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Area 5: Global Initiatives for Disease Control |
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Children
from villages hard-hit by AIDS. Thirteen million
children in sub-Saharan Africa have lost one or both
parents to AIDS, and the number is expected to reach
40 million by 2010.15
The number of AIDS orphans is also growing in Asia and
Latin America.
Global
efforts are underway to help these children and prevent
further devastation from HIV/AIDS and other infectious
diseases. These global initiatives involve complex alliances
among public and private groups, health and trade experts,
and national and international donor organizations.
Photographer:
Bobbie Person, Office of Health Communication, National
Center for Infectious Diseases, CDC |
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Dr. Gro Bruntland, Director-General of WHO, has said that “solutions,
like problems, have to be global in scope.” In accord with this idea,
WHO is helping to coordinate major global initiatives to reduce deaths
from malaria, TB, and HIV/AIDS—diseases that contribute to poverty
and economic stagnation. This approach was endorsed by the Group of Eight
Industrialized Nations at the Okinawa summit in July 2000. WHO is also
helping to coordinate global initiatives to increase developing-country
access to vaccines against acute respiratory diseases, yellow fever, hepatitis
B, and other diseases, through the Global
Alliance for Vaccines and Immunization  (GAVI).
Although these global initiatives have clearly stated goals and are supported
by multiple private and public sector partners (Box 6), the details of
their implementation are still under discussion. Previous efforts to eradicate
malaria by using a narrow approach to vector control ended in failure.
Because no proven vaccines are yet available against malaria, TB, or AIDS,
“one-shot” solutions are not feasible, and it will be necessary
to employ multiple control strategies, including behavioral interventions
that require a high degree of cooperation and trust in affected communities.
The incidence of TB, HIV/AIDS, and acute respiratory infections is high
in poor, war-torn, or post-Communist countries in which public health
infrastructures have deteriorated. Moreover, emerging drug resistance
complicates the treatment and control of each of these diseases.
A new priority for CDC will be to elevate the level of its participation
in these and other global initiatives (Box 6). CDC and its partners will
also consult on future international priorities for disease control, elimination,
and eradication efforts—as well as for antimicrobial resistance monitoring
and pandemic influenza preparedness planning—and help evaluate progress
through the collection and analysis of disease surveillance data.
Increased participation in global health initiatives will require long-term
partnerships with host countries, as well as improved coordination with
public health partners throughout the world. CDC will build on its strengths
in disease surveillance, laboratory science, and program evaluation to
assist development agencies, international organizations, NGOs, and development
banks that support international programs to strengthen healthcare systems
and control disease. As a partner in the Global AIDS alliance (Boxes 6
and 21), for example, CDC has a special opportunity to work with UNAIDS
and USAID to implement HIV/AIDS control programs on all continents (http://www.unaids.org/africapartnership/files/mrpretoria.doc).
As a partner in Roll
Back Malaria
, Stop TB
, and GAVI, CDC can contribute to the Shared
Agenda for Health in the Americas
16
developed by PAHO, the Inter-American Development Bank, and the World
Bank.
Increased participation in global health initiatives also will require
additional staff to work on projects overseas, as well as to provide diagnostic
support from CDC laboratories in the United States. Full participation
in GAVI, for example, will require increased programmatic support and
technical expertise in acute respiratory diseases, yellow fever, hepatitis
B, and meningococcal meningitis. There remains a shortage of U.S. and
world expertise in many infectious disease areas. (See also Priority
Area 6.)
CDC staff will also continue to work with ministries of health, WHO,
PAHO, USAID, and other partners on disease elimination or eradication
campaigns. In addition, CDC staff will help further efforts to reduce
illness and death from acute respiratory diseases and diarrheal diseases,
which—in addition to HIV/AIDS, TB, and malaria—are the leading
infectious causes of death, worldwide. CDC will also continue to conduct
applied research to improve our understanding of the genetics, physiology,
and pathogenesis of microbes that cause illnesses targeted by global initiatives
for disease control. (See Priority Area 3.) Previous
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