Memorandum by the United Nations Association
of the UK (UNA-UK)
UNA-UK'S SUBMISSION OUTLINES HOW DIFFERENT
AGENCIES IN THE UN SYSTEM PLAY PIVOTAL ROLES IN COMBATING AND
CONTROLLING THE SPREAD OF COMMUNICABLE AND INFECTIOUS DISEASE,
AND THE NEED FOR STRONG CONTINUING SUPPORT FOR COORDINATED ACTION
AT AN INTERNATIONAL LEVEL
INFECTIOUS DISEASE—"A
PROBLEM WITHOUT
A PASSPORT"
1. Intergovernmental organisations are fundamental
to formulating effective strategies for preventing the spread
of infectious and communicable diseases. Communicable and infectious
diseases are easily transmitted in today's interdependent world;
they are spreading geographically much faster than at any time
in history. Since 1967, at least 39 new pathogens have been identified.
Other old threats, such as pandemic influenza, malaria and tuberculosis,
continue to pose a risk to health through a combination of mutation,
rising resistance to medicines and weak health systems. Many other
diseases, long considered eradicated or non-fatal in the developed
world—remain prevalent in developing countries.
THE WHO—ITS
CENTRAL ROLE
IN SAFEGUARDING
INTERNATIONAL PUBLIC
HEALTH
2. The WHO coordinates national and international
efforts to contain public health emergencies and protect global
health security. In 2003, for example, WHO's leadership was pivotal
in stopping the spread of SARS.
3. The WHO builds country-level capacity
to detect and respond to outbreaks of disease through the provision
of technical support and ethical evidence-based policy options.
The WHO generates and disseminates health research, helping to
identify priorities.
4. The WHO monitors the evolution of infectious
diseases, providing early warning about actual or potential outbreaks
of disease. WHO has unrivalled access to ministries of health
and national statistical institutions, enabling it to provide
region-specific analyses of data on health trends.
5. The WHO sets international norms and
standards in public health. This helps standardise the terminology
used for the diagnosis and treatment of diseases, as well as for
substances, technologies, methods and procedures, making possible
the comparison of data on a worldwide basis. The WHO International
Health Regulations establish rules that countries must follow
to identify disease outbreaks and stop them from spreading.
THE WHO—ITS
RECORD OF
SUCCESS
6. As the only organisation with a truly
global reach the UN—and specifically its World Health Organization
(WHO)—is best equipped to meet such pervasive threats to
international public health. Its successes are notable and concrete.
By 1980 a WHO-led effort had eradicated smallpox, saving an estimated
$1 billion per year in vaccination and monitoring costs—a
return of almost 300%. Over the last two decades, over 20 million
lives have been saved through immunisation campaigns against preventable
diseases. Immunisation rates for the six major vaccine-preventable
diseases—polio, tetanus, measles, whooping cough, diphtheria
and tuberculosis—have risen from under 5% in the early 1970s
to about 76% today. Deaths from measles declined by approximately
50% from 1999 to 2005. Immunisation against tetanus saved hundreds
of thousands of mothers and newborn children, and 104 developing
countries have eliminated the disease altogether.
CONTINUING PROGRESS
TOWARDS ERADICATING
INFECTIOUS DISEASE—THE
EXAMPLE OF
POLIO
7. The WHO and its partners (including UNICEF,
Rotary Club International and the US Centers for Disease Control
and Prevention) are currently on the verge of eradicating poliomyelitis
(polio), a disease now largely eliminated but endemic in four
countries. Polio is a highly infectious viral disease which mainly
affects young children. The virus is transmitted through contaminated
food and water, and multiplies in the intestine, from where it
can invade the nervous system. Many infected people have no symptoms,
but excrete the virus in their faeces, thus transmitting infection
to others. In a small proportion of cases the disease causes paralysis,
which is often permanent and can lead to death. There is no cure
for polio—it can only be prevented by immunisation: polio
vaccine, given multiple times, can protect a child for life. It
is estimated that just $1 is needed to immunise a child for life.
