Infectious Diseases, Research Paper Example

Infectious diseases have become an issue of international concern. They spread worldwide and require joint international cooperation to combat. While the infectious diseases ceased to be the main health problem of developed countries where the first place has been taken by chronic illnesses, they remain the scourge of developing countries which often appear unable to struggle of their own.

D.P. Fidler mentions a number of ways in which public health has been critically affected by globalization (Fidler, 1996). First, technology and economic interdependence makes the world seem smaller and allows a rapid spreading of infectious diseases. The two factors presenting the greatest threat in terms of infection are the increase in international travel and the global nature of food handling, processing, and sales. The result is a surging of HIV/AIDS, tuberculosis, cholera, and malaria worldwide. In addition, the reverse of eliminating economic and political boundaries often appears to be poorer disease control. For instance, the free movement of goods, capital, and labor within the European Union makes it more difficult for particular states to protect their domestic populations from diseases acquired in other countries.

Second, as economic competition intensifies and the pressure on governments to reduce expenditures increases, public health programs budget shrinks in many countries leaving them unprepared to deal with disease problems. A number of reasons lead to the global deteriorating of health public infrastructures, which is the case even in developed countries.

Third, due to World Health Organization and other health-related nongovernmental organizations, public health programs become global. The latest medical achievements are increasingly available all over the world. The famous example is the worldwide eradication of smallpox in 1977. The reverse side of the process is extended life expectancy and overpopulation which, from the viewpoint of combating infectious diseases, is a fertile ground for the spread of disease due to lack of sanitation and overstretched public health infrastructures. Another negative aspect is the widespread use and overuse of antibiotic treatments which has led to the development of drug-resistant pathogens.

In Fidler’s estimation, the experience of infectious disease fighting that we had had by the end of the twentieth century was not very positive (Fidler, 1996). Although WHO succeeded in globalizing disease control programs, it seems to have been unwilling to use international law despite being entitled to do so. The International Health Regulations administered by WHO include a set of international legal rules relating to infectious disease control. However, the regulations only cover plague, yellow fever, and cholera. International declarations and treaties (like the Universal Declaration of Human Rights or International Covenant on Economic, Social and Cultural Rights stress the importance of health creating the right for it, but this right does not mean the introduction of efficacious infectious disease control. WHO failed to adopt rules on trade inhuman blood and organs which is also relevant to the question we are discussing as can be seen from the sale of HIV-contaminated blood in international commerce. Disease control was also addressed in international regulations apart from the ones produced by WHO, for example, treaties controlling marine pollution from ships. Other parts of international public health law such as rules about infant formula and guidelines on pharmaceutical safety do not deal straight with the control of infectious diseases.

Unfortunately, the legislation in terms of international disease control was questioned in the twentieth century many times. In 1975, WHO published a report stating that the International Health Regulations had not functioned satisfactorily at times of serious disease outbreaks. Later the Regulations were called a failure and were not complied with. The ensuing HIV/AIDS outbreak proved the point (Melansek, 2009). The Regulations did not cover AIDS and  states did not have any notification requirements covering the new disease. As HIV/AIDS spread globally, many states introduced exclusionary policies that often violated provisions of the health regulations. In other words, in case of HIV/AIDS, the biggest disease crisis of the century, the International Health Regulations appeared irrelevant and even had to be openly violated.

Many argue that the reason why WHO appeared so passive when it came to applying international legislation was that WHO was mainly composed of scientists, doctors, and medical experts and had a non-legal strategy.

The dire need for measures against infectious diseases made Japan announce the Okinawa Infectious Diseases Initiative (IDI) at the G8 Kyushu-Okinawa Summit held in July 2000. The results were summarized in  the part Infectious Diseases of ODA Disbursements in Fiscal Year 2005. The target plan was to spend 3.0 billion US dollars over five years from 2000 and carry out comprehensive measures to fight against infectious diseases in developing countries through bilateral and multilateral assistance. The expenditures, however, exceeded the target sum amounting in 2004 to 5.8 billion US dollars. In June 2005, when the IDI was completed, the Government of Japan announced the Health and Development Initiative (HDI). This program is more extensive and is to provide comprehensive assistance amounting to approximately 5.0 billion US dollars over five years, including measures against infectious diseases.

