Eight million people died of measles every year in the 1960s. Today, thanks to vaccination programs reaching deep into the Third World, measles claims many fewer, 900,000.
The disease could be wiped out if vaccination programs could reach all children, and at 26 cents a dose, which is the cost of administering measles vaccine, that goal seems like it should be attainable.
Yet measles is just one disease that continues to take lives and cause debilitating harm around the world even though the diseases could be controlled in a cost-effective way.
The World Health Organization found that communicable diseases are responsible for half the premature deaths worldwide of people younger than 45, according to a report issued yesterday. Six diseases cause 90 percent of the those deaths, says David Heymann, WHO executive director-communicable diseases. In addition to measles, the killers are acute respiratory infections, including pneumonia, 3.5 million people; AIDS, 2.3 million; diarrheal infections, 2.2 million; tuberculosis, 1.5 million; and malaria, 1.1 million.
The toll on families and communities goes beyond the deaths. There are, for example, a third of a billion disabling malaria episodes a year, which have sapped Africa of billions of dollars in economic development in this decade alone. In Nigeria, WHO estimates that small farmers spend 13 percent of total household income on malaria treatment.
Heymann says the report, "Removing Obstacles to Economic Development," was issued "to give a wake-up call to the global community."
"Governments are not investing in infectious diseases, at the same time donor countries aren't providing funding," he says. "Less than 9 percent of all foreign assistance goes to health and only 1.5 percent goes to infectious diseases. Deaths and disabilities from infectious diseases are obstacles to economic development."
Interventions that work include a program known as Integrated Management of Childhood Illnesses, which can prevent most childhood deaths attributable to infectious diseases. In the case of tuberculosis, managing an illness involves a six-month regimen of drugs that is supervised by a health care worker who goes to a patient's house, hands over pills and watches as the patient takes the medication. That supervision is one way to guarantee that patients don't stop taking their medication once they begin to feel better, and it has prevented 60 percent of the TB deaths that could have been expected without the program, and slowed the disease's spread.
Another strategy developed over the past five years by WHO and the U.S. Agency for International Development has reduced childhood deaths from malaria by 25 percent. In it, nets to enclose beds are treated with insecticide to provide a barrier between the night-feeding malaria mosquito and sleeping people. It costs $5.50 a year to refresh the insecticide.,
As hopeful as the WHO report is, it also contains a warning: Many diseases are developing resistance to drugs. "Five years ago, Eastern Europe had very little drug-resistant TB," Heymann says. Now, "20 percent of those with TB in prisons have drug-resistant TB. It costs 50 times more to treat."
"Gonorrhea facilitates the transmission of HIV. Twenty years ago, gonorrhea was easily treated everywhere in Africa with tetracycline and penicillin," he says. Now, in many instances, instead of those basic antibiotics, health workers must use more advanced generations of drugs, which cost more. Global travel is turning drug-resistant diseases into a global problem. "The window to get at these diseases is now," Heymann says.
Americans understand this and are ready to help. A survey conducted for the Global Health Council found that Americans rated global infectious disease very high on the scale of problems confronting the world, just behind poverty, hunger and the development and spread of biological and chemical weapons. Released Wednesday, the council's survey was conducted when ethnic warfare in Kosovo was dominating the nightly news, yet respondents rated global infectious diseases ahead of regional warfare. "This is an issue that really matters to American people," says Nils Daulaire, the council's president. Nearly half knew somebody who had had TB, hepatitis, HIV/AIDS or malaria "and one in 20 have had experience themselves with them."
The survey also found the public has not made the connection between fighting infectious diseases and the economic development and political stability that can result in healthier nations. "We see this as where education needs to be done," Daulaire says.
The survey also found overwhelming support for increasing government spending on global health efforts. And 90 percent of respondents felt the best way to fight these diseases was at the source -- not by blocking borders. "The public is quite sophisticated and knowledgeable about what it takes," Daulaire says. "This is an area where they lead the elected representatives."
But Americans also felt that this was not a battle the United States should fight alone and that other rich countries and the governments in developing countries weren't pulling their weight. "One of the messages that clearly needs to get out is that other countries are doing a lot . . . that will help build support," Daulaire says.
The council survey was released at the Center for Strategic and International Studies, which also has identified global infectious diseases as a threat to national and international security.
An alliance between the global health community and the national security community, with the strong support the American public already shows, could help make WHO's plan of action a reality. Think of what the world would be like if we could shift a fraction of the money, energy, ingenuity and talent that went into the Cold War to a campaign to eradicate the six most deadly infectious diseases. This may well be the key to world stability in the 21st century.