Eradicating a deadly trio

There are only a few certainties in life. Death, of course, is the main one. But as long as we live, there is another factor we have to contend with - disease. We know hardly anyone who has not been afflicted by some form of disease, mild or serious. Despite the major advances gained by medical science, some diseases are still deadly or have no permanent cure.

The saddest part of this story is that drugs and/or vaccines are available to control many previously deadly diseases, but these are not equally distributed around the world. Access to medication is still a problem.

While rich countries spend billions of dollars on defence and defence related research, there is a lack of funds for procuring medicine and vaccines for certain diseases that still rage in much of the Third World. This is a pathetic situation that not even the looming 2015 deadline for the Millennium Development Goals has not been able to address. Millions of lives, especially those of children under five, can be saved if more countries contribute heavily and generously to the global efforts to eradicate deadly diseases.

International health agencies at the United Nations, led by the World Health Organisation, have documented enormous gains made over the past decade to curb three devastating diseases: AIDS, tuberculosis and malaria. Despite this great progress, there is still a big gap between what has been accomplished and what more could be done with sufficient financing.

The World Health Organisation estimated in the World Malaria Report issued last week that global efforts to control and eliminate malaria had cut the mortality rate by 45 percent globally and by 49 percent in Africa between 2000 and 2012. This translates to 3.3 million lives saved. Even so, there were an estimated 627,000 malaria deaths in 2012 (from 207 million cases), a vast majority in sub-Saharan Africa. This is an inexcusable state of affairs, given the relatively low cost of anti-malaria drugs and the availability of no-cost preventing measures such as clearing mosquito breeding sites.

The main weapons against malaria are insecticide-treated bed nets to ward off mosquitoes and drugs for those who become infected. In sub-Saharan Africa, much less than half of the population had access to nets this year, and millions lack access to tests and drug treatments. Global financing for malaria control reached an estimated $2.5 billion in 2012, just under half the amount needed each year. Raising the rest of the money will be an easy task if more countries genuinely want to see an end to this scourge.

High-risk

According to the WHO, an estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Among them, 1.2 billion are at high risk. In high-risk areas, more than one malaria case occurs for every 1,000 population.

Another challenge is the emergence of anti-malaria drug resistance, which is confounding experts. Four countries - Cambodia, Myanmar, Thailand and Vietnam - make up an “epicentre to malarial drug resistance,” says Robert Newman, the director of the World Health Organisation's Global Malaria Program.

Researchers have found that people in the South-east Asia region have surprisingly high rates of resistance to artemisinin-based combination therapies, which are considered the best ways to treat the most deadly of the four types of parasites that cause malaria in humans.

The cases represent only a tiny portion of malaria cases worldwide, but nevertheless require “more attention because history has taught us what happens if these cases get out of control,” Newman said. Keeping drug resistance from reaching Africa is also critical, he said. There are several reasons why malaria keeps spreading - malaria is transmitted across borders due to the ruse in worldwide travel and insufficient regulation and inappropriate use of drugs also contribute. There are many patients who stop using the medication after a few days because they start to feel better. Fittingly, the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria, which received US$ 12 billion in pledges from countries and donors worldwide last week, has committed US$ 100 million over the next three years to addressing drug resistance in the South-east Asia region.

That brings us to the other two diseases mentioned above - Tuberculosis and AIDS, on which we commented on last week. The WHO reported two months ago that the global mortality rate from tuberculosis had fallen by 45 percent since 1990. But, in 2012, 1.3 million people died, an unacceptably high toll given that most deaths are preventable if cases are detected early and treated properly. Sri Lanka is one developing country which has had a fair degree of success against both malaria and TB and it is fact an example to other developing countries grappling with the problem.

Resistance

Drug resistance has emerged as major problem with TB as well. Global health officials are warning that the proliferation of antibiotic-resistance tuberculosis is a looming public health disaster. According to the World Health Organisation’s (WHO) estimations, 500,000 people are infected with a TB strain that’s resistant to the two drugs typically used to treat it - but many of those people go undiagnosed, and end up spreading the deadly strains even further. Tuberculosis still kills about a million people around the world. WHO officials say the growing public health threat represents a “ticking time bomb,” since about 80 percent of the people who have drug-resistant TB are not currently being treated.

The pattern is repeated in the battle against the virus that causes AIDS. A United Nations agency recently estimated that new H.I.V. infections among adults and children totalled 2.3 million in 2012, a 33 percent drop since 2001, and that AIDS-related deaths totalled 1.6 million, a drop of 30 percent from a peak in 2005, mostly because more patients had gained access to antiviral drugs. But an estimated 35 million people, mostly in sub-Saharan Africa, are infected and only about 10 million are being treated.

In all these cases, the best answer is vaccination which prevents the disease in the first place. A TB vaccine is already available, but newer, more effective versions are also under development. A viable malaria vaccine could be with us in two-three years while the holy grail of vaccines - an AIDS vaccine - could be some time away. A global vaccination campaign spearheaded by WHO for all three diseases could effectively save practically every life that is now claimed by the deadly trio mostly in the developing nations. The world will be a much better place if more funds could be made available to fight these three diseases as well as several other childhood diseases.