World Bank Seminar Series: Global Issues Facing Humanity

World Bank Seminar Series: Global Issues Facing Humanity Diseases without borders PART I

Slide 1: Presentation Summary • Profile of Major Communicable Diseases • Factors Driving the Spread of Communicable Diseases • What makes Communicable Diseases a Global Issue?

Slide 2: Profile of Communicable Diseases Steady Progress during the 20th Century in controlling communicable diseases • Immunization • Eradication of smallpox, containment of polio • Widespread use of drugs including antibiotics • Impressive advances in medicine

Slide 3: Yet infectious diseases remain a leading cause of death worldwide • Annually, more than 10 million deaths worldwide are caused by communicable diseases • More than half of all deaths due to communicable diseases are attributed to HIV/AIDS,TB and malaria

Slide 4: Magnitude of the Problem • HIV has infected more than 60 million people worldwide, more than 20 million of whom have died • TB causes 8.8 million new infections each year and is responsible for an annual mortality of 1.7 million • HIV-TB co-infection: about a third of HIV positive people also suffer from TB • Malaria endemic areas cover a third of the world’s population and the estimated annual mortality is 1.2 million

Slide 5: Emerging Infectious Diseases • Zoonotics (diseases caused by infectious agents that can be transmitted between animals and humans) • Characteristics include mutation during transmission, leading to highly contagious (“superspreader”) or deadly forms • Examples - Severe Acute Respiratory Syndrome (SARS), Avian Flu, Ebola, Lyme Disease

Slide 6: Factors driving the spread of communicable diseases • Changes in human demographics and behavior • Economic development • Dramatic increase in volume of international travel and commerce – people, animals, food, commodities • Microbial adaptation and change • Breakdown of public health capacity at all levels (Source: Institute of Medicine)

Slide 7: What Makes Communicable Diseases a Global Issue? First, the sheer global magnitude of the problem - a substantial threat to people everywhere - an obstacle to a nation’s social and economic development - worst affected include the poorest households further impoverish the already poor – loss of productivity, treatment costs The poor have a greater share of the burden of disease and have less access to affordable and quality care

Slide 8: What Makes Communicable Diseases a Global Issue? Second, diseases do not recognize international boundaries or sovereign states • Diseases can emerge anywhere on the globe and spread quickly to other regions • Examples: West Nile virus, SARS, Avian Flu

Slide 9: Transmission Routes of SARS virus during the 2003 outbreak

Slide 10: Avian Flu- Bird Migratory Pattern

Slide 11: What makes Communicable Diseases a Global Issue? Third, globalization has resulted in a close link between international economics and public health. • Local outbreaks have global implications because of disruption of travel and trade - Examples, outbreak of plague in India - Impact of SARS on East Asian economies

Slide 12: What makes Communicable Diseases a Global Issue? Fourth, communicable diseases affect other global issues discussed in this seminar series: • Climate change • Malnutrition • Biodiversity • Access to safe water • Migration

Slide 13: What makes Communicable Diseases a Global Issue? Finally, global action is needed to: • Identify, control and prevent diseases • Obtain adequate and predictable funding for the above • promote awareness and changes in behavior and • accrue global benefits from R&D

World Bank Seminar Series: Global Issues Facing Humanity Diseases without borders PART II

Slide 14: Presentation Summary • International Cooperation Against Diseases without Borders • Key Elements of a Global Disease Response Plan • The Role of the World Bank • Conclusion

Slide 15: International Cooperation Against Diseases Without Borders • International Sanitary Regulations (1851) following cholera epidemic in Europe • WHO International Sanitary Regulations (1951) • WHO International Health Regulations (1969) • Revised WHO International Health Regulations (2005)

Slide 16: International Cooperation Against Diseases without Borders Various forms of Voluntary cooperation amound international agencies • Roll Back Malaria • Stop TB Campaign • UN Millennium Development Goals

Slide 17: International Cooperation Against Diseases without Borders Millennium Development Goal # 6 • Have halted by 2015 and begun to reverse the spread of HIV/AIDS • Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Slide 18: International Cooperation Against Diseases without Borders An estimated 70 other Global Health Initiatives • Global Fund to Fight AIDS, TB and Malaria • Bill and Melinda Gates Foundation • Global Alliance for Vaccination and Immunization (GAVI) • Multi Country AIDS Program for Africa (MAPS) • US Emergency Plan for AIDS Relief

WHO and the Center for Diseases Control (CDC) plans for global diseases outbreaks Outbreak Management Disease Surveillance National and Local Public Health Services Health Workforce Research and Development International Legal and Regulatory Framework Disease Prevention and Control Slide 19: Key Elements of a Global Disease Response Plan

The Bank’s first Health, Nutrition and Population (HNP) strategy in 1997, currently under revision. Typical activities include: Health policy reform Strengthening of primary health care systems Health workforce development Strengthening surveillance systems Pharmaceutical procurement and planning Slide 20: The Role of the World Bank

Slide 21: The Role of the World Bank The World Bank is one of the largest financiers of disease control programs • About $150 million since 2000 in the fight against malaria • $560 million for TB prevention and control in current portfolio in 30 countries • $2.5 billion committed for 106 projects for HIV/AIDS projects or components for HIV prevention in health, education, transport projects

Slide 22:The Role of the World Bank Strong Partnerships now central to Bank work • Commitment to MDGs • Partnership for Maternal, Neonatal and Child Health • Safe Injection Global Network • Global Alliance for Vaccines and Immunization • Global Alliance for Improved Nutrition

Slide 23: Role of the World Bank Different instruments available to finance initiatives • Investment loans • Adjustment (policy reform) loans • Grants for pilot or research activities • Poverty Reduction Strategy Credits • Avian Flu Fund

Slide 24: The Role of the World Bank Investments in health through other sectors or cross-cutting themes • Infrastructure projects • Slum upgrading • Electrification • Governance • Human rights

Slide 25: The Role of the World Bank Bank evaluations of its health projects/portfolio Bank support has been successful in: • Expanding health care coverage • Training health personnel • Supplying basic inputs • Influencing health policy The Bank has been less successful in: • Sustained, systemic service quality improvement • Institutional change

Slide 26: Conclusion • High risk that a major pandemic will occur sometime during the 21st century • Factors that contribute to spread of diseases will continue to be at work • “If we truly want to end the threat of infectious diseases, we must ..inject into global gatherings the urgency of working together to defeat infectious diseases; .. Continue to invest in vaccine research and development.. Work to ensure that drugs, vaccines and tests are available during an emergency.. Pool our greatest resources – our imagination and intellect – to fight this collective fight” - James Hughes, Director, CDC

World Bank Seminar Series: Global Issues Facing Humanity