United Nations Millennium Goals and Infectious Disease

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United Nations Millennium Goals and Infectious Disease

Introduction

In 2000, the United Nations (UN) adopted a series of goals designed to improve the lives of people throughout the world by reducing poverty, hunger, disease, maternal and infant mortality, by providing better education for children, equal opportunities for women, and moving toward a healthier environment. According to the UN, these eight Millennium Development Goals (MDGs) are providing “a framework for countries around the world for development, as well as time-bound targets by which progress can be measured.” Several of these goals are aimed specifically at reducing the incidence and prevalence of infectious disease, most notably HIV, malaria, and tuberculosis, as well as the prevention of infectious disease, especially measles, among children.

Data subsequently collected by the UN suggests that several countries in sub-Saharan Africa are successfully lowering HIV infection rates and expanding treatment, thus demonstrating that the war against AIDS is not a hopeless endeavor. In addition, the resurgence of tuberculosis and malaria in Africa have been linked to the HIV/AIDS epidemic due to the increased vulnerability of immunocompromised persons (those with weakened immune systems) who are co-infected with both HIV and either malaria or tuberculosis. However, the resurgence of malaria and tuberculosis is also independent of HIV/AIDS, and combating these diseases is addressed separately in the Millennium goals.

The Millennium Goals pertaining to the global control of infectious disease include 1) “Reduce child mortality,” a major part of which is the reduction of childhood deaths from measles through vaccination programs, and 2) “Combat HIV/AIDS, malaria and other diseases,” which will be achieved mainly by international aid to poor nations to help implement prevention and treatment measures that are known to be effective.

History and Policy Response

HIV/AIDS

Over the past 25 years, more than 25 million people have died from AIDS. This death toll among adults in their sexual and occupational prime has resulted in the orphaning of 15 million children and economic devastation, which has in turn, exacerbated poverty and hunger. HIV/AIDS has become the leading cause of death among adults ages 15–59, and has afflicted both genders equally worldwide. It has taken most of these 25 years for the world community to mount a strong and concerted response to the epidemic, signified by the adoption of the Declaration of Commitment on HIV/AIDS in June 2001. A major component of this response has been the establishment of The Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2002 to provide low- and middle-income nations with financial aid to help control the epidemic. In addition, the prices of some AIDS medicines have been significantly reduced. Groups such as the World Health Organization (WHO) and The Joint United Nations Program on HIV/AIDS (UNAIDS) have launched the “Three by Five Initiative,” which has helped to substantially increase the number of people receiving antiretroviral treatment.

Despite these efforts, the overall growth of the HIV epidemic worldwide continues to overwhelm the effect of current efforts. Several countries report success in reducing HIV infection rates through programs that promote behavior changes such as reducing the number of sexual partners, using condoms, and avoiding sharing needles. However, infection rates overall are still growing. Approximately 39 million people globally were infected with HIV in 2005, while some 4.1 million people became infected with HIV and an estimated 2.8 million died from AIDS. The Human Development Report 2005 of the United Nations Development Program (UNDP) concluded that the HIV/AIDS pandemic had done more to reverse human development than any other single factor. Sub-Saharan Africa remains the center of the epidemic. With just over 10% of the world population, 64% of HIV-positive people and in some areas, up to 90% of children under age 15 are infected with the virus. Twelve million sub-Saharan African children are orphans. Women comprise 59% of HIV-positive adults in sub-Saharan Africa (13.2 million people). HIV prevalence among people aged 15–49 in sub-Saharan Africa appears to be leveling off, although at an extremely high rate. However, this apparent stabilization reflects the fact that as new people acquire the virus, nearly the same number die from AIDS.

Malaria

A greater awareness of the heavy toll exacted by malaria has been matched in recent years with greater commitment to contain the disease. Increased funding coming from the World Bank's Global Fund to Fight AIDS, Tuberculosis, and Malaria, along with the United States President's Malaria Initiative and the Bill and Melinda Gates Foundation, among others, are expected to encourage important malaria control interventions, particularly insecticide-treated net use and access to effective anti-malarial drugs. The sale of insecticide-treated mosquito nets has increased ten-fold, but mostly among urban-dwellers. Poor rural communities in endemic areas remain extremely vulnerable to malaria.

Tuberculosis

The number of new tuberculosis cases grow by about 1% annually, with the most rapid increases occurring in sub-Saharan Africa. In the Commonwealth of Independent States (the nations comprising the former Soviet Union), tuberculosis incidence increased during the 1990s, but peaked around 2001, and has since fallen. Worldwide, tuberculosis kills about 1.7 million people per year. Of the nearly nine million new cases in 2004, almost 9% were among people infected with HIV.

Measles

One major aspect of the MDGs concerning child mortality includes reducing measles deaths through immunization. Measles vaccination of children is one of the most cost-effective public health interventions on record. However, the disease killed nearly a half-million children in 2004, and left many others blind or deaf. A majority of unvaccinated children live in China, Congo, India, Indonesia, Nigeria, and Pakistan. On the other hand, considerable progress in measles immunization has been achieved in Latin America, the Caribbean, and sub-Saharan Africa. According to the MDG report, sub-Saharan Africa achieved the largest reduction in measles deaths of any region, with a decrease of nearly 60% between 1999 and 2004.

WORDS TO KNOW

ENDEMIC: Present in a particular area or among a particular group of people.

IMMUNOCOMPROMISED: A reduction of the ability of the immune system to recognize and respond to the presence of foreign material.

INCIDENCE: The number of new cases of a disease or injury that occur in a population during a specified period of time.

PANDEMIC: Pandemic, which means all the people, describes an epidemic that occurs in more than one country or population simultaneously.

