The cost of pandemics, and how to reduce it

SARS, bird flu, swine flu, Ebola, Zika. It is hard to believe that not too long ago, there was an idea that infectious diseases had been largely conquered, at least in principle. Then along came AIDS, and now with more people on the planet and more travelling, new infections are actually becoming more common.

Ebola has infected almost 30,000 people, killing 11,000, and inflicted an economic cost of more than $2 billion on some of the poorest countries in the world. SARS infected far fewer – 8,000, and killed 800, but because it hit richer places, it cost more than $40 billion. A recent report on global health risks put potential global losses from pandemics at around $60bn a year.

America’s National Academy of Medicine suggests that $4.5bn a year, about 3% of what the rich world spends on development aid, invested in medical research, public health services and better emergency co-ordination could significantly strengthen our defences against disease.

More effective health systems would help fight illnesses such as tuberculosis that costs perhaps $12bn a year, and malaria which probably costs several times that. Better research could help find vaccines to treat diseases that at the moment are mercifully rare, but which could become pandemics, such as Lassa fever and Crimean-Congo haemorrhagic fever.

AIDS - are we winning the war?

Thirty years ago, I was one of the first foreign television reporters to report on AIDS in Africa. At that time, the disease was a death sentence. There was no effective treatment. But, at a speed that surprised quite a few in the medical profession, effective drugs began to appear, and, though still dangerous, the virus ceased to look all-conquering.

Now the United Nations says life expectancy of those with the HIV virus, which causes AIDS, has grown by 20 years since 2001, thanks to a sharp increase in access to effective drugs, the price of which have fallen dramatically. In 2000, the cost per year was $14,000. Now it is just $100.

In 2000, fewer than 700,000 of those with the virus were getting effective treatment. Now the figure is 15 million. The executive director of the UN’s AIDS programme, Michel Sidibé (pictured), describes this as ‘one of the greatest achievements in the history of global health.’

Not that everything in the garden is rosy. Up to 41.4 million are now infected by the virus, the majority of them in sub-Saharan Africa. So most are not getting access to treatment, and experts warn that if we do not invest more money, deaths will start increasing again. 

Where AIDS began

The origins of the AIDS pandemic have been traced back to 1920s Kinshasa in what is now the Democratic Republic of the Congo, 60 years before the disease first came to international attention. It has now infected nearly 75 million people.

Researchers from Oxford and Leuven used mutations in the virus’s genetic code to discover its roots. It is thought to have originated in chimpanzees before making the jump to humans.

When it arrived in Kinshasa, the city was growing rapidly. Thousands of male labourers had poured in, so that they outnumbered women by two to one. A thriving sex industry developed and medical records show that sexually transmitted disease was widespread.

It seems the virus then travelled via the railway network, and through vaccination campaigns where unsterilised needles were used. The researchers describe the conditions prevailing in 1920’s Kinshasa as a ‘perfect storm’.

AIDS cure hopes dashed

One of the most worrying and depressing features of the AIDS virus is that it appears to leave its victims infected, and able to infect others, for life. So there was great excitement back in March when it appeared that a little American girl, born with the virus, had been cured by retroviral drugs.

These medicines are able to keep the virus in check, but it had always seemed that once treatment stopped, the disease would advance again. Then along came the ‘Mississippi baby’ who was treated within a few hours of birth, with apparently dramatic results.

The shattering of these hopes with the reappearance of the virus in the four year old has been "obviously disappointing" in the words of Dr Anthony Fauci, director of the USA’s National Institute of Allergy and Infectious Diseases.  

The world has made progress on reducing the number of people newly infected with AIDS. In 2012, the figure was 2.3 million, down by a third since 2001, but that still leaves more than 35 million people across the world living with the disease.

Ebola spreads

Mali is the latest West African country to go on alert against the Ebola virus, after three cases were reported close to the border with Guinea where 86 people have died. Another six people have died in Liberia, while Sierra Leone has also reported cases.

