Choosing Our Inquiry
6. We considered a number of areas of IGO activity
which would be suitable for inquiry, including Peacekeeping, Human
Trafficking, Disarmament and Controlling the Proliferation of
Weapons of Mass Destruction. One subject, however, commanded clear
support as deserving a clear-cutting and urgent inquiry—namely,
controlling the global spread of infectious diseases.
7. It was once thought that, with rapid advances
in medical science, the twentieth century had seen the main killer
diseases—such as smallpox, polio-myelitis, tuberculosis
and malaria—brought under control. That is not, however,
what health or national security experts now think. Medical science
has indeed advanced, but lifestyles have changed substantially
and sometimes in a way that threatens to undermine its achievements.
During the last 50 years trade and travel between nations have
increased at a considerable rate—the number of international
tourist journeys alone rose from 25 million in 1950 to over 800
million in 2005, while world trade has grown more than 20-fold
over the same period. As a result infections which were once limited
to specific parts of the globe are now able to spread more easily
and rapidly to others, often before we are aware of their potential.
Within many poorer countries there has been substantial urbanisation,
which obliges millions of people to live together in close proximity
and often poor conditions of hygiene and which creates a fertile
ground for the spread of infectious diseases. There have also
been significant changes in agricultural practices and ecology
generally, not to mention changes in climatic conditions.
8. There is also increasing evidence that a number
of killer diseases, including tuberculosis and malaria, are becoming
resistant to once-effective antibiotics. And, of course, there
are new and deadly infections emerging. Though most publicity
has been given to the Human Immuno-deficiency Virus (HIV), which
if uncontrolled often results in the lethal disease of AIDS, there
are many others, including SARS (Severe Acute Respiratory Syndrome),
ebola and avian influenza, which, unlike HIV/AIDS, have the potential
to cause rapid and devastating sickness and death across much
of the world if they are not detected and checked in time.
9. For these reasons we decided as a committee
that our first priority should be to examine the action which
is being taken through IGOs to control the global spread of communicable
diseases. We were agreed, however, that we should not look at
intergovernmental management in a vacuum but that it would be
helpful if we could relate what was being done to certain specific
diseases. This, we hoped, might provide us with working illustrations
of the problems which the relevant IGOs are facing and of good
and bad practice in dealing with them. The diseases we selected
are all highly infectious and all pose serious problems for global
health if not controlled. They do however differ from each other
in some important aspects and thereby furnish examples of different
issues.
10. HIV is an infection which was recognised
in the 1980s and has spread globally since then. In 2007 some
33 million people were estimated to be living with HIV. During
the same year 2.5 million people became newly infected and 2.1
million people died of AIDS. HIV is an infection which, though
concentrated mainly in sub-Saharan Africa and parts of Asia, has
spread worldwide. But, unlike the other three infections on which
we have focused, its spread is largely attributable to lifestyle
factors, in particular sexual behaviour. There is as yet no cure
or vaccine, though antiretroviral (ARV) drugs have proved to be
effective in retarding the onset of AIDS and thereby prolonging
the lives of those infected.
11. Pandemic influenza might be said to
be at the opposite end of the spectrum. At the time of going to
press, there has been no recent outbreak of pandemic influenza
reported. Historically, however, such outbreaks have occurred
on average three times every century, and the last outbreak was
in 1968. The last two pandemics (1958 and 1968) were caused by
relatively mild strains of the virus, but the next one could have
more serious consequences, especially if it should come in the
form of a virus, such as the H5N1 variety, which is common in
birds and poultry, which has already jumped the species barrier
to infect humans and which might at some point in the near future
become capable of human-to-human transmission. The Government's
evidence to us on this was sobering:
"While there has not been a pandemic since
1968, another one is inevitable, whether or not it arises from
H5N1. Estimates are that the next pandemic will kill between 2
million and 50 million people worldwide and between 50,000 and
750,000 in the UK. Socio-economic disruption will be massive"
(p 2).
In other words, we have in pandemic flu an infection
which is not yet with us but which, when it arrives, is likely
to have a devastating, if relatively short-lived, impact.
12. Tuberculosis (TB) and malaria
might be said to fall within these two extremes. Here we have
infectious diseases which have been around for centuries, and
steady progress was being made until about 30 years ago towards
eradicating them. In both cases effective antibiotics had been
found and, in the case of malaria, house-spraying with DDT was
proving effective in controlling the mosquitoes which spread the
disease. In both cases, however, the disease has begun to develop
resistance to conventional antibiotics and there has been some
fall-away in DDT spraying as a result of fears of side-effects
for human health and the environment. In addition, the rise of
HIV has had a considerable impact on the incidence of TB, which
is present harmlessly in a large proportion of the world's population
but is able to develop into pathogenic form where natural immunity
to infection has been compromised. According to the London School
of Hygiene and Tropical Medicine, TB is the most common cause
of death in people infected with HIV.
13. In selecting these four diseases, therefore,
as illustrations of intergovernmental health management we have
attempted to cover a spectrum of disease types. There are, we
recognise, many other serious infections, including ebola, SARS,
pneumococcal disease and leprosy, and our choice does not imply
that there is not a need for concerted intergovernmental action
to deal with them. The ones we have selected are intended simply
as working examples of how IGOs are going about their task.
Acknowledgements
14. Our Call for Evidence, which was issued on
10 December 2007, is shown at Appendix 2. In response we received
56 submissions of written evidence, and we subsequently took oral
evidence, in London, Geneva and Paris, from 34 persons or organisations.
Volume II of this report shows all the evidence received, both
written and oral. We would like to thank all those who assisted
us in this way: without their help our inquiry could not have
been carried out.
