Download What will it be, When will it come, and Why?

The next pandemic: what will it be,
when will it come, and why?
Mark Collins BA MBA PhD
Director,
Commonwealth Foundation
Introduction
Patterns of infectious disease emergence over the
past 40 years give serious cause for concern
• Late 1960s – diseases believed to be under control
• New diseases like HIV and SARS emerged
• Tuberculosis and malaria grew once again
• Resistance to anti-microbials complicates matters
• New animal diseases discovered, e.g.BSE
• Bird flu becomes a global pandemic and threatens
to bridge across to humans.
Infectious diseases kill more than 20% of people in
the world and we don’t know when or from where the
next pandemic might come.
UN Health Targets
The Millennium Development Goals, adopted in 2000,
include some fundamentally important targets for health:
Goal 1: Eradicate extreme poverty & hunger
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6 : Combat HIV & AIDS, malaria &
other diseases
At the half way point, the picture is mixed.
Source: http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
Eradicate extreme poverty
Target: Halve between
1990 and 2015 the
proportion (%) of people
whose income is less
than US$1 per day
Achievement: Poverty
has fallen from one third
of all people to one fifth
Source: http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
Improve maternal health
Target: reduce by
three quarters the
maternal mortality
ratio
Histogram shows
proportion of
deliveries
attended by skilled
health care
personnel, 1990
and 2005 (%)
Source: http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
Reduce child mortality
Target: two thirds
reduction in mortality rate
of children under five
Histogram shows under 5
mortality rate expressed
as deaths per 1000 live
births in 1990 and 2005
Source: http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
Combat HIV, AIDS, malaria
& other diseases
HIV prevalence
has levelled off in
the developing
world, perhaps
partly because
deaths from AIDS
continue to
increase in subSaharan Africa
Source: http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
Today’s major killers
Disease
Worldwide mortality 2002
% total deaths
Total number
Lower respiratory tract
HIV and AIDS
Diarrhoea
Tuberculosis
Malaria
Childhood infections
Other infections
6.8%
4.9%
3.2%
2.7%
2.2%
2.0%
1.0%
4.0 M
2.8M
1.8M
1.6M
1.3M
1.1M
0.6M
TOTALS
22.8%
13.2M
Source WHO 2004 Statistical annexe
Impact of disease on nations
Developing countries
• Underlying burden of infection greater
• Children disproportionately affected
• Half of deaths in under 5’s due to infections
• Malnutrition exacerbates the problem
• Low tech measures can make a big difference
Developed countries
• High social costs from infectious disease
• In UK 10% of deaths are from infection
• 50% of adult consultations die to disease
• Prevention of pandemics is costly
• But pandemic outbreaks could cripple nations
Origins of pandemic infections
Six major sources of potential future pandemics
•
•
•
•
•
•
Novel pathogens – viruses continually evolve
Pathogens acquiring resistance
Zoonoses – diseases acquired from animals
HIV and AIDS, tuberculosis and malaria
Acute respiratory tract infections
Sexually transmitted diseases, including HIV
Trends in novel pathogens
Bird flu H5N1
HIV
vCJD
SARS
New human pathogen species detected since 1980.
Source: Foresight project, UK OSI, 2006
Pathogens acquiring resistance
This is a problem that is getting worse:
• Resistance arises in bacterial, viral,
fungal and parasitic diseases
• Antibiotics, vaccines, fungicides and
insecticides become less effective
• Resistance from mutation, acquiring
new genes or natural selection
• Enteric pathogens, pneumonia, TB,
gonorrhoea, malaria, HIV and
MRSA all resist
• Currently controlled diseases could
re-emerge as a result
Zoonoses
• Animals are a common
source of human disease
• The risk is growing because
of intensive farming
• Bushmeat hunting in Africa
presents more chance for
species jump
• Viral haemorrhagic fevers
could mutate to chronic
forms and spread
Bushmeat - risk of disease
Growth in
bushmeat
hunting in Africa
presents a major
risk of new
zoonotic
diseases – and
detection would
be slow.
HIV and AIDS, TB & malaria
These three diseases are linked as the dominant epidemics in
Africa. In some areas 80% of TB cases are in people living with
HIV. The cost of malaria to Africa is US$12 billion annually.
Fighting the diseases presents special problems:
• Stigma and discrimination against people with HIV and AIDS
• Lack of access to care for living with TB
• Drug resistance to malaria, and lack of mosquito nets
HIV in Africa
Respiratory tract infections
•
•
•
•
•
Epidemic ARIs are generally zootic in origin
Bird flu is an acute respiratory disease
Today’s biggest new disease threat
Confirmed in 60 countries
Probably worldwide in
nine months
• More than 240M poultry
killed
• Massive risk of socioeconomic impact in Asia
Bird flu: the risk to humans
•
•
•
•
•
•
It could cross to humans as Spanish flu did
Humans have no immunity to this strain
Vaccines cannot be made in advance
World capacity for vaccine production low
Low income countries are most at risk
Rural community risks
contact with poultry
• Medical and essential
services overwhelmed
Sexually transmitted diseases
• Sexually transmitted diseases are on the
increase worldwide
• Antimicrobial resistance is on the increase
• Many infections remain undiagnosed and even
more are untreated
• Pregnant women are a
key target, to reduce
transmission to newborn
children
Disease risk from
environmental change
Damage to ecological processes can create better
conditions for infectious disease. Factors include:
• Encroachment into forests that harbour zoonoses
• Reduction in natural biodiversity that controls pests
• Creation of conditions that favour disease vectors
- climate change
- changes in surface waters
• Long distance trade in wild
animals
Source: Ecosystems & Human Wellbeing. Millennium Ecosystem
Assessment 2005. WHO
Climate change
Climate change increases risk of
1 metre sea level rise
pandemic by:
will inundate 17.5%
• assisting survival of pathogens,
of Bangladesh
hosts and vectors;
• creating new and favourable habitats,
• and through social change.
Disease patterns:
• HIV & AIDS and TB unchanged
• cholera and diarrhoeal diseases
more common
• malaria and other vector borne
diseases spread more widely
Source: Baylis M. 2006 Climate change & disease of plants,
animals and humans: an overview. OSI, London
Health care systems
Human resources limitations in the developing world
constrain achievement of the MDGs and heighten the
risk of pandemics. Problems include:
• Lack of trained personnel
• Lack of motivation & poor performance
• Migration of health workers, including pharmacists
• Impact of HIV and AIDS
Source: Wagstaff A. & Claeson, M. 2004.
The Millennium Development Goals for
Health: Rising to the Challenge. World
Bank 186 pp.
Medicine access & affordability
Tackling pandemics and the MDGs
will require much-improved access
to medicines:
• Shortages are commonplace in
developing world health centres
• Counterfeit drugs are everywhere
• Affordability prevents many from
getting access.
Source: Wagstaff A. & Claeson, M. 2004. The Millennium
Development Goals for Health: Rising to the Challenge.
World Bank 186 pp.
Pandemics and pharmacists
Pandemic diseases are not yet controlled, and new ones will
certainly arise. They kill millions of people and the social and
economic costs of control and prevention are huge.
Three principal actions need to be taken:
1. Increase overseas development
assistance and invest in medical training
and health care systems.
2. Improve access to and affordability of
genuine drugs; improve drug use to control
resistant strains
3.Develop and implement new detection,
identification and monitoring systems, from
global satellite surveillance to hand-held
diagnostic kits.
Thank you!
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