FOREWORD—WHAT THIS
REPORT IS ABOUT
FOREWORD—What this report is about
We were appointed in November 2007 as a new ad hoc Select Committee of the House of Lords to review the effectiveness with which intergovernmental organisations (IGOs) are operating in specific fields and how the UK is making use of its membership of those organisations to ensure that their objectives are being met. For our first inquiry we have examined how IGOs are tackling the global spread of infectious diseases.
The twentieth century witnessed remarkable advances in many parts of the world in standards of public health and in the conquest of killer diseases, such as smallpox and poliomyelitis. However, during the second half of the century the advent of globalisation (in particular, increased international trade and travel) and changes in human lifestyles (for example, greater human-animal contact) have enabled new infections to emerge and to spread much more rapidly around the world. The onset of HIV in the 1980s and the outbreaks of SARS and avian influenza in the 1990s are striking, but by no means the only, examples. On average, a previously unknown infectious pathogen emerges somewhere every year. At the same time a number of infectious diseases, including some—such as tuberculosis and malaria—which were previously close to eradication, have developed resistance to antibiotics and in their resistant form they are much more difficult to treat. These problems cannot be tackled solely by States within their own borders: effective intergovernmental action is needed.
In recent years there has been a substantial and welcome upsurge in funding for infectious disease control from governmental, intergovernmental, charitable and private sources. At the same time, however, there has been a significant increase in the number of organisations involved, with the result that the landscape of international health has become, in the Government's words, "crowded and poorly coordinated". We have taken evidence from many of these organisations, and it is clear to us that, while there is an urgent need for rationalisation of effort, it is unrealistic to think in terms of imposing coordinating structures from above. The process has to be evolutionary rather than revolutionary, but it needs leadership. There is no doubt in our mind, and in the minds of most of those from whom we have taken evidence, that that leadership function must rest with the World Health Organisation (WHO) and that, given appropriate strengthening of its management arrangements, WHO's remit and resources should be developed in order to encourage and support collaboration and rationalisation among the many actors on the international health stage.
Many of the new initiatives for tackling the spread of diseases are vertically-based—meaning that they are targeted at combating specific diseases, or groups of diseases, rather than improving the quality and quantity of health systems generally (the horizontal axis). While vertical disease-control campaigns are necessary to bring serious outbreaks of disease (such as HIV, malaria and tuberculosis) under control, they are likely to prove unsustainable without parallel investment in horizontal health care structures. Vertical campaigns may have the side-effect of strengthening general health services, but conversely the recruitment of health care staff in developing countries to fight specific diseases can denude basic health services of the doctors and nurses they need to fulfil their normal functions. There is therefore a need for vertical campaigns to be structured and managed in such a way that they complement essential strengthening of horizontal infrastructures. The need for more horizontal investment is particularly acute in the area of infectious disease surveillance. Though Britain and many other countries have effective surveillance systems and though WHO operates a competent international surveillance network, many developing countries are seriously deficient in this respect. On the basis that a chain is as strong as its weakest link, there is a need to direct greater investment into this vital area of global disease control.
Similarly, there has been a tendency in recent years to focus more on the treatment of infectious diseases and less on their prevention. Such an imbalance of investment is not only not cost-effective: it can be counterproductive. For example, while the provision of antiretroviral drugs has done much to preserve the lives of HIV sufferers, by this very fact it risks increasing the incidence of the disease unless it goes hand in hand with effective prevention measures. We consider that the Government should use its influence within the relevant IGOs to achieve some rebalancing of investment.
A number of other issues have come to our attention where we consider that action is needed. One of them concerns the close linkage between human and animal diseases. We have been told that three out of four new emerging infections in humans have come from animals. Yet there is little coordination between the intergovernmental systems for conducting surveillance of human and animal diseases, to the point where, as has been shown in the case of avian influenza, we are all too often failing to pick up animal infections until they have jumped the species barrier to humans. There is a need for better coordination here at the intergovernmental level.
The UK is a highly-respected player in the field of international health by reason of its sound policies, its high technical expertise and its commitment of money and staff. The Government is developing a Global Health Strategy involving all Whitehall departments with an interest under the leadership of the Department of Health. While we commend this imaginative initiative, we hope the Government will give due weight, in regard to leadership issues, to the expertise, resources and experience of the Department for International Development and the Foreign and Commonwealth Office in addressing the international dimensions of the Strategy.
We feel it appropriate to conclude on a sobering note. We have been told that an influenza pandemic is overdue and that, when (rather than if) it comes, the effects could be devastating, particularly if the strain of the virus should be of the H5N1 variety that has been seen in South East Asia in recent years. While much progress has been made in the last ten years in improving global surveillance and response systems, much remains to be done if we are to detect new strains of the virus and counter them before they have had the chance to spread. That requires more intergovernmental investment in potential source countries in surveillance programmes. This is unlikely to hit the headlines and its impact may not be immediately apparent, but it is vital to us all.
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