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

2. Slide 1: Presentation Summary
Profile of Major Communicable Diseases
Factors Driving the Spread of Communicable Diseases
What makes Communicable Diseases a Global Issue?

3. Slide 2: Profile of Communicable Diseases
Steady Progress during the 20th Century in controlling communicable diseases
Immunization
Eradication of smallpox, containment of polio
Widespread use of drugs including antibiotics
Impressive advances in medicine
Public good, externalities

4. Slide 3: Yet infectious diseases remain a leading cause of death worldwide
Annually, more than 10 million deaths worldwide are caused by communicable diseases
More than half of all deaths due to communicable diseases are attributed to HIV/AIDS,TB and malaria

5. Slide 4: Magnitude of the Problem
HIV has infected more than 60 million people worldwide, more than 20 million of whom have died
TB causes 8.8 million new infections each year and is responsible for an annual mortality of 1.7 million
HIV-TB co-infection: about a third of HIV positive people also suffer from TB
Malaria endemic areas cover a third of the world’s population and the estimated annual mortality is 1.2 million

6. Slide 5: Emerging Infectious Diseases
Zoonotics (diseases caused by infectious agents that can be transmitted between animals and humans)
Characteristics include mutation during transmission, leading to highly contagious (“superspreader”) or deadly forms
Examples - Severe Acute Respiratory Syndrome (SARS), Avian Flu, Ebola, Lyme Disease

7. Slide 6: Factors driving the spread of communicable diseases
Changes in human demographics and behavior
Economic development
Dramatic increase in volume of international travel and commerce – people, animals, food, commodities
Microbial adaptation and change
Breakdown of public health capacity at all levels
(Source: Institute of Medicine)

8. Slide 7: What Makes Communicable Diseases a Global Issue?
First, the sheer global magnitude of the problem
- a substantial threat to people everywhere
- an obstacle to a nation’s social and economic development
- worst affected include the poorest households
further 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

9. Slide 8: What Makes Communicable Diseases a Global Issue?
Second, diseases do not recognize international boundaries or sovereign states
Diseases can emerge anywhere on the globe and spread quickly to other regions
Examples: West Nile virus, SARS, Avian Flu
TB costs the average patient three or four months of lost earnings, which can represent up to 30 percent of annual household income
-- Malaria slows economic growth in Africa by about 1.3 percent a year
-- When the prevalence of HIV/AIDS reaches 8 percent  the cost in growth is estimated at about 1 percent a year.

10. Slide 9: Transmission Routes of SARS virus during the 2003 outbreak

11. Slide 10: Avian Flu- Bird Migratory Pattern

12. Slide 11: What makes Communicable Diseases a Global Issue?
Third, globalization has resulted in a close link between international economics and public health.
Local outbreaks have global implications because of disruption of travel and trade
- Examples, outbreak of plague in India
- Impact of SARS on East Asian economies

13. Slide 12: What makes Communicable Diseases a Global Issue?
Fourth, communicable diseases affect other global issues discussed in this seminar series:
Climate change
Malnutrition
Biodiversity
Access to safe water
Migration

14. Slide 13: What makes Communicable Diseases a Global Issue?
Finally, global action is needed to:
Identify, control and prevent diseases
Obtain adequate and predictable funding for the above
promote awareness and changes in behavior and
accrue global benefits from R&D

15. World Bank Seminar Series: Global Issues Facing Humanity
Diseases without borders
PART II

16. Slide 14: Presentation Summary
International Cooperation Against Diseases without Borders
Key Elements of a Global Disease Response Plan
The Role of the World Bank
Conclusion

17. Slide 15: International Cooperation Against Diseases Without Borders
International Sanitary Regulations (1851) following cholera epidemic in Europe
WHO International Sanitary Regulations (1951)
WHO International Health Regulations (1969)
Revised WHO International Health Regulations (2005)

18. Slide 16: International Cooperation Against Diseases without Borders
Various forms of Voluntary cooperation amound international agencies
Roll Back Malaria
Stop TB Campaign
UN Millennium Development Goals

19. Slide 17: International Cooperation Against Diseases without Borders
Millennium Development 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

20. Slide 18: International Cooperation Against Diseases without Borders
An estimated 70 other Global Health Initiatives
Global Fund to Fight AIDS, TB and Malaria
Bill and Melinda Gates Foundation
Global Alliance for Vaccination and Immunization (GAVI)
Multi Country AIDS Program for Africa (MAPS)
US Emergency Plan for AIDS Relief

21. Slide 19: Key Elements of a Global Disease Response Plan
WHO and the Center for Diseases Control (CDC) plans for global diseases outbreaks
Outbreak Management
Disease Surveillance
National and Local Public Health Services
Health Workforce
Research and Development
International Legal and Regulatory Framework
Disease Prevention and Control

22. Slide 20: The Role of the World Bank
  The Bank’s first Health, Nutrition and Population (HNP) strategy in 1997, currently under revision.
Typical activities include:
Health policy reform
Strengthening of primary health care systems
Health workforce development
Strengthening surveillance systems
Pharmaceutical procurement and planning

23. Slide 21: The Role of the World Bank
The World Bank is one of the largest financiers of disease control programs
About $150 million since 2000 in the fight against malaria
$560 million for TB prevention and control in current portfolio in 30 countries
$2.5 billion committed for 106 projects for HIV/AIDS projects or components for HIV prevention in health, education, transport projects

24. Slide 22:The Role of the World Bank
Strong Partnerships now central to Bank work
Commitment to MDGs
Partnership for Maternal, Neonatal and Child Health
Safe Injection Global Network
Global Alliance for Vaccines and Immunization
Global Alliance for Improved Nutrition

25. Slide 23: Role of the World Bank
Different instruments available to finance initiatives
Investment loans
Adjustment (policy reform) loans
Grants for pilot or research activities
Poverty Reduction Strategy Credits
Avian Flu Fund

26. Slide 24: The Role of the World Bank
Investments in health through other sectors or cross-cutting themes
Infrastructure projects
Slum upgrading
Electrification
Governance
Human rights

27. Slide 25: The Role of the World Bank
Bank evaluations of its health projects/portfolio
Bank support has been successful in:
Expanding health care coverage
Training health personnel
Supplying basic inputs
Influencing health policy
The Bank has been less successful in:
Sustained, systemic service quality improvement
Institutional change

28. Slide 26: Conclusion
High risk that a major pandemic will occur sometime during the 21st century
Factors that contribute to spread of diseases will continue to be at work
“If we truly want to end the threat of infectious diseases, we must ..inject into global gatherings the urgency of working together to defeat infectious diseases; .. Continue to invest in vaccine research and development.. Work to ensure that drugs, vaccines and tests are available during an emergency.. Pool our greatest resources – our imagination and intellect – to fight this collective fight”
- James Hughes, Director, CDC