INFECTIOUS DISEASES IN WEST AFRICA
Mankind has been battling infectious diseases since the dawn of the species. Though there have been many victories over the centuries, this is a war not yet won. The health systems in sub-Saharan Africa face severe challenges in addressing infectious diseases and other healthcare needs. In addition to the lack of physical infrastructure and financial resources to provide adequate healthcare, countries are beset with a crippling shortage of trained healthcare workers. While sub-Saharan Africa which has 24% of the global disease burden, it has only 3% of the world healthcare workforce and accounts for less than 17% of the global healthcare spending.
Of every 1000 babies born in the United Kingdom, five die before they reach their first birthday. In Mozambique, nearly 350 babies out of every 1000 die within a year. The death of any infant is a tragedy but why do forty times as many Mozambican families suffer this painful loss. In the UK, thanks to better hygiene, antibiotics and vaccines, infectious illnesses are a shadow of the threat they once were. In the developing countries, however, it’s a very different story.
With limited global resources available to deal with the problem, where should we focus our efforts? Should we develop new drugs and vaccines to combat these diseases? Or would we be better off addressing underlying social, cultural, environmental and economic problems? Should the rich countries do more to help the poor ones? Or are there enough solutions ahead but not enough political will and cooperation to implement them.
Bricke Institute for Global Health (BIGH) which is one of the major players in the Infectious Diseases advocacy initiatives believes that no government or organization could single handed tackle a problem as vast as Infectious Diseases in developing countries. But many different organizations including charities and pharmaceutical companies could make a vital impact in particular areas. The institute’s proposed World Health Initiative (WHI) christened the ACT NOW CAMPAIGN seeks to establish an International Public Private Partnership (IP3) for the control and eradication of eleven major Infectious Diseases within the next five years of the implementation of its 5-year strategic plan (2010-2014). IP3 will be a distinctive feature of the global health care landscape. One of the many advantages of the proposed IP3 is that it will mobilize partners with different even hostile philosophies around one common goal. IP3 makes it possible to share risks and responsibility and they embody the principle of ‘win-win’ solutions creating benefits for all parties. Pharmaceutical companies know they have guaranteed sales of new products perhaps also a subsidy from public or donor funds. Countries know they are getting high quality products at affordable prices. The pharmaceutical companies bring its unique skills and expertise to bear in developing new products and getting them through the regulatory approval process.
WHI has come to believe that some of the set terrors in the limelight are caused by three diseases very much in the news: AIDS, TB and Malaria. Such attention for the big three infectious diseases is understandable. The consequences of the AIDS epidemic are so profound that they are now recognized as a threat to global security. Fuelled by the AIDS epidemic, TB has re-established itself often in its multi-drug resistant form as a contagious and costly leading cause of death. TB’s return with a vengeance to wealthy nations shocked the world out of its complacent view that infectious diseases were a declining threat. Malaria stands out as probably the single most important impediment to socio economic development in endemic countries. It is deadly, firmly entrenched and inextricably linked to poverty. Malaria is also important to wealthy countries because it threatens the health of International travellers. Together, these three diseases cause over 700 Million episodes of illnesses and more than 20 Million deaths annually.
Outbreaks of diseases are costly wherever and whenever they occur. However, outbreaks come to an end. The burden imposed by AIDS, TB and Malaria on economies in developing countries is enormous and constant. I believe that Malaria has powerfully shaped the global distribution of income and poverty. If the disease has been eliminated 35 years ago, up to $200 Billion could have been added to sub Saharan Africa’s current GDP of $300 Billion.
Biological terror also comes in the form of so called neglected diseases, neglected because they do not affect wealthy nations, do not make headlines and do not interest the research community including the research based pharmaceutical industry. They cause great terror in their homeland but little international concern. The number of people incapacitated by these diseases is enormous. At the human level, the impact of the disease on development can be simply expressed. People who are sick cannot work or attend school. Malaria alone causes between 400 Million to 900 Million episodes of illnesses in African Children. High fever and febrile convulsions in infants and children can retard brain development with profound implications for societies. Schistosomiasis which infects 200 million people is also associated with impaired growth and development and poor school performance. For these and other neglected diseases, illness is not an episode like an outbreak that ends. If untreated, infection progresses to a point where disability is permanent. Blindness is the consequence of untreated Onchocerciasis and Trachoma. Severe heart disease develops in young people as a result of Chagas disease. Deformities associated with leprosy, leishmaniasis and lymphatic filariasis can become so severe that patients are cast out of the society as well as eliminated from the work force.
The cost of medicines whether quality drugs or counterfeit can easily exceed the purchasing power of people living on less than $1 a day in countries where total annual health expenditure amounts to no more than $11 per person. For some of these diseases, money cannot buy an effective cure as none exists. For others, control tools are rapidly losing their effectiveness as antimicrobial resistance develops and spreads. The statistics are alarming and have been for quite some time.
Conventional approaches have brought very little progress. Considerable hope now centres on our promise of IP3. Some academic observers believe that our idea of an efficient IP3 have the potential to transform the global public health landscape. It will bring major resources to bear on neglected diseases that affect large populations and can thus prove pivotal in fulfilling the moral obligation to improve the health status of poor people in low-income countries.
The ACT NOW 5-Year strategic plan will focus primarily on key areas of infectious disease management which include: developing Rapid Diagnostic Test Kits (RDTK) for each of the eleven infectious diseases of interest, Drug Donation (and Production) Partnerships (D2P and DP2), Vaccine Development and Vector Control Initiative (VCI). We will build strong strategic alliances with government; pharmaceutical companies, Research institutions and the private sector in various World Health Initiatives that will ensure that new therapeutics are brought into the market.
On the proposed WHI, our new headquarters shall have state of the art facilities and technology which will be at the disposal of our employees. This will challenge them to use their expertise and creativity as members of an interdisciplinary team. It is necessary to state that our philosophy is one of shared visions, goals, knowledge and performance. We believe this approach will bring shared success and ultimately shared value and hopefully, within the next 5-Years, we would have been able to achieve at least 80% of our shared goals.
DR. ECHEFU BRIGHT IKECHUKWU
Chief Development Officer
Bricke Institute for Health