Global Infectious Diseases


Excerpt From: Rischard, Jean-Francois.

“High Noon: 20 Global Problems, 20 Years To Solve Them.” iBooks.


“The world suddenly faces an appalling health crisis. Once more, it originates largely in poverty and destitution—in the developing world. AIDS, malaria, tuberculosis, pneumonia, diarrhea, and measles now kill 13 million people a year, and the numbers keep going up. They threaten to reverse decades of development in many developing countries. They know no borders and spread faster than ever: for perspective, consider that at the end of World War I, swine flu circled the world five times in eighteen months, when commercial air traffic did not even exist.18 Imagine how fleet-footed diseases have become now. AIDS, malaria, and tuberculosis are especially challenging.

Today, 40 million people suffer from AIDS,20 95 percent of them in developing countries, 28 million in Africa alone. Since the epidemic started, twenty or so years ago, more than 60 million have developed AIDS, and 25 million have died—close to the toll of the Black Death between 1347 and 1352 in Europe.Every day, 15,000 get infected, most of them between the ages of fifteen and twenty-four. The spread of AIDS has slowed in Africa—in part because the virus encounters fewer uninfected people—but it is now accelerating in India, Russia,22 the Caribbean, and lately China.23 In Africa it’s often spread by roaming armies, in Russia by intravenous drug users, in India by truckers, in Thailand by inmates sharing needles while in prison, in Myanmar by poor monks sharing one razor blade—the disease always finds its carriers. Prostitution and unsafe sex are always part of the equation.

Some 12 million children have been orphaned by AIDS, a figure projected to balloon to 40 million by 2010. Life expectancy, which had inched up about twenty years in many places in Africa and elsewhere over the last thirty years, has abruptly declined—by an average of six to seven years in Africa, and by more than ten years in South Africa and well-managed Botswana. In South Africa, for example, 4 to 7 million could die in this decade alone if no effective treatment is provided.24

More than sixteen African countries have incidence rates exceeding 10 percent of the adult population. When those rates reach 20 percent or more—as they have in some seven countries—the loss of annual income can exceed 1 percent of GDP. A downward spiral sets in. The disease strikes at young, sexually active people who would be the core of the labor force of tomorrow.25 In some countries, already fragile civil services get depleted fast, and one of the worst casualties has been in education. In Côte d’Ivoire, AIDS has been responsible for 70 percent of the deaths among teachers. In some countries, as many teachers die from AIDS as retire or are trained annually.

Malaria, caused by a mosquito-borne parasite, is preventable but remains one of the great challenges of our times. Almost 2 billion people are affected in one way or another by the disease and its fallout, and the situation is getting worse. There are now some 300 to 500 million clinical cases a year, 90 percent in sub-Saharan Africa. One million people die from it every year. And in Africa, malaria inflicts an even greater disease burden than AIDS. Without malaria, Africa’s GDP could well be $100 billion higher. But even outside Africa—in Asia, Latin America, even Eastern Europe—the malaria situation is getting worse.

Why the flare-up? Because of the debilitated health systems in Africa—now also massively burdened by AIDS—and the disease’s new resistance to drugs, reported all over the world.


Even tuberculosis—caused by bacteria spread mostly by already infected people’s coughing—is making a comeback, fifty years after the discovery of drugs that can cure it. It is on the rise all over the developing world—and now is increasing again even in rich countries, where half the cases are among the foreign-born population. There are now 8–10 million new cases of tuberculosis a year, with the major increase registered in African populations heavily affected by AIDS, but with the greatest absolute burden in Asia. About 2 million people die from it each year, and the disease costs the world some $12 billion annually in lost income. After decades of successful control, country after country is slipping back, with Peru one of the most spectacular cases.

Why so? Again, partly because health systems are being cluster-bombed by so many diseases at once, and partly because of the emergence of drug-resistant strains.

The agenda for global action has numerous parts, many of which have received intense international discussion—but timid effort:

We need to strengthen the health systems in many developing countries. This won’t be possible from local resources alone and is yet another reason for thinking big with respect to official aid. Better health promotion and prevention are important in this—considering the stark fact that treatment for AIDS, even at reduced drug prices, costs thirty times the average $10–15 per inhabitant that the poorest developing countries can typically afford to spend on their health systems.

We need special emergency funds to prevent and treat the three diseases. The G7 group of leading countries, together with some partner countries and private donors, did just that at the 2001 Genoa summit, but at a level (about $2 billion for a first go) far below the real needs. The total financing needed to curb these three diseases is on the order of $5–7 billion a year over twenty years, and possibly much more.26

Part of these resources should be used to make advance purchase commitments at a global level for new, more effective products, so as to give laboratories a bigger incentive to develop them. Today, their incentives are all stacked towards research on noncommunicable diseases in rich countries.

For that reason, we also need to create tax incentives in rich countries to encourage development and clinical testing of these products, and to remove blockages to their marketing in poor countries.

We may have to come up with tiered drug-pricing systems and rethink licensing rules so as to strike the difficult balance between making products more affordable and not wrecking the laboratories’ motivation for developing them in the first place—a typical dilemma in the area of intellectual property rights (see Chapter 14).

We may need to construct a new global public health approach that focuses on the good of the global public as such, above and beyond country concerns and the primacy given to individual health.

Infectious diseases have become one of the world’s most urgent issues. We are in a race against time to control the spread of the most dangerous diseases, before the diseases wear down the drugs themselves. Though much of it is centered on Africa, infectious disease is an inherently global issue, and like poverty and education, is an “underlier” issue—failing to solve it sets back the solution of other issues. And as some of the figures above show, the cost of resolution is again modest in global terms.”


Excerpt From: Rischard, Jean-Francois.

“High Noon: 20 Global Problems, 20 Years To Solve Them.” iBooks.