe Role of the World Bank ConclusionConclusion

Slide 15: International Slide 15: International Cooperation Against Cooperation Against

Diseases Without BordersDiseases Without Borders International Sanitary Regulations International Sanitary Regulations

(1851) following cholera epidemic in (1851) following cholera epidemic in EuropeEurope

WHO International Sanitary WHO International Sanitary Regulations (1951)Regulations (1951)

WHO International Health WHO International Health Regulations (1969)Regulations (1969)

Revised WHO International Health Revised WHO International Health Regulations (2005)Regulations (2005)

Slide 16: International Slide 16: International Cooperation Against Cooperation Against

Diseases without BordersDiseases without BordersVarious forms of Voluntary Various forms of Voluntary

cooperation amound international cooperation amound international agenciesagencies

Roll Back Malaria Roll Back Malaria Stop TB CampaignStop TB Campaign UN Millennium Development Goals UN Millennium Development Goals

Slide 17: International Slide 17: International Cooperation Against Cooperation Against

Diseases without BordersDiseases without Borders Millennium Development Goal # 6Millennium Development Goal # 6 Have halted by 2015 and begun to Have halted by 2015 and begun to

reverse the spread of HIV/AIDSreverse the spread of HIV/AIDS Have halted by 2015 and begun to Have halted by 2015 and begun to

reverse the incidence of malaria and reverse the incidence of malaria and other major diseasesother major diseases

Slide 18: International Slide 18: International Cooperation Against Diseases Cooperation Against Diseases

without Borderswithout Borders An estimated 70 other Global An estimated 70 other Global

Health InitiativesHealth Initiatives Global Fund to Fight AIDS, TB and Global Fund to Fight AIDS, TB and

MalariaMalaria Bill and Melinda Gates FoundationBill and Melinda Gates Foundation Global Alliance for Vaccination Global Alliance for Vaccination

and Immunization (GAVI)and Immunization (GAVI) Multi Country AIDS Program for Multi Country AIDS Program for

Africa (MAPS)Africa (MAPS) US Emergency Plan for AIDS ReliefUS Emergency Plan for AIDS Relief

Slide 19: Key Elements of a Slide 19: Key Elements of a Global Disease Response Global Disease Response

Plan Plan WHO and the Center for Diseases Control WHO and the Center for Diseases Control (CDC) plans for global diseases outbreaks(CDC) plans for global diseases outbreaks

Outbreak ManagementOutbreak Management Disease SurveillanceDisease Surveillance National and Local Public Health ServicesNational and Local Public Health Services Health WorkforceHealth Workforce Research and DevelopmentResearch and Development International Legal and Regulatory International Legal and Regulatory

FrameworkFramework Disease Prevention and ControlDisease Prevention and Control

Slide 20: The Role of the Slide 20: The Role of the World BankWorld Bank

    The Bank’s first Health, Nutrition and The Bank’s first Health, Nutrition and Population (HNP) strategy in 1997, currently Population (HNP) strategy in 1997, currently under revision. under revision.

Typical activities include:Typical activities include: Health policy reformHealth policy reform Strengthening of primary health care systemsStrengthening of primary health care systems Health workforce developmentHealth workforce development Strengthening surveillance systemsStrengthening surveillance systems Pharmaceutical procurement and planningPharmaceutical procurement and planning

Slide 21: The Role of the Slide 21: The Role of the World BankWorld Bank

The World Bank is one of the largest The World Bank is one of the largest financiers of disease control programsfinanciers of disease control programs

About $150 million since 2000 in the About $150 million since 2000 in the fight against malariafight against malaria

$560 million for TB prevention and $560 million for TB prevention and control in current portfolio in 30 control in current portfolio in 30 countriescountries

$2.5 billion committed for 106 projects $2.5 billion committed for 106 projects for HIV/AIDS projects or components for HIV/AIDS projects or components for HIV prevention in health, for HIV prevention in health, education, transport projectseducation, transport projects

Strong Partnerships now central to Strong Partnerships now central to Bank workBank work

Commitment to MDGsCommitment to MDGs Partnership for Maternal, Neonatal and Partnership for Maternal, Neonatal and

Child HealthChild Health Safe Injection Global NetworkSafe Injection Global Network Global Alliance for Vaccines and Global Alliance for Vaccines and

ImmunizationImmunization Global Alliance for Improved NutritionGlobal Alliance for Improved Nutrition

Slide 22:The Role of the Slide 22:The Role of the World BankWorld Bank

Slide 23: Role of the World Slide 23: Role of the World BankBank

Different instruments available to Different instruments available to finance initiativesfinance initiatives

Investment loansInvestment loans Adjustment (policy reform) loansAdjustment (policy reform) loans Grants for pilot or research activitiesGrants for pilot or research activities Poverty Reduction Strategy CreditsPoverty Reduction Strategy Credits Avian Flu FundAvian Flu Fund

Slide 24: The Role of the Slide 24: The Role of the World BankWorld Bank

Investments in health through Investments in health through other sectors or cross-cutting other sectors or cross-cutting themesthemes

Infrastructure projectsInfrastructure projects Slum upgrading Slum upgrading ElectrificationElectrification GovernanceGovernance Human rightsHuman rights

Slide 25: The Role of the Slide 25: The Role of the World BankWorld Bank

Bank evaluations of its health Bank evaluations of its health projects/portfolioprojects/portfolio

Bank support has been successful in:Bank support has been successful in:- Expanding health care coverageExpanding health care coverage- Training health personnelTraining health personnel- Supplying basic inputsSupplying basic inputs- Influencing health policyInfluencing health policy

The Bank has been less successful in:The Bank has been less successful in:- Sustained, systemic service quality Sustained, systemic service quality

improvementimprovement- Institutional changeInstitutional change

Slide 26: ConclusionSlide 26: Conclusion

High risk that a major pandemic will occur High risk that a major pandemic will occur sometime during the 21sometime during the 21stst century century

Factors that contribute to spread of diseases Factors that contribute to spread of diseases will continue to be at work will continue to be at work

““If we truly want to end the threat of infectious If we truly want to end the threat of infectious diseases, we must ..inject into global gatherings diseases, we must ..inject into global gatherings the urgency of working together to defeat the urgency of working together to defeat infectious diseases; .. Continue to invest in infectious diseases; .. Continue to invest in vaccine research and development.. Work to vaccine research and development.. Work to ensure that drugs, vaccines and tests are ensure that drugs, vaccines and tests are available during an emergency.. Pool our available during an emergency.. Pool our greatest resources – our imagination and greatest resources – our imagination and intellect – to fight this collective fight”intellect – to fight this collective fight”

- James Hughes, Director, CDC- James Hughes, Director, CDC