8. WHO and its partners have immunised more
than two billion children worldwide. In 2005 alone, more than
400 million children were immunised in 49 countries. This is testament
to the WHO's global reach, and its ability to penetrate even the
most remote areas or regions affected by conflict.
9. WHO's efforts have produced clear results:
the number of cases of polio has been cut by more than 99%—from
an estimated 350,000 cases in 1988 to 1,951 in 2005. As a result,
five million children are today walking, who would otherwise have
been paralysed, and more than 1.5 million childhood deaths have
been averted.
THE NEED
FOR EVEN
STRONGER INTERNATIONAL
COORDINATION
10. But as long as anyone is infected with
polio, there remains a risk that the disease could become resurgent.
The virus could easily be imported into a polio-free country where
it could spread rapidly through an unimmunised population. Between
2003 and 2005, 25 previously polio-free countries were re-infected
due to importations. In 2007, the world's four remaining endemic
countries (Afghanistan, India, Nigeria and Pakistan) and the six
re-infected countries (Angola, Chad, Democratic Republic of Congo,
Niger, Myanmar and Somalia) continued to report cases.
11. Thus, the WHO and other relevant parts
of the UN system (see below) will remain key to effectively addressing
the threat of infectious disease. The WHO's greatest strength
is its international legitimacy, which stems from its perceived
political neutrality, and its efficacy and expertise in international
public health matters. In combating communicable and infectious
disease, from polio to SARS, the WHO is able to intervene in the
domestic affairs of states in a way that would be unthinkable
if conducted by another country or non-governmental actor. In
the case of the SARS outbreak of 2003, the WHO combined scientific
and technical assistance with frank but well-judged public criticism
of China's early treatment of the disease, and was able to effect
a significant policy change by the Chinese government. This was
a major accomplishment and potentially prevented a large-scale
international epidemic.
UNAIDS—THE
JOINT UNITED
NATIONS PROGRAMME
ON HIV/AIDS
12. UNAIDS provides coherent leadership
within global efforts to combat HIV/AIDS. It draws on expertise
across the UN family, bringing together ten UN system organisations
which act as co-sponsors of UNAIDS: the ILO, UNDP, UNESCO, UNFPA,
UNHCR, UNICEF, UNODC, WFP, the WHO and the World Bank.
13. UNAIDS supplies countries with strategic
information and technical assistance to strengthen and guide national
AIDS responses. It is the leading resource for AIDS-related data
and analysis. UNAIDS policy recommendations promote a rights-based
approach to HIV/AIDS with a dual focus on reducing stigma and
on legal reform to protect the rights of people living with HIV,
the rights of women, and the rights of marginalised groups.
14. UNAIDS undertakes surveillance of the
epidemic and evaluates the efficacy of responses to it. More than
50 UNAIDS country advisers help strengthen national monitoring
and evaluation capacity by building local expertise in the collection,
analysis and interpretation of data.
15. UNAIDS fosters broad partnerships in
efforts to tackle HIV/AIDS, harnessing the energies and complementary
strengths of governments, civil society organisations, the private
sector, and labour organisations. UNAIDS also mobilises celebrities,
special envoys and the media to keep AIDS a priority issue on
the global political agenda.
16. UNAIDS mobilises financial, human and
technical resources for HIV/AIDS initatives. One way it does this
is by helping countries access funds from the Global Fund to Fight
TB, Malaria and HIV/AIDS. UNAIDS also tracks expenditure on AIDS
and issues projections of resources needed, giving donors a precise
understanding of funding gaps.
UNAIDS—EXAMPLES
OF HOW
IT STRENGTHENS
NATIONAL HIV/AIDS RESPONSE
17. In 2006, UNAIDS and the Jamaica Council
of Persons with Disabilities ran a country-wide programme to ensure
that information on HIV prevention, treatment and care was available
to deaf women and girls. UNAIDS assisted the Belarusian ministry
of internal affairs in formulating a comprehensive HIV prevention
programme for prisons. In Mauritius, UNAIDS helped develop the
HIV Preventive Measures Act, which mandates the implementation
of a national programme for needle exchange and an expansion of
access to voluntary and confidential HIV testing and counseling.
