In our increasingly interconnected world, global health is facing a further challenge—new diseases are emerging at the rate of one per year. Since 1967 at least 39 new pathogens have been identified, including HIV, Ebola fever, Marburg fever, and SARS (severe acute respiratory syndrome). Other century-old threats such as pandemic influenza, malaria, TB, continue to pose a threat through a combination of factors such as mutation, rising resistance to antimicrobial medicines, and weak health care systems.
Airlines now carry more than 2 billion passengers annually, greatly increasing opportunities for the rapid international spread of infections. The industrialization of food production and processing, the globalization of marketing and dependence on chemicals have also furthered the threat. No nation, no matter how wealthy or technologically advanced, can alone prevent, detect and respond to all public health threats.
More than ever, global public health security depends on international cooperation. It is both a humanitarian imperative, and in their national self interest, for the richer countries to help the poorer ones. Poverty deepens disease and disease leads to poverty. Diseases are much more prevalent where malnutrition, unclean water, and inadequate sanitation exist. Disease is also a stark barrier to economic growth, social progress and civil peace.
Microbes have no respect for borders—or neighborhoods. During the Industrial Revolution, the major cities of London and New York experienced typhoid and cholera travelling from the slums to the residential areas of the wealthy. Only then were sewer systems built and clean water supplied for the whole population. Inequality in health care resources worldwide continues. About 90% of the world’s health care resources are used by less than 20% of the world’s population, mostly in the richer countries. Africa and southeast Asia have the largest share of disease and about 40% of the world’s population. Yet they spend only 2% of the world’s health resources.
WHO’s 2007 World Health Report focuses on the international spread of disease. They are particularly concerned with a potential influenza pandemic, paying special attention to influenza viruses coming from the animal world, which could affect 1.5 million people. A precedent exists. The last great flu epidemic after World War 1 devastated populations in the wealthy countries. To prepare for this possibility, a WHO conference created a gathering of health representatives from many countries, and vaccine manufacturers to ensure a stockpile of available flu vaccine. They expect to have about 4.5 million by 2010.
Partnership by many countries with WHO has resulted in a dramatic drop of 90% of measles deaths in Africa, requiring follow-up of vaccinations every two to four years. Progress has also been made in halting the resurgence of yellow fever in Africa.
The 2007 Report outlines a successful revision on International Health Regulations, binding regulations adopted by most countries to contain threats from emerging infections, chemical spills, leaks, dumping or nuclear melt-downs. The previous regulations addressed only four diseases, cholera, plague, yellow fever, and smallpox. Happily, smallpox has since been eradicated.
The 2005 revision adopted by the World Health Assembly has led to an unprecedented agreement of the utmost importance because it subjects the sensitive principle of national sovereignty to international health security. In the past, regulations were focused at borders and involved only passive measures of notification and control. Now the agreement permits action to travel to the source. This agreement came into force on June 15, 2007. It includes coverage of all disease and health events that may constitute a public emergency of international concern.
Only the United Nations could have created such a legal framework— from global necessity to local action. Since people are travelling more, both for pleasure and need, and diseases are travelling as well, these obscure laws may save lives many times over.
Phyllis Ehrenfeld, President, National Service Conference of the AEU and NSC Representative to the UN
Dr Sylvain Ehrenfeld, IHEU Representative to the UN.