The international community established the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Global Fund’s task is to promote wide-ranging public-private partnership and extend the traditional scheme of inter-governmental cooperation. The Global Fund has approved a total of 5.6 US dollars in 132 countries in support of about 400 projects. By the year 2010, the Global Fund is expected to succeed in the following:

1. a) providing anti-retroviral treatment (an anti-AIDS drug) to 1.8 million people;
2. b) HIV counseling and testing for 62 million people;
3. c) basic care and support for 1 million AIDS orphans;
4. d) providing tuberculosis treatment (Directly Observed Treatment, Short course) to 5 million people;
5. e) distributing 109 million insecticide-treated bed nets;
6. f) providing Artemisinin-based Combination Therapy (an anti-malaria drug) to 264 million people.

If we turn to the statistics, we will see that an estimated number of 40 million people are infected with HIV worldwide. The measures against it in developing countries include HIV/AIDS prevention activities for young people and high-risk groups which are to encourage people to change their sexual behavior, free distribution of condoms, voluntary counseling and testing for HIV and developing AIDS testing and diagnostic systems. Other measures include the prevention of infection through blood transfusions – the establishment of blood donation volunteer networks primarily among university students, the enhancement of the blood donor data bank and strengthening testing functions.

Tuberculosis remains an issue of primary importance for public health. The situation today is characterized by high incidence of tuberculosis both in developing and developed countries, high level of multidrug-resistant tuberculosis, the appearance of extensive drug-resistance type, tuberculosis outbreaks in the growing pool of people living with HIV and vast population in prisons, the increasing mobility of people leading to difficulties in controlling the disease. According to the World Health Organization Regional Office for Europe, which developed  Plan to Stop TB in 18 High-priority Countries in the WHO European Region, 2007–2015, the high-priority tuberculosis countries in the European regions include Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. The Plan to Stop Tuberculosis in the Region for 2007-2015 includes the following measures:

1. a) achieving and exceeding the targets of 70% detection of sputum-smear positive case and 85% treatment success rate;
2. b) providing universal access to high-quality care for all people with tuberculosis, especially the poor and marginalized.

These measures are to be reinforced by poverty fighting policies.

Other tuberculosis priority countries include Cambodia, Myanmar, the Philippines, Zambia etc. It is intended to provide the Directly Observed Treatment, Short Course strategy there.

Efforts to combat malaria in Africa mainly include providing long-lasting insecticide-treated nets which is expected to prevent the deaths of up to 160,000 children in Côte d’Ivoire, Ethiopia, the Democratic Republic of the Congo etc.

Polio has been nearly eradicated from the entire world. In 2000, WHO declared the western Pacific region a polio-free area. However, UNICEF and WHO provide active assistance for the dissemination of polio vaccinations in the South Asian and African regions, where polio still presents a formidable threat (Ethiopia, Ghana, Sudan, Sierra Leone, Nigeria, Zimbabwe etc.).

Parasitic Diseases are fought with through the International Parasite Control Centers that have been established in Thailand, Kenya, and Ghana as bases. The anti-parasite measures include prevention and treatment, educational campaigns, and the installation of toilets. The measures are aimed at combating Chagas disease, duracunculiasis, filariasis, schistosomiasis, and other parasitic diseases. Steps are taken to eradicate filariasis in the western Pacific region with the objective of achieving this by 2010.

Measles is still a major cause of child mortality among the vaccine-preventable diseases. The international launched the Measles Initiative in 2001 and is working at halting the spread of measles in regions and countries and its eventual elimination. The international community should assist the Global Measles Partnership and encourage the WHO to continue to implement its plans on measles prevention and elimination, as mandated by the World Health Assembly in 2004, and to propose measures donors and national governments should take to reach and maintain a high level of immunity to measles.

