Where do infectious diseases fall on the WHO’s list of challenges to address during the 2020s?
The World Health Organization (WHO) is ushering in the new decade by releasing a list of urgent health challenges that require global attention.
The list comprises 13 challenges, many of which are interwoven and require attention from more than just the health sector. These hurdles range from addressing health worker shortages to expanding global access to medicines. As Tedros Adhanom Ghebreyesus, PhD, WHO director-general, pointed out, none of these challenges are simple fixes, but with proper resource investment, there are solutions that can be reached.
“Countries invest heavily in protecting their people from terrorist attacks, but not against the attack of a virus, which could be far more deadly, and far more damaging economically and socially. A pandemic could bring economies and nations to their knees. Which is why health security cannot be a matter for ministries of health alone,” Tedros wrote.
How do infectious diseases fall into the WHO’s list? Let’s take a look.
According to the WHO, infectious diseases such as HIV, tuberculosis, hepatitis, and malaria will lead to an estimated 4 million deaths in 2020. Most of the individuals who will be affected will be those from lower-income countries with poor health.
Although neglected tropical diseases, sexually transmitted infections, and emerging infections are a serious threat to global health, vaccine-preventable diseases are still unnecessarily claiming lives across the globe. In 2019, measles infection resulted in 140,000 deaths worldwide, many of which occurred in children.
Additionally, polio cases, which have been on the decline, rose in 2019. Throughout the year, 156 cases of wild poliovirus were detected, which amount to the most in a single year since 2014. As Contagion® reported, the US Centers for Disease Control and Prevention (CDC) announced that the number of circulating vaccine-derived poliovirus (cVDPV) outbreaks worldwide more than tripled to 29 in 15 countries between January 2018 and June 2019.
“The root causes are insufficient levels of financing and the weakness of health systems in endemic countries, coupled with a lack of commitment from wealthy countries,” the authors of the list wrote.
In order to quell the threat of infectious diseases, the WHO stresses that it is necessary to increase health funding services and efforts to improve data collection regarding infectious diseases. It is also critical to conduct research on both the effects of drug resistance and the development of new diagnostics, medicines, and vaccines.
“Every year, the world spends far more responding to disease outbreaks, natural disasters, and other health emergencies than it does preparing for and preventing them,” the authors of the WHO report wrote.
The authors point out that another influenza pandemic is unavoidable, but the severity and time frame are unknown.
In the latest Contagion® flu update featuring 2019-20 seasonal estimates from the CDC, it was reported that there have been approximately 9.7 million flu illnesses, 87,000 hospitalizations, and 4800 deaths from flu, including 32 pediatric deaths so far this season. More than 170 million doses of the flu vaccine have been administered, the agency added.
In addition to concerns about influenza pandemics, the WHO report also acknowledges that vector-borne diseases such as malaria, Zika, chikungunya, and dengue are on the rise and these infections can lead to epidemics.
In fact, a national epidemic was declared in the Philippines in August 2019 after more than 146,000 cases of dengue were documented in the first 7 months of the year.
In order to confront this challenge, the WHO recommends that countries use the 2019 Global Preparedness Monitoring Board report, which provides steps that can be adopted to bolster epidemic and pandemic preparedness and prevention.
"It is critically important for communities, regions, and nations to be prepared ahead of an epidemic. Trying to play catch-up when an outbreak occurs is inefficient and costs lives. We need to make global investments now in health care infrastructure, planning and preparation for epidemic response, and specific training for health care and public health professionals," Wendy Bamberg, MD, told Contagion®. Bamberg is a medical consultant in Colorado and serves as Contagion®’s Emerging and Re-emerging Infections Section Editor.
For the latest on ongoing outbreaks and epidemics, be sure to check out the Contagion® Outbreak Monitor.
Antimicrobial resistance is happening and it’s happening now.
As the WHO report authors point out, the rise of resistance is the culmination of several factors, which include improper and unregulated antibiotic use, lack of clean water and sanitation, and a lack of infection prevention and control.
It is imperative to address antimicrobial resistance now in order to prevent a return to the pre-antibiotic era.
In November, the CDC released Antibiotic Resistance Threats in the United States, 2019, a report stating that more than 2.8 million antibiotic-resistant infections occur in the United States each year.
“We believe there are encouraging signs of progress that reflect action,” Arjun Srinivasan, MD, CDC’s associate director of health care-associated infection prevention programs, previously told Contagion®. “That said, we all agree that more needs to be done.”
Authors of the WHO list indicate that the agency is working alongside officials “in the environment, agriculture and animal sectors” to address the root causes of resistance while also advocating for the development into new antibiotics.
“Public health is compromised by the uncontrolled dissemination of misinformation in social media, as well as through an erosion of trust in public institutions,” the authors of the WHO report write.
Perhaps one of the most notable examples of this is the antivaccination movement. Last year the WHO listed vaccine hesitancy as one of the top threats to health in 2019.
Despite a record-breaking year, the United States has maintained its measles elimination status. In total, 1282 cases of measles were documented across 31 states in 2019. This is the largest number of cases since 1992. Of these, 128 patients were hospitalized and 61 reported complications which included pneumonia and encephalitis.
“Public health wants to help providers as well because we know from a lot of research on examining attitudes toward vaccines that parents will always say having that recommendation from the providers is the No 1 source of trusted information, and that’s what influences parents to vaccinate,” Christina Tan, MD, MPH, a New Jersey state epidemiologist said in a Contagion® Insights program.
According to Tan, clinicians can refer to toolkits compiled by the CDC, state health departments, and the American Academy of Pediatrics to access strategies to make evidence-based recommendations on vaccinations to parents of young children.
The authors of the WHO report indicated that the agency is also working with social media platforms to verify that users are receiving reliable information about vaccination through these channels. They are also encouraging more investments be made in public health data information systems.
“The cost of doing nothing is one we cannot afford. Governments, communities, and international agencies must work together to achieve these critical goals. There are no shortcuts to a healthier world. 2030 is fast approaching, and we must hold our leaders accountable for their commitments,” Tedros concludes.