DRUG resistance and urban poverty have pushed the worldwide death toll
from infectious diseases to 17 million a year, the WHO revealed this week in its
1996 World Health Report. This alarming figure, which amounts to a
third of all deaths, has prompted some Western governments to call for a review
of the WHO鈥檚 funding policies. They want the organisation to concentrate on
reducing the number of deaths from infectious diseases instead of trying to deal
with all the world鈥檚 health problems.
The WHO says that the vast majority of people who die of infectious
diseases鈥攕uch as TB, malaria and respiratory infections鈥攁re young,
otherwise fit people in the developing world. 鈥淭his situation has been building
up for a number of years,鈥� says Lindsey Martinez, chief of the WHO鈥檚 Emerging
and Communicable Diseases Division. 鈥淲hen populations start moving into cities,
there is overcrowding, insufficient clean water and bad housing. Many diseases
are becoming difficult to treat鈥攑articularly resistant TB and
尘补濒补谤颈补.鈥�
The WHO鈥檚 figures show that from 1994 to 1995, the number of deaths from TB
rose by 13 per cent, from 2.7 million to 3.1 million. In the same period, deaths
from malaria rose by 5 per cent, from 2 million to 2.1 million.
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The report highlights the huge costs to developing countries of dealing with
such infectious diseases. For example, treating existing AIDS cases in Rwanda
could consume 60 per cent of the country鈥檚 public health budget. Guinea worm, a
parasitic nematode that burrows beneath the skin, costs Nigeria鈥檚 rice growers
12 per cent of working days. And the eradication of river blindness
(onchocerciasis) would make available enough farm labour in West Africa to feed
another 17 million people a year. 鈥淭he economic consequences are horrendous for
these countries,鈥� says Martinez. 鈥淓ven local disease outbreaks can be
诲别惫补蝉迟补迟颈苍驳.鈥�
The growing resistance of some strains of disease organisms to drugs is also
pushing up the cost of treatment. The WHO estimates that it costs up to
$250 000 to treat a single case of multi-drug resistant TB, a form of the
disease which is spreading in the US and has begun to crop up in Europe (This
Week, 30 March, p 8).
The report coincides with the 1996 World Health Assembly, in which the WHO
meets the world鈥檚 governments to discuss funding. Before the meeting, the WHO鈥檚
director-general, Hiroshi Nakajima, warned that 鈥渇atal complacency among the
international community鈥� over infectious diseases is costing millions of lives.
He said that the WHO鈥檚 priorities in dealing with infectious diseases were to
eradicate certain scourges, such as polio and leprosy, tackle 鈥渙ld鈥� diseases
that are flaring up in drug-resistant forms, and control recently discovered
diseases such as hepatitis C and Ebola.
A senior source at Britain鈥檚 Department of Health says that the WHO鈥檚
worsening cash crisis means it should concentrate its resources on acute
problems such as epidemics of infectious disease. At the moment, the
organisation is spreading itself too thin and is even duplicating some of the
work and responsibilities of the European Commission. 鈥淭he WHO has real
financial problems,鈥� he says. 鈥淲e need to balance the needs of the developing
world, particularly in communicable disease, against those of the developed
飞辞谤濒诲.鈥�
Increasingly, the WHO鈥檚 priorities are to deal with communicable diseases,
which kill millions of people, he says. But cardiac disease and cancer are
bigger killers in the world鈥檚 rich countries. 鈥淭he WHO has got to sort out
whether it wants to be the world鈥檚 communicable disease body or whether it鈥檚
going to carry on trying to do everything,鈥� he says.