And in Croatia UNAIDS helped conduct a legislative review to identify
gaps in protection for HIV-positive people and determine whether
any provisions discriminated against them.
UNFPA—THE UNITED
NATIONS POPULATION
FUND
18. UNFPA defends reproductive rights and
promotes better reproductive health for all, with a focus on women
and girls. UNFPA works with local and national governments to
formulate development strategies which encourage postponement
of marriage, girls" retention in schools, and sexual and
reproductive health education in school curricula.
19. UNFPA equips young people to protect
themselves from HIV/AIDS. Every day, 14,000 young people are newly
infected, half of whom are under the age of 25. UNFPA provides
"safe spaces" where adolescents can access information
about HIV/AIDS, receive counselling and undergo voluntary testing.
UNFPA—AN EXAMPLE
OF ITS
RIGHTS-BASED
APPROACH TO
HIV PREVENTION
20. Female condoms represent the only existing
female-controlled means of effectively preventing pregnancy, HIV
and other sexually transmitted diseases. Yet use remains low—including
in those countries hit hardest by the HIV epidemic. Greater investment
is needed in order to increase the supply and affordability of
female condoms; advocacy is needed to stimulate demand for them.
Studies show that increasing use of the female condom would be
a cost-effective public health intervention: a model focusing
on South Africa, for example, forecast that, at a unit cost of
$0.77 and assuming an uptake of 4 million, 1,740 HIV infections
could be prevented, with a net saving to public health care of
$980,000. Preventive HIV strategies are estimated to be 28 times
more cost-effective than treatment.
In 2005, UNFPA and partners launched a multi-year
effort to scale up availability of female condoms by working with
governments to develop and improve female condom programming.
In 2006, 23 countries were participating in the initiative; 15
of these had established "national condom programming teams',
tasked with identifying means of scaling up supply and distribution
of female condoms, and in four countries the health ministry had
appointed national condom coordinators.
As a result of these efforts, the global procurement
of female condoms increased by 41%.
UNICEF—THE
UNITED NATIONS
CHILDREN'S
FUND
21. UNICEF promotes young child survival
and development. Every year an estimated 9.7 million children
under the age of five die of entirely preventable causes like
pneumonia, diarrhoea and malaria. To prevent unnecessary maternal
and child deaths and reduce undernutrition, UNICEF undertakes
proven interventions which are low-cost but high-impact: for example,
vaccines, antibiotics, micronutrient supplementation, insecticide-treated
bednets, improved breastfeeding practices and promotion of safe
hygiene practices.
UNICEF—AN EXAMPLE
OF ITS
IMMUNISATION WORK
IN SOMALI
22. The absence of a functioning government
in Somalia poses huge challenges for the provision of essential
health services to the country's population. Social indicators
for Somali children are among the worst in the world. One in eight
dies before the age of five, one in three is chronically malnourished
and just 30% goes to school. Almost no children under the age
of five have received the full recommended course of vaccinations.
UNICEF is the world's largest provider of vaccines
for developing countries and reaches 40% of the world's children.
In December UNICEF immunised 100,000 children and women living
in camps in the Afgoye-Mogadishu corridor in southern Somalia.
UNICEF uses immunisation as an opportunity to maximise the positive
impact of the intervention on the child: in addition to vaccinating
children under five against measles, polio, diphtheria, tetanus
and tuberculosis, UNICEF administers vitamin A to boost immunity
and gives iron supplementation and tetanus toxoid immunisation
to women of reproductive age.
In this way UNICEF and WHO plan to reach 3.5
million Somali women and children over the next two years and
estimate that this will cost $15 per person.
21 January 2008
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