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Foundations of Global Health Communicable Diseases (Part 2

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Foundations of Global Health Communicable Diseases (Part 2 Foundations of Global Health Learning Objectives • Identify disease prevention, Communicable Diseases (Part 2): control and elimination efforts Programs, Control & Elimination Efforts • Describe the progress towards eradication of poliovirus and We've taken on the major health problems of guinea worm the poorest - tuberculosis, maternal mortality, AIDS, malaria - in four countries. We've • Distinguish between control scored some victories in the sense that we've cured or treated thousands and changed the programs for HIV, Malaria & TB discourse about what is possible. Dr. Paul Farmer • Outline successful interventions against communicable diseases AIDS and malaria and TB are national security issues. A worldwide program to get a start on dealing with these issues would cost about $25 billion... It's, what?, a few months in Iraq. Jared Diamond, author Guns, Germs, & Steel 2 30 Years After Smallpox… Poliovirus • Potential eradication of poliomyelitis and • Family: Picornaviridae guinea worm • 3 serotypes (wild) – Type 1: frequent outbreaks • Global Polio Eradication Initiative largest – Type 2: eliminated public health program ever attempted – Type 3: geographically confined • Behind schedule to • Vaccine derived strains can also circulate meet target • Fecal-oral transmission deadlines • Human reservoir • 95% asymptomatic cases (ratio 200:1) 3 4 Epidemiology Polio already eradicated in >100 countries (& one type of poliovirus already eradicated) • World Health Assembly adopted eradication goal 1988 • Last case in United States in 1979 • Western Hemisphere certified polio-free in 1994 • Worldwide decline: – 1988: 350,000 paralytic cases – 2008: 1606 cases 1988 Recurrent importations2009 into polio-free areas 5 Slide Source: Rotary International 6 1 2010 Polio Map Wild polio virus type 2 already eradicated Slide Source: Dr. Weiser, EIS CDC 7 8 Future Challenges Financing, 1988 to 2010: $7.13 billion USAID US CDC France Italy • Eradication not been met due to failure to UK Domestic G8 Canada Resources 49% Bangladesh vaccinate enough children with multiple doses Germany 14% Indonesia Russian India • Variety of reasons continue to hinder Federation Japan Pakistan campaign European Multilateral Commission Netherlands Non-G8 Sector OECD/ IFFIm Denmark – Nigeria: rumors about vaccine safety led to 12% Other 5% suspended polio immunizations in 2003 – 2004 World Bank (India) Norway WB Investment Partnership for Polio Sweden – Afghanistan/Pakistan: political instability or Others UN Foundation armed conflicts Private 2009-10 Funding Gap: Bill and Melinda Gates Sector Rotary Foundation 20% International US$ 345m of $1.34b budget – India: underserved populations difficult to reach ‘Other’: Governments of Angola, Austria, Australia, Belgium, Czech Republic, Finland, Hungary, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malaysia, Monaco, Namibia, New Zealand, Nigeria, Oman, Pakistan, Portugal, Qatar, Republic of Korea, Russian Federation, Saudi Arabia, Singapore, Spain, Switzerland, Turkey, the United Arab Emirates; African Development Bank; AG Fund; American Red Cross; De Beers, Inter-American Development Bank, Central Emergency Response Fund (CERF), InternationalSlide Federation Author: of Red Christy Cross andOttendorfer, Red Crescent Societies, Oil for Food Programme, OPEC Fund, 9 Sanofi Pasteur; Saudi Arabian Red Crescent Society, Smith KlinePhD, Biologicals, MSPH UNICEF (2010) National Committees, UNICEF Regular and Other Resources, United Arab Emirates Red Crescent Society, WHO Regular Budget and Wyeth. 4 Strategies to STOP Polio Polio • Routine immunization – high infant-immunization coverage – 4 doses of oral polio vaccine (OPV) within 1st year • National Immunization Days – mass immunization campaigns – conducted in 2 rounds, 1 month apart – 3 to 5 years required to interrupt transmission, sometimes longer • Surveillance – find, report, investigate cases of acute flaccid paralysis • Supplementary Immunization Activities (SIAs)/ mop-up campaigns – targeted, large scale immunization campaigns following new polio cases – house to house calls 11 12 2 Rotary International • World’s first service club organization – 1.2 million members in 33,000 clubs worldwide • Since 1985, volunteers work to eradicate polio under the motto Service Above Self • PolioPlus program – Estimated to raise $1.2 billion for eradication – Funds operational costs (transportation, vaccine delivery, social mobilization, health worker training) – National Immunization Days 13 14 Polio: The Final Inch Dracunculiasis: Guinea Worm • 99% reduction in cases since 1988 • Parasitic worm Dracunculus medinensis known as • Stronghold in 4 countries– but fewer