Global Challenges-8

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

The more complete version of this challenge along with actions to address it, graphs, and indicators to measure change is available on the CD-ROM included with the 2004 State of the Future.

General Description	Comments
The Copenhagen Consensus rated the fight against HIV/AIDS as the most important issue facing the world. AIDS has killed 22 million people, while another 42 million are living with HIV/AIDS today. Although AIDS is the leading cause of death in sub-Saharan Africa, it is now spreading more rapidly in Eastern Europe and Central/Southern Asia. One study showed that spending $60 billion to promote condom use and distribute antiretroviral drugs would save the world $3 trillion. The yearly cost of antiretroviral medicine available to some in developing countries has fallen as low as $300 per person, and a new 40-hour AIDS test may affect the spread of the disease. Genetically modified vaginal bacteria may be able to protect women against HIV and to be stored in freeze-dried tablets. Meanwhile, bioterrorism is emerging as a threat on a par with nuclear war, triggering bio-sensor R&D for global deployment, general vaccines, and quarantine systems. The rapid and unprecedented international cooperation to contain SARS (which infected 8,000 people in 30 countries, killing more than 700) and avian flu (in process) is a key element in the emerging global system to address these threats. Human clinical trials for a SARS vaccine began a year after its outbreak. Infectious diseases cause about 30% of deaths worldwide. More than 30 new and highly infectious diseases have been identified in the last 20 years, such as avian flu, Ebola, AIDS, SARS, and cross-species viruses in Africa; for many there is no treatment, cure, or vaccine. Furthermore, 20 known strains of diseases such as tuberculosis and malaria have developed resistance to antibiotics, while old diseases such as cholera, plague, dengue fever, meningitis, hemorrhagic fever, diphtheria, and yellow fever have reappeared. These developments are compounded by factors such as the rapid increase in international air travel and large populations who are malnourished and undereducated, living in unhealthy conditions. The globalization of trade, as well as recent changes in the production, handling, and processing of food and breeder stock, has heightened the risk of food-borne diseases. Activities such as deforestation, tourism, conflict, climate change, and migration into remote habitats have increased exposure to disease.
Approaches to address this challenge	Comments
Incentives need to be created to change unhealthy behaviors that affect the world; one example is subsidies to help Hong Kong and Shanghai poultry farmers to replace their live-market businesses with frozen-products markets. The live markets in these cities are a key breeding ground for influenza. The responses to avian flu and SARS have shown that even without a vaccine it is possible to control a disease by preventing infection through early detection and accurate reporting, prompt isolation of those infected, and quarantine as needed. Donors should increase their support for WHO's network of collaborating laboratories to improve the global surveillance system, strengthen the international rapid response system to infectious disease, and expand WHO's vaccines program. Additionally, support should be increased for applications of tele-medicine and tele-health; women's rights programs related to AIDS; safe water supply; advanced generations of antibiotics; innovative health measures such as the "Miracle Tree" (Moringa) in Senegal that is environmentally adaptable, edible as nutrition, and contains needed vitamins; and understanding the relationship among disease, ecology, and genetics. In the future, genetic engineering, stem cell research, and nanotechnology may one day be used to improve our immune systems to prevent infection by known and unknown viruses and disease; one vaccination could be permanent and heritable to future generations.
Regional Perspectives	Comments
Africa: Although prevalence of HIV/AIDS appears to remain stable, there is overall no decline in the epidemic. The high number of HIV infections can be lost in the total HIV/AIDS statistics by the equally high number of AIDS deaths. Only 75,000 people receive adequate AIDS medications in Africa; a WHO initiative would provide 3 million people with antiretrovirals by 2005. Some 14 million children have lost parents due to AIDS, a number that could grow to 42 million by 2010. Massive health education seems to have had little effect on changing African sexual behavior; some awareness programs are working, however: HIV prevalence was cut by one-third among young women in Addis Ababa from 1995 to 2001; Senegal's infection rate is 1.7%, while neighboring countries report rates of more than 10%. AIDS death rates among professionals are high enough to threaten development in many countries.
Asia and Oceania: SARS has improved regional health cooperation, which should affect other contagious diseases. By 2010, more people could have AIDS in Asia than in Africa. The 5 million in India with HIV/AIDS and 2 million in China show the early stages of the pandemic; UNAIDS forecasts 10 million in China will be infected by 2010. Malaria is endemic, outbreaks of dengue are common, and even in modern, sanitized Singapore there has been a resurgence of tuberculosis. With the massive influx of foreign workers, diseases that had almost disappeared are rapidly reemerging in South Korea.
Europe: Schools in Catalonia Spain are installing condom vending machines, defying the Catholic Church. Much of Russian and Central and East European health systems are near collapse, just as AIDS accelerates; Estonia has passed Russia in the prevalence of AIDS. Other problems in Europe come from migration and influenza. Future problems may come from synthetic bacteria from gene laboratories and unknown nano-organisms.
Latin America: Although the region's traditional health indicators have improved, these are uneven among countries and population groups. Today communicable diseases (most of them curable) are responsible for about two-thirds of all deaths in Latin America and the Caribbean. However, 2 million people live with HIV/AIDS, which has helped tuberculosis to return to the region, and in many countries public health systems remain fragmented, bureaucratized, politicized, under-funded, and underreported in spite of widespread health sector reform efforts. Brazil is an exception with its success in reducing the growth of AIDS by massive public financing to produce nelfinavir domestically and give it free to its citizens.
North America: Canada doubled its annual contribution to fight AIDS, tuberculosis, and malaria, while the United States pledged $15 billion over five years. Increased food imports raise vulnerability to infections from overseas. Society promotes the use and sale of antibiotics on scales that fuel growth of microbial resistance. New antibiotics and vaccines, rising living standards, responsible use of and leadership in biotechnology, and global and national systems of surveillance and response are critical to address health challenges. How can pharmaceutical companies be encouraged to invest in R&D for disease eradication that might not be too profitable but important to the poor majority?

Additional Comments: