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 Why are Communicable Diseases a Global Issue Major Communicable Diseases Major Communicable Diseases Emerging Communicable Disease challenges Emerging Communicable Disease challenges

3. Slide 2: Why are Communicable Diseases a Global Issue Magnitude of the Problem Magnitude of the Problem Annually, about 14.5 million deaths worldwide are caused by communicable diseases (=60% of all deaths) 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 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 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 Externalities : spill-over benefits or losses from one individual to others Equity : Both a cause and consequence of poverty Equity : Both a cause and consequence of poverty Impoverish the already poor – loss of productivity, treatment costs 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 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 Not contained within national boundaries – not the problem of just one country/region Global action is needed to ensure : Global action is needed to ensure : ade quate and predictable funding ade quate and predictable funding promote awareness and changes in behavior and promote awareness and changes in behavior and accrue global benefits from R&D accrue global benefits from R&D

6. Slide 5: Major Communicable diseases Goal 6: Goal 6: Have halted by 2015 and begun to reverse the spread of HIV/AIDS 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 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 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 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 60 million infected and 20 million deaths Half of the 14,000 new infections each day occur among young people below age 25 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 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 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 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 exacerbates poverty and inequality puts tremendous pressure on health and social services puts tremendous pressure on health and social services creates large numbers of orphans who need support creates large numbers of orphans who need support decimates the workforce with enormous economic and social consequences decimates the workforce with enormous economic and social consequences

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

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

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

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

14. Slide 13: Magnitude and Trends in TB 8.8 million new cases/1.7 million deaths each year 8.8 million new cases/1.7 million deaths each year 95% of cases and 98% of TB deaths occur in the developing world 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 Africa has the highest TB rates per capita, but Asia carries the greatest absolute burden Poor people are especially vulnerable to TB due to: Poor people are especially vulnerable to TB due to: underlying health status underlying health status adverse living conditions adverse living conditions limited access to treatment 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 Without any treatment, half of those who fall ill will die Directly Observed Treatment, Short (DOTS) Directly Observed Treatment, Short (DOTS) cure rates of up to 95% cure rates of up to 95% prevents new infections prevents new infections prevents the development of drug resistance prevents the development of drug resistance treatment under DOTS is as little as US$ 10 per patient treatment under DOTS is as little as US$ 10 per patient Drug resistance is a major challenge Drug resistance is a major challenge

17. Slide 16: Magnitude and Trends in Malaria 500 million new clinical cases per year 500 million new clinical cases per year more than one million deaths each year more than one million deaths each year 40% of the world’s population exposed to malaria risk 40% of the world’s population exposed to malaria risk malaria reduces GDP growth by approximately 1% per year malaria reduces GDP growth by approximately 1% per year Poor worst affected: Poor worst affected: less access to services, information and protective measures less access to services, information and protective measures less power to avoid living or working in malaria-affected areas 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. Slide 18: Malaria -Prevention and Treatment The most cost-effective interventions are: The most cost-effective interventions are: - rapid diagnosis and effective treatment - rapid diagnosis and effective treatment - insecticide-treated bednets - insecticide-treated bednets - intermittent-presumptive treatment for - intermittent-presumptive treatment for pregnant women pregnant women - epidemic preparedness - epidemic preparedness Resistance to conventional anti-malarial drugs is a major challenge Resistance to conventional anti-malarial drugs is a major challenge ACTs ACTs Vaccine Vaccine

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

21. Slide 20: Avian Flu- Migratory Pattern