The international community also feels that more intensive measures should be taken to fight against other preventable diseases, including pneumonia, diarrhea and neglected diseases such as leishmaniasis and onchocerciasis, especially by increasing the volume and quality of medical research on neglected diseases in developing countries.

The problems associated with outbreaks of new infectious diseases should also be solved at international level. The emerging diseases include, for example, SARS and avian influenza, the latter having been recognized among domestic poultry, primarily in Asia, since the end of 2003 (Asamoa-Baah, 2004). This highly pathogenic strain (virus subtype H5N1) has been gradually spreading geographically, leading to a number of human infections and deaths. As there are more and more cases of the infection being transmitted from birds to humans, so does the danger of emergence of a new influenza strain. The international community has been discussing the promotion of countermeasures. Taking early containment measures including monitoring occurrence of outbreaks, quarantining patients, and placing restrictions on movements of people should prevent a world pandemic.

The nature of the emerging disease threat presents specific difficulties for international law. The global character of the problem means that what is needed to control emerging diseases is agreement by most states. If any large country or group of countries fails to participate, a gap in the global surveillance and control network threatens the efficacy of the entire effort. The problem is akin to the one emerging in case of environmental threats, such as ozone depletion, when only global regimes can deal with the problem adequately.

The general task of the G8 formulated on the Summit in Saint-Petersburg in July 2006 and presented on Canada G8 website is as follows:

1. to improve international coordination on the surveillance and monitoring of infectious diseases, including better coordination between animal and human health communities, building laboratory capacities etc.;
2. to intensify scientific research and exchanges and involve scientist from developing countries;
3. to fulfill prior G8 commitments on the major infectious diseases, in particular by mobilizing support for the Global Fund to Fight AIDS, Tuberculosis, and Malaria, in terms of fighting HIV/AIDS, stopping tuberculosis, scaling up action against malaria etc.
4. to improve access to prevention and treatment of diseases for people in need;
5. to work with relevant international organizations to mitigate the health consequences of emergencies (both natural and man-made disasters) through better cooperation and capacity building.

In conclusion, the threat of infectious diseases faced by our increasingly globalized world requires effective cooperation of the international community. It is to provide permanent disease control and take prevention measures by giving everyone access to healthcare and adequate sanitation, vaccination etc. It also should ensure an effective universal legislation in terms of infectious diseases and provide treatment for people who already suffer from them worldwide. A particular challenge to the international community is presented by emerging infectious diseases which require extensive scientific research and immediate measures to stop their spreading.

References

Asamoa-Baah, A. (2004) Can New Infectious Diseases Be Stopped? Lessons from SARS and Avian Influenza. Retrieved March 25, 2009, from http://www.oecdobserver.org/news/fullstory.php/aid/1284/Can_new_infectious_diseases_be_stopped__Lessons_from_SARS_and_avian_influenza_.html

Canada’s G8 Website. Fight Against Infectious Diseases. Retrieved March 23, 2009, from http://www.canadainternational.gc.ca/g8/summit-sommet/2006/infectious_diseases-maladies_infectueuses.aspx

Fidler, D.P. (1996) Globalization, International Law, and Emerging Infectious Diseases. Retrieved March 25, 2009, from http://www.cdc.gov/ncidod/eid/vol2no2/fidler.htm

Melansek, A. (2009). International Community. Retrieved March 25, 2009, from http://www.idebate.org/debatabase/topic_details.php?topicID=267

ODA Disbursements in Fiscal Year 2005. Infectious Diseases. Retrieved March 24, 2009, from http://www.mofa.go.jp/policy/oda/white/2006/ODA2006/html/honpen/hp202020302.htm

World Health Organization Regional Office for Europe. Plan to Stop TB in 18 High-priority Countries in the WHO European Region, 2007–2015. Retrieved March 25, 2009, from http://www.euro.who.int/InformationSources/Publications/Catalogue/20071221_1