cases reported in 2010 "Guinea worm" – Re-established transmission in 23 other countries from importation • Ancient disease called the fiery serpent • In 2009, over 361 million children immunized in 40 countries, with 273 SIAs • 3.5 million cases reported in the 1980s from 20 • Very, very close– hardest part is reaching every child (Final Inch) countries – Impoverished people, lack access to clean water • Parasite migrates under An HBO Documentary Film the skin to emerge from feet or joints • Debilitating disease 15 16 Guinea Worm Map Guinea Worm Cycle 17 18 3 Good Indicators • Easy diagnosis (presence of emerging worm) • Cyclop transmission vector is not a mobile vector • Limited incubation period in both cyclops and humans • Effective, low cost interventions • Limited geographic distribution, seasonal timing • Government political commitment • No known animal reservoir 19 Source: Carter Center 20 Recent Estimates Guinea Worm Eradication Efforts • Education campaigns • Treatment of water sources with insecticides • Filters for drinking water • NO VACCINE or MEDICINE used Source: WHO. 21 22 Control Programs: Triple Threat Triple Threat = MDG 6 • Communicable diseases continue to cause large • Target 6a: Halt and begin to reverse the spread of HIV/AIDS – Lower HIV prevalence among population aged 15-24 years burden on Global Health – Increase condom use at last high-risk sex • Triple Threat: An estimated 13.6 million – Increase knowledge of HIV/AIDS in population aged 15-24 years died in 2008 from an – HIV infectious disease • Target 6b: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it – Malaria – Provide access to antiretroviral drugs to progressive cases – Tuberculosis • Target 6c: Halt and begin to reverse incidence of malaria & other major • Brief discussion on diseases – Lower incidence and death rates associated with malaria successful programs – Increase # of children under 5 sleeping under insecticide-treated bednets for control of these diseases – Increase anti-malarial drug treatment of children under 5 with fever – Lower incidence, prevalence and death rates associated with tuberculosis • Eradication or elimination remains a distant goal – Increase # of TB cases detected and cured under DOTS 23 24 4 HIV in United States HIV Map • More than 1 million people living with HIV – 1 out of 5 do NOT know they are infected • Every 9½ minutes someone is infected • 56,300 new infections in 2006– complacency?! • People with HIV still develop AIDS • More than 14,000 people with AIDS still die each year (US), even with new therapies 25 26 HIV Population Impacts HIV/AIDS Prevention Timeline 27 28 100% Condoms Program Condom King • Mechai Viravaidya is a physician and fantastic • Widespread sex industry in Thailand public health program manager Tiger Woods statue made • HIV prevalence in brothel sex workers entirely of condoms. – Led programs that dramatically cut Thailand’s Created by Dr. Mechai for increased from 3% (1989) to over 15% (1991) Cabbages & Condoms population growth rate & new HIV infection rate • 100% Condom Programme started in ’91 restaurant in Bangkok. • Started NGO called Population & Community – No condom, no sex Development Association (PDA) in 1974 – Monitored condom use in brothels – Largest non-profit organization in Thailand with – Scheduled medical check ups on sex 600 employees and over 12,000 volunteers workers – Reached over 10 million people in 18,000 villages – Education campaigns • Effective educational methods: – Free condoms – Condom-blowing competitions • Tracing of STD infections to – "Cops and Rubbers" campaign brothels = fines – Cabbages and Condoms restaurants • Dramatically lowered incidence of HIV infections • HIV rate declined by 75% between 1990-2003! 29 30 5 HIV/AIDS Treatment Timeline 3 x 5 Initiative (WHO) • Launched by UNAIDS & WHO in 2003 • Ambitious goal of providing ART treatment to 3 million people in 50 developing countries by 2005 (3x5) – Planned to train over 100,000 health workers, improve health infrastructure ART therapy is critical life-saving – But, over $5 billion funding shortfall treatment for HIV/AIDS patients. A true miracle drug that can bring • Did not reach the target goal until 2008 people back to life, shown below in before and after photos! • World is still very far from providing ART to all HIV/AIDS patients (universal coverage) 31 32 HIV/AIDS Spending Timeline President's Emergency Plan for AIDS Relief • Introduced in 2003 (PEPFAR v.1) by former President George W. Bush • Largest commitment by any nation to combat a single disease – Cornerstone & largest component of U.S. Global Health Initiative • In 2008, reauthorized for $48 billion through 2013 (PEPFAR v.2) – Prevent 12 million new infections – Treat 3 million people living with AIDS, – Care for 12 million people (esp. orphans) • Transition from EMERGENCY
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