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UK government report calls for strong international leadership to control the spread of infectious diseases

5 Aug 2008

Paul Chinnock

Source: UK Parliament (see original article)
Source: Press Association (see original article)
Source: Lancet (see original article)
Source: Sydney Morning Herald (see original article)

A report by the UK parliament’s House of Lords Intergovernmental Organisations Committee has examined the state of efforts by international bodies to address the spread of infectious diseases. The report – Diseases Know No Frontiers: How effective are Intergovernmental Organisations in controlling their spread? – was published in July and attracted considerable media coverage, in the UK and beyond.

Committee chairman Lord Soley said: ‘The last 100 years have seen great advances in public health and disease control through the world, but globalisation and changes in lifestyles are giving rise to new infections and providing opportunities for them to spread rapidly throughout the world. We have been impressed by the increased international resources and commitment which are now being devoted to controlling infectious diseases, and we hope this will continue and grow. However, for that to be effective it is vital that there is sufficient surveillance of disease outbreaks to limit their spread.’

The committee chose not to consider the global infectious disease burden as a whole but to focus on just four diseases: HIV/AIDS, tuberculosis, malaria and pandemic influenza. The ‘neglected’ infectious disease of poverty (such as schistosomiasis, trypanosomiasis and filariasis) do not feature in the report. The main conclusions of the committee may be summarized as follows.

• International leadership is essential. The World Health Organization (WHO) must take the key role but reform and strengthening of the organization is necessary.

• National surveillance standards vary; where they are weak (mainly in developing countries) they must be strengthened.

• Improved coordination is needed between human and animal disease surveillance programmes.

• Vertical campaigns are often necessary in disease control but they should take into account horizontal health care programmes; the latter should be strengthened.

• Often more is invested in treatment than in prevention; this imbalance should be addressed.

• Influenza pandemic is a particular risk (a major pandemic is already overdue) and intergovernmental investment in potential source countries is needed.

A range of other recommendations includes further support for family planning programmes in developing countries, world population growth being seen as a factor in rising rates of infections. Also stressed is the need for accountability and effective control mechanisms.

The committee expresses its enthusiasm for the concept behind the International Health Partnership, but says it is not yet clear what it will achieve in practice.

Reactions

Most of the media coverage of the report was sensationalized, focusing on the statement in the report that a flu epidemic in the UK could lead to up to 750,000 deaths and that a pandemic could cause 2 to 50 million fatalities. However, the committee was only restating generally accepted estimates.

An editorial in the Lancet says, ‘...the report accurately reflects the situation in international health today. But many of its findings are not new.’ The Lancet highlights the committee’s call to the UK government to ensure that a fundamental review is initiated of the inter-relationship between WHO Headquarters and its Regional and Country offices, and on the system of appointment of Regional Directors. The journal notes that it is not the first time that this has been called for.

The Sydney Morning Herald said that Australian experts considered the report to be simplistic and unhelpful. ‘It’s more difficult to predict the path of these diseases than the House of Lords suggest,’ said Professor Greg Tannock, who sits on the Australian government’s national influenza pandemic action committee and is a WHO consultant on bird flu. ‘We in Australia are about as best prepared as we can be with vaccines and antiviral stockpiles,’ he said. In Professor Tannock’s view, processes within WHO have ‘improved immensely’ in recent years.

See also a TropIKA.net commentary in Editorial opinion.

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