World Bank Seminar Series: Global Issues Facing Humanity

1. World Bank Seminar Series: Global Issues Facing Humanity Diseases without borders

2. Slide 1: Table of contents • Why are Communicable Diseases a Global Issue • Major Communicable Diseases • Emerging Communicable Disease challenges

3. Slide 2: Why are Communicable Diseases a Global Issue • Magnitude of the Problem • Annually, about 14.5 million deaths worldwide are caused by communicable diseases (=60% of all deaths) • More than half of all deaths due to communicable diseases are attributed to HIV/AIDS,TB and malaria • Primarily affect children and young adults in their most productive years

4. Slide 3: Why are Communicable Diseases a Global Issue • Externalities : spill-over benefits or losses from one individual to others • Equity : Both a cause and consequence of poverty • Impoverish the already poor – loss of productivity, treatment costs • The poor have a greater share of the burden of disease and have less access to affordable and quality care

5. Slide 4: Why are Communicable Diseases a Global Issue • Not contained within national boundaries – not the problem of just one country/region • Global action is needed to ensure : • adequate and predictable funding • promote awareness and changes in behavior and • accrue global benefits from R&D

6. Slide 5: Major Communicable diseases Goal 6: • Have halted by 2015 and begun to reverse the spread of HIV/AIDS • Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases • HIV/AIDS, malaria and TB are responsible for 6 million deaths per year • Avian flu is estimated to cause between 2 to 7.5 million deaths if a human pandemic occurs

7. Slide 6: Magnitude and Trends in HIV/AIDS • 60 million infected and 20 million deaths • Half of the 14,000 new infections each day occur among young people below age 25 • Over 8 million children (<15 years) have been orphaned by AIDS • Feminization of the epidemic – In Africa, rates of infections among young women (15-19 years of age) are 5-6X higher than for young men • Disproportionately affects poor countries and the poor in these countries

8. Slide 7: Most HIV/AIDS Infected Live in Africa and South Asia

9. Slide 8: HIV/AIDS - Multi-sectoral Approach HIV/AIDS has health, other social and economic consequences • exacerbates poverty and inequality • puts tremendous pressure on health and social services • creates large numbers of orphans who need support • decimates the workforce with enormous economic and social consequences

10. Core set of prevention and Rx interventions exist: - promoting behavior change - increasing condom use - STI management - ensuring a safe blood supply - preventing MTCT - supporting harm reduction among IDUs - anti-retroviral treatment Slide 9: HIV/AIDS Interventions

11.   Comprehensive prevention could avert 29 million of the 45 million new infections projected by 2010 However, prevention programs reach fewer than one in five people who need them Slide 10: HIV/AIDS Prevention Reach

12. Slide 11: HIV/AIDS Treatment Reach • 6 million people need antiretroviral treatment • 1 million people are currently on ART • Recent treatment scale-up averted between 250,000 and 350,000 deaths in 2005 • Annual basic care and treatment for AIDS can cost as much as 2-3 times per capita GDP in the poorest countries

13. Slide 12: Linkages between Communicable Diseases • Over 12 million persons live with TB and HIV worldwide • More HIV-infected persons die due to TB than to any other opportunistic infection

14. Slide 13: Magnitude and Trends in TB • 8.8 million new cases/1.7 million deaths each year • 95% of cases and 98% of TB deaths occur in the developing world • Africa has the highest TB rates per capita, but Asia carries the greatest absolute burden • Poor people are especially vulnerable to TB due to: • underlying health status • adverse living conditions • limited access to treatment

15. Slide 14: Magnitude and Trends in TB

16. Slide 15: Tuberculosis Treatment • Without any treatment, half of those who fall ill will die • Directly Observed Treatment, Short (DOTS) • cure rates of up to 95% • prevents new infections • prevents the development of drug resistance • treatment under DOTS is as little as US$ 10 per patient • Drug resistance is a major challenge

17. Slide 16: Magnitude and Trends in Malaria • 500 million new clinical cases per year • more than one million deaths each year • 40% of the world’s population exposed to malaria risk • malaria reduces GDP growth by approximately 1% per year • Poor worst affected: • less access to services, information and protective measures • less power to avoid living or working in malaria-affected areas

18. Slide 17: Magnitude and Trends in Malaria • 20% of all childhood deaths in Africa are due to malaria

19. The most cost-effective interventions are: - rapid diagnosis and effective treatment - insecticide-treated bednets - intermittent-presumptive treatment for pregnant women - epidemic preparedness Resistance to conventional anti-malarial drugs is a major challenge ACTs Vaccine Slide 18: Malaria -Prevention and Treatment

20. Slide 19: Emerging Challenge: Avian Flu • HPAI is an emerging zoonotic – caused 69 deaths and 135 infections • animal-to-animal and limited animal-to-human transmission of H5N1 • increasing probability of human-to-human transmission and a global influenza pandemic • cost of a pandemic could exceed $800 billion/year • control is beyond the scope and resources of a single country or region

21. Slide 20: Avian Flu- Migratory Pattern