© Neena Bhandari

Professor Kevin Marsh, Director of the Kenya Medical Research Institute (KEMRI) Wellcome Trust programme in Kilifi, Kenya and Professor of Tropical Medicine at the Oxford University

What are the most important challenges in the field of infectious diseases facing the world in the coming decade?

The three major infectious diseases problems worldwide have been Tuberculosis, HIV and Malaria. We can add three more massive global issues: Pneumonia, which is always ignored. It is a major killer of children throughout most of the world and still there isn't the same degree of emphasis on it.

Secondly, the general issue of drug resistance and antibiotic resistance in particular, which is going to be a major issue all over the world. As it gets worse, it removes cheap effective drugs and pushes us towards more expensive drugs and that in the end, in case of sudden infections, will make it very difficult to treat if resistance keeps developing in the same sort of way as it has been in the last couple of years.

Thirdly, the unknowns i.e. something completely out of the blue like the SARS outbreak a few years ago. The problem is knowing how to prepare for it and even if you do prepare for it then getting it right. If you under prepare, you will be criticised for allowing a disaster and you over prepare, you will be criticised for wasting money. So the problem of how to deal with global new emerging infections is always there in the background.

Are there sufficient global resources for fighting Malaria, AIDS, and Tuberculosis? The challenges of malaria in Africa and how is it different to Asia?

There has been a real increase in international and national investment and the amount spent on malaria control has gone up 10 times in the last 10 years. It is now about US$ 2 billion while a decade ago it used to be US$ 200 million so in that sense things are improving a lot. But it is still not yet enough because we need about US$ 5 billion a year. There has been a significant increase in money for controlling these diseases from the Global Fund and governments.

The number of people exposed to Malaria in Asia is more than in Africa so in one sense we have underestimated the problem in Asia, but it is still true that 90 per cent of all deaths due to malaria happen in Africa. Malaria in Africa is much more concentrated and intense so even though the number of people exposed to the disease is less, the impact in terms of health is greater.

There are five species of malaria that commonly infect humans and two are most important in terms of numbers and they are Plasmodium falciparum and vivax. Plasmodium Falciparum is a problem all over the world and also in Africa. On the other hand, Asia has both species and they are often in the same places. It has been assumed in Asia that vivax isn't so important, but now people are beginning to realise that for cause of ill-health, it is really more important than people thought and it is also more difficult to deal with in terms of control than Plasmodium falciparum.

So Asia has this additional problem of dealing with a species that is more difficult to control. There is a third emerging species of Plasmodium knowlesi, which is a malaria transmitted in monkeys. In the last few years across Asia and particularly in parts of Malaysia, this species is causing severe disease in humans. This is a new disease in humans, but in terms of numbers it affects less people than the other two species.

Is global warming having an impact on the spread of malaria and dengue in some of the most populous tropical and equatorial countries?

While global warming is not having an impact on the spread of malaria as yet, it is predicted that global warming will spread the range of dengue and the disease may begin to surface in areas where it wasn't previously a problem.

Are governments meeting their commitments to health aid and the Millennium Development Goals when it comes to immunization?

Immunization has been one of the most successful international efforts. In the 1960s, less than five percent of the world's children were immunised and now 80 percent or more are immunized. There are individual countries, where there have been lapses and they haven't met their commitment, especially countries where there has been political conflict or war and in others like Nigeria, where there has been a problem with polio vaccine because of religious concerns.

People are worried that the Millennium Development Goals won't be met, but although there are clearly lots of problems, they can be met in many places, they will be met in some places and they could be met in other places. There isn't that hopelessness, which many think there is when it comes to health issues in Africa. There are quite large areas of Africa where things are happening fast and they could be accelerated elsewhere with the right kind of inputs.

Two things will be really critical to meeting the MDGs in Africa - controlling malaria as now we know that malaria causes lots of secondary deaths, and controlling pneumonia. Malaria makes it more likely to get other serious illnesses. In Bioko, Equatorial Guinea, malaria was controlled in one sweep in a year and their childhood mortality was reduced by two-thirds in one go. If you control malaria aggressively, you can prevent an enormous number of deaths due to not just malaria but other diseases. In Africa, if you control malaria, you can reduce childhood mortality down to the levels to achieve MDGs.

In coastal Kenya, malaria has dropped by 90 percent in the last five years. Infant childhood deaths have dropped by 40-50 percent in the last few years. It used to be 115 deaths per 1000 children under 5 years old, last year's survey put it at 74/1000. It is one of the countries closer than other in meeting the MDGs. In some countries of Africa, there has been a major drop in mortality like Ethiopia, Malawi and Niger.

Is there a renewed commitment for research on vaccines for the Third World such as Malaria, HIV, acute respiratory disease, diarrhoeal disease, meningitis?

There have been vaccine initiatives for malaria which is in its Phase 3 Trials and may go for registration in the next few years.

Pneumococcal vaccination standardly used in the US, Europe and Australia, has now been introduced in Africa. It is likely to significantly reduce deaths due to pneumonia and that will help achieve the MDGs in Africa by bringing down childhood mortality.

The issue in the long term is affording the vaccines in routine use. The Global Alliance for Vaccines and Immunisation (GAVI) funds governments but in the long run governments would have to develop mechanisms to fund it themselves to maintain vaccine coverage. 

© Neena Bhandari, Inter Press Service

SYDNEY, June 11, 2010 (IPS) – While successful immunisation programmes worldwide have saved millions of lives, the threat of new infectious diseases and drug-resistant strains of existing diseases are posing a major challenge to governments, especially in developing regions like Asia, in meeting their commitment to the Millennium Development Goals (MDGs).

“We have two major problems in the context of emerging infectious diseases in the coming decade – outbreaks, which might develop into pandemics, and the continuing increase in anti-microbial resistance,” Professor Tanya Sorrell, director of the newly established Sydney Institute of Emerging Infectious Diseases and Biosecurity, based at University of Sydney, tells IPS. 

This raises “the dual problems of preventing and managing outbreaks and treating infections which are not responsive to the drugs we have available,” she says.