IN CONTEXT: DISEASE IN DEVELOPING NATIONS

Three out of the eight Millennium Development Goals and 18 quantitative of the 48 total quantitative indicators monitor progress relate directly to health issues. In May 2005 the United Nations stated that “some developing countries have made impressive gains in achieving the health-related Millennium Development Goals, targets and indicators. However, many more are falling behind. Progress is particularly slow in sub-Saharan Africa.”

With regard to reducing child mortality, the U.N. states, “Some progress has taken place in specific countries. However, nearly 11 million children under the age of five die every year globally. In 16 countries, 14 of which are in Africa, levels of under-five mortality are higher than in 1990.”

With regard to combating the spread of HIV/AIDS, malaria, and other diseases, the United Nations states “There have been successes in selected countries where they have made progress on reversing the spread of HIV/AIDS. However, the story is bleak in many countries. With three million deaths from HIV/AIDS alone each year, the worsening global pandemic has reversed life expectancy and economic gains in several African countries.”

SOURCE: World Health Organization, Fact Sheet 290, May, 2005

Impacts and Issues

Of the four diseases mentioned in the Millennium Goals report; HIV/AIDS, malaria, tuberculosis, and measles, HIV/AIDS presents the greatest long-term challenge from both technical and policy standpoints. To a large extent, malaria, tuberculosis, and measles require more assiduous application of existing therapies and prevention methods as well as the prevention of resistant strains. While the fight against HIV/AIDS will also require all of these measures, it will additionally require the development of new treatments and vaccines. The AIDS pandemic has helped fuel current malaria and tuberculosis epidemics due to co-infection. Therefore, containing the HIV/AIDS epidemic is the paramount public health challenge worldwide.

WHO AND THE MILLENNIUM DEVELOPMENT GOALS (MDG)

In May 2005 (Fact Sheet 290), the United Nations estimated that “the global estimate of what is required is a doubling of aid from US$ 50 to US$ 100 billion each year to achieve all of the Millennium Development Goals which would require a fivefold increase indonor spending on health (The Zedillo Commission: Monterey Conference).”

Moreover, to reach millennium goals, “the economic and health policies in developing countries must reflect the needs: current health spending in most low-income countries is insufficient for the achievement of the health MDGs. African leaders pledged to raise public spending on health to 15% of GNP at the African summit in 2001.”

SOURCE: World Health Organization

The world community has agreed to redouble efforts to control HIV/AIDS, and at the 2005 World Summit Outcome, national political leaders pledged a massive increase in HIV prevention, treatment, and care programs with the aim of approaching the goal of universal access to treatment by the year 2010. These programs have begun to reduce some trends in national HIV prevalence, with recent declines noted in Cambodia, Thailand, Kenya, and Zimbabwe, in urban areas of Burkina Faso and Haiti, and in four states in India. The numbers of people receiving antiretroviral therapy for HIV infection in low- and middle-income countries by December 2005 increased to 1.3 million people, including an eightfold increase from 100,000 to 810,000 treated persons in sub-Saharan Africa between 2003 and 2005 (more than doubling in 2005 alone). The number of people receiving antiretroviral therapy in Asia nearly tripled to 180,000, in 2005.

In response to the call from the UN General Assembly to increase efforts against the AIDS pandemic, UNAIDS and its co-sponsors developed a program to help countries move towards universal access to anti-retroviral treatment and issued a report on these efforts entitled Towards Universal Access, which includes practical recommendations on setting and supporting national priorities, including

ensuring predictable and sustainable financing
strengthening human resources and systems
removing the barriers to ensure affordable commodities
protecting the AIDS-related human rights of people living with HIV, women, and children, and people in vulnerable groups
setting targets and accountability mechanisms.

In June 2006, five years after the issuance of the Declaration of Commitment on HIV/AIDS, UN member states

committed to specific actions to achieve the goal of universal access to HIV prevention, treatment, care and support by 2010
recognized the UNAIDS estimate that $20 billion to $23 billion would be required annually by 2010 to fund sufficient responses
committed to setting up ambitious national targets and estimated the cost of national plans
agreed to focus on the key factors of the epidemic such as gender disparity, social and behavioral challenges for young people and stigma and discrimination against AIDS victims.

Political leaders of every persuasion worldwide now agree that the HIV/AIDS epidemic requires an extraordinary response. In order to bring the pandemic under control, among the main challenges in the future will be the need to work more closely and openly with populations impacted most by HIV/AIDS, including men who have sex with men, sex workers, and injecting drug users. Moving from short-term emergency responses to a longer-term response that recognizes the uniqueness of AIDS and is incorporated into national development planning and execution is envisioned. Strategies that are rational and ambitious, striking a balance between prevention and treatment based on adequate urgent funding have been called for to achieve the UN Millennium Development Goals as they relate to infectious disease. With such an urgent approach, progress made to date indicates that a considerable impact on even the HIV/AIDS epidemic could be made in a short period of time.

BIBLIOGRAPHY

Web Sites

United Nations. “Millennium Development Goals Report 2006.” Sections 2.10–11 (Child Mortality from Infectious Disease), Sections 2.14–15 (Malaria and AIDS Goals) <http://unstats.un.org/unsd/mdg/Resources/Static/Products/Progress2006/MDGReport2006.pdf> (accessed March 11, 2007).

United Nations. “Progress towards the Millennium Development Goals, 1990–2005.” <http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Products/Progress2005.htm> (accessed March 11, 2007).

United Nations. “Secretary General's Report on the Work of the Organization.” <http://mdgs.un.org/unsd/mdg/Resources/Static/Products/SGReports/61_1/a_61_1_e.pdf> (accessed March 11, 2007).

United Nations. “UN Development Group National Monitoring Reports.” <http://www.undg.org/index.cfm?P=87> (accessed March 11, 2007).

Kenneth T. LaPensee

Infectious Diseases: In Context