Millennium Project
Global Challenges Facing Humanity
8. Health
How can the threat of new and reemerging diseases and immune microorganisms be reduced?

Since the world is short 2.4 million doctors, nurses, and midwives, according to WHO, tele-medicine, biochip sensors for self-diagnosis, and other automated systems may be increasingly necessary as people live longer. The threat of SARS has been eliminated by coherent human response. Now the world is preparing for genetic variations that could occur in the avian flu H5N1 virus that could kill 25 million people with untold effects on airlines, tourism, and other economic sectors. So far no sustained human-human transmission has occurred. Asian poultry farmers should get incentives to replace their live-market businesses with frozen-products markets. Avian flu has moved westward among birds in more than 63 countries, including Europe and scattered cases in the U.S. As of June 2007, WHO had confirmed 317 human cases of avian flu in 13 countries, with 191 deaths—an increase of 15% between 2005 and 2006 compared with a 55% increase from 2004 to 2005.

About 30% of all deaths are caused by infectious diseases. The most common infectious disease in the world today is hepatitis B virus, which affects 2 billion people. AIDS is the fourth leading cause of deaths in the world: 25 million people have died from AIDS, with 2.9 million deaths in 2006; 34.1–47.1 million people have HIV, of which 3.6–6.6 million were new cases during 2006. An estimated 7.3 million girls have HIV/AIDS compared with 4.5 million boys. About 28% of those with AIDS in low- and middle-income countries now receive drugs—a 54% increase over 2005—but for every person who begins this therapy, six more become infected with HIV/AIDS. The Clinton Foundation has helped reduce the annual cost of a range of AIDS drugs to nearly $100 and the daily one-pill to $1/day. Although AIDS is the leading cause of death in sub-Saharan Africa, it is spreading more rapidly in Eastern Europe and in Central and South Asia. Global funding has increased to $12 billion in 2006, and the cost of self-AIDS testing is beginning to fall to $15 per test. No significant positive vaccine results are yet available, but new genetic-based vaccines and microbicides are in trial, while studies show that up to 50% of HIV can be avoided in males through circumcision.

The responses to avian flu and SARS have shown that even without a vaccine it is possible to control a disease by early detection and accurate reporting, prompt isolation, and ongoing global awareness. WHO averages 200 outbreak investigations every year, and around 50 will require an international response. More than 30 new and highly infectious diseases have been identified in the last 20 years. Furthermore, 20 known strains of diseases have developed resistance to antibiotics, while old diseases have reappeared, such as cholera, yellow fever, plague, dengue fever, meningitis, hemorrhagic fever, and diphtheria. Viral incidence in animals is being mapped in Africa, China, and South Asia to divert epidemics before they reach humans. Future uses of genetic data, software, and nanotechnology will detect and treat disease at the genetic or molecular level. Meanwhile, hand washing may be the most cost-effective way to reduce communicable disease.

Global health is affected by poverty, migration, trade, human encroachment in natural habitats, environmental damage, deforestation, international travel, armed conflicts, and concentrations of increasingly large numbers of people in cities in unsanitary environments. Bioterrorism has increased R&D for bio-sensors and general vaccines that could be placed around the world like fire extinguishers. Better trade security will be necessary to prevent increased food- or animal-borne disease. Other problems may come from synthetic bacteria from gene laboratories and unknown nano-organisms.

WHO’s eHealth systems, new regulations to address SARS-like threats, immunization programs, and the Global Outbreak Alert and Response Network are global responses to this challenge, along with the $7 billion contributed through the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has negotiated lower drug prices and delivered 30 million insecticide-treated bednets to reduce malaria. Scientists are working to develop a genetically modified mosquito that would not carry the malaria parasite. One day medicines may temporarily boost our immune systems to prevent infection by known and unknown causes, and one vaccination could become permanent and heritable to future generations.

Regional Considerations

Africa: With 24% of global disease, Africa has only 3% of the world’s health workers and less than 1% of world health expenditures. Adult prevalence of HIV/AIDS in sub-Saharan Africa is beginning to decrease: 2004 prevalence was 5.3–6.8% and 2006’s was 5.2–6.7%. Yet an additional 2 million people got HIV during this period, making a total 21.8–27.7 million, reducing life expectancy as much as 15 years in Southern Africa. AIDS death rates among professionals are high enough to threaten development in many countries. Some 90% of the 1 million annual deaths from malaria occur in sub-Saharan Africa, costing the region $12 billion per year. Trials for an experimental vaccine for malaria are expected in Africa within two years.

Asia and Oceania: About 8.6 million people have HIV in the region, including 5 million in India and 2 million in China. Within five years the number infected in the region could grow to 20 million. Malaria is endemic, outbreaks of dengue are common, and even in modern, sanitized Singapore there has been a resurgence of TB. Southeast Asia has the highest rate of TB infection in the world, with 3 million new cases annually. Indonesia now has the world’s highest human toll from avian flu. Promotion of hand washing among low-income children in Karachi decreased impetigo by 34%, diarrhea by 53%, and pneumonia by 50%.

 Europe: An estimated 84,000 Europeans died of AIDS during 2006. Russia has the highest HIV/AID rates in Europe and has launched an initiative to stop its spread. TB is also on the rise in Eastern Europe. The prevalence of HIV in Western and Central Europe has stabilized around 0.3%, as have new HIV infections at 22,000 per year and AIDS deaths at 12,000 per year.

 Latin America: Brazil began offering free combination antiretroviral therapy to all citizens with AIDS in 1996, which has saved the country an estimated $2.2 billion in hospital costs between 1996 and 2004 and has inspired similar efforts elsewhere. Treatment coverage in countries such as Argentina, Brazil, Chile, and Cuba now exceeds 80%. The bulk of the 1.8 million people living with HIV/AIDS in Latin America are in Argentina, Brazil, and Colombia. Latin America provides AIDS treatment to 72% of those who need it.

North America: Biotech companies are developing many new mechanisms for diagnosis and treatment; greater incentives will increase investment in R&D for disease eradication that might not be very profitable but is important to the poor majority. Over a million people in the U.S. are now HIV-positive, as are 58,000 people in Canada. Antiretroviral medications keep AIDS death rates low. Increased food imports raise vulnerability to infections from overseas.

Graph: Physicians (density per 1,000 population)

Source: World Health Organization, Core Health Indicators

You are invited to participate in updating and improving this challenge. Please click here for the online suvey form.

 Millennium Project Homepage