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WHO outlines need to control emerging diseases
Global health experts laud urgency and importance of latest WHO report.
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A new report offering recommendations to help secure the world’s public health security was recently released by WHO.
The report, “A Safer Future: Global Health Public Security in the 21st Century,” summarizes the global threat and history of disease spread. The report also includes calls from WHO officials to step up worldwide pandemic preparedness efforts.
Experts lauded the WHO report as a compendium of much-needed initiatives to thwart the effects infectious diseases have on the world population, regardless of geography.
“What’s clear here is that this is not a set of issues that any one country alone can address,” Nils Daulaire, MD, MPH, president and CEO of Global Health Council, told Infectious Disease News. “The countries of the north have to recognize the importance of supporting public health in developing nations.”
Other public health experts echoed Daulaire’s concern of the issues of global public health outlined in the report. “The premise of the report is that we are living in a very different world than ever before,” Serat Aksoy, PhD, professor of epidemiology and infectious disease at Yale School of Public Health, told Infectious Disease News. “We used to look at tropical diseases as diseases that would remain in those regions, but that has changed drastically given the amount of global travel at present. Outbreaks no longer remain where they first occur; they have the propensity to expand.”
Identifying new pathogens
According to WHO, since 1967, scientists have identified at least 39 new pathogens worldwide – at least one per year since 1970 – including HIV, Ebola, Marburg fever and SARS. The 2003 SARS outbreak illustrates the health and economic effect of infectious diseases. An estimated $60 billion in gross expenditures and business losses were attributed to SARS. The outbreak also threatened global public health.
“The SARS outbreak was a clear indication of why all countries should be concerned about what is happening in the rest of the world,” Daulaire said. “Although a particular disease might not pose an immediate threat to Americans or Europeans, this report highlights how evolution and mutation of these diseases to deadlier and more rapidly transmissible forms can put everyone at risk unless there is full global protection.”
The report also traces the history of efforts to contain diseases such as smallpox, cholera and plague as evidence of the need for preparedness and collaboration.
In the past five years, WHO has recognized more than 1,100 epidemic events worldwide.
“Given today’s universal vulnerability to these threats, better security calls for global solidarity,” Margaret Chan, MD, director-general of WHO, said in a press release. “International public health security is both a collective aspiration and a mutual responsibility. The new watchwords are diplomacy, cooperation, transparency and preparedness.”
Global thinking
Experts agreed that a key aspect of the WHO report is the recommendations for developed nations to help developing nations secure public health for global health security.
“The rich countries of the world are doing nowhere near enough to help developing nations in capacity building for public health, which has been seen for years as an act of charity that becomes optional at the end of the list of important things to do,” Daulaire said. “The rich nations of the world need to realize that building health systems within the developing world is critical to their own self interests.”
Capacity building, the ability of a national scientific community to respond to its own public outbreaks, is an urgent need for global health although it is a massive undertaking because it involves building centers of excellence, laboratories and collaborations between countries to effect public health change.
“This is not something that will happen overnight, but capacity building is financially worthwhile in the long run,” Aksoy said. “If a country has the ability to respond to its own outbreaks, rather than rely on a team of people running there to diffuse the situation, then we will all be ahead.”
Recommendations made
The WHO report includes six key recommendations for increased public health security. Recommendations include full implementation of the revised International Health Regulations by all countries and global cooperation in surveillance of outbreak alert and response. The revised regulations are based on the fact that no country can fully isolate citizens through border control in the face of infectious dis- ease outbreaks.
Open sharing of knowledge, technologies and materials — including viruses and samples – are key to optimizing the security of global health, according to the report. Capacity building within public health infrastructures of all countries and collaboration of governments are also important initiatives for public health.
Public health security requires increased global and national resources for training, surveillance, laboratory capacity, response networks and public health campaigns, according to the WHO recommendations.
Public health lacking
WHO officials outlined several factors which contribute to insecurity in global public health including inadequate investments in public health due to a false sense of security induced by a lack of major global outbreaks.
Unexpected policy changes – such as the decision to halt immunizations in Nigeria, which led to the re-emergence of polio there – are defined as adding to public health problems. Conflict situations, which may force refugees to live in overcrowded conditions conducive to infectious disease outbreaks, are also often a factor.
Microbial evolution, antibiotic resistance and food processing threats have also lead to the insecurity world public health, according to the report.
Outbreak evolution
In response to infectious disease outbreaks, WHO is involved in monitoring outbreaks, including the recent Marburg fever outbreak in Uganda. WHO and the Global Outbreak and Response Network, which includes CDC, MSF, the Uganda Virus Research Institute, the African Field Epidemiology Network and local NGOs, are working to strengthen surveillance to contain the outbreak.
Efforts include studying transmission to improve understanding of the virus and try to prevent future outbreaks.
WHO is also involved in the global response to H5N1, which has caused at least 308 human deaths and several outbreaks among poultry since it was first isolated in humans in 1997. – by Kirsten H. Ellis
For more information:
- The WHO report is available online at www.who.int.