Senegal has now closed its border with Guinea, and controls are being imposed on people entering Mali’s capital, Bamako.  The virus first appeared in Guinea's remote south-eastern region of Nzerekore, where most of the deaths have happened, but it was not confirmed as Ebola for six weeks, and it has now reached the capital, Conarky.

This is the first known outbreak of the disease in Guinea. Most recent cases have appeared in Uganda and the Democratic Republic of the Congo, and a sign of the alarm it is causing is that Saudi Arabia has suspended visas for Muslim pilgrims from Guinea and Liberia.

The virus is spread easily and kills 25-90% of those it infects. Just as with AIDS when it first appeared, there is no vaccine and no cure. The deadliest outbreak so far came in Congo (then Zaire) in 1976 (pictured), when 280 people died - about 88% of those infected.

Road accidents becoming no 1 killer

Fascinating piece in the Economist of Jan 25 on road accidents. At present, they kill about 1.3 million people a year – not far short of the number who lose their lives to tuberculosis, but the World Health Organisation expects the total to reach nearly 2 million by 2030, well outstripping tb deaths and catching up with AIDS as a killer.

The biggest increase is expected in the poorest countries, with deaths almost tripling. One of the main reasons being that when money is invested in new roads, little is spent on safety.

Already, road crashes are the main cause of death worldwide for people aged 15 to 29, with most victims men and boys. In poor countries, most of the people killed are pedestrians, while in developing countries such as Thailand, it tends to be motorcyclists.

In the developed world, better safety measures have seen road deaths actually being reduced. New York now has fewer than it did 1910, while Sweden has halved the number since 2000, cutting them by 80% since 1970.

*My updated website - http://www.disasterhistorian.com/index.html

AIDS - good news and bad news

The United Nation’s latest report on the prevalence of the AIDS virus across the world shows that the number of children newly infected last year is nearly a quarter fewer than the figure for 2009, though that still means there were 330,000 new infections.

The number of new infections among adults on the other hand has remained broadly stable for the last four years at about 2.5 million.   Across the world, 34 million people are thought to have the virus.

Over recent years, the number of victims receiving drugs that can keep the virus at bay has increased substantially, but the report reckons that 7 million people who need them still do not get them.   Sub-Saharan Africa remains the part of the world that is worst hit, though some countries there have managed to reduce the number of new cases.

In contrast, the number of new infections in Russia is growing, and there have been increases in AIDS-related deaths in Eastern Europe, Central Asia, the Middle East and North Africa.  The UN has ambitious targets to reduce the spread of the virus and provide treatment for all who need it by 2015.

AIDS - the German Patient

When I first reported on AIDS in 1985, it seemed like a death sentence for those diagnosed with the disease.   Then along came antiretroviral drugs which allowed people to live with the illness provided they could afford the medicines.   Now comes real hope of a cure.

Last month’s International AIDS Conference in Washington DC reverberated with talk about a man from Berlin named Timothy Brown, who was already infected with the HIV virus (which causes AIDS) when he underwent radical treatment for the leukaemia from which he also suffered – namely, the complete destruction of his immune system.

To provide him with a new system, his doctor found a donor with a rare genetic mutation which gives immunity to HIV infection.   Then he treated Mr Brown with bone marrow cells from the donor.   After this, the HIV virus seems to have disappeared from Mr Brown’s body.

The treatment would be too expensive and too risky to try on a large scale, but it is one of a number of signs that a cure may be possible.   In the meantime, the disease still managed to kill 1.7 million people last year.

AIDS - 30 years on

It was 30 years ago this month that the world was first alerted to the threat of AIDS as the US Centers for Disease Control and Prevention received reports that five homosexual men from Los Angeles had a rare form of fungus-borne pneumonia known as PCP. 

Three decades on, there are some grounds for cautious optimism.    The peak year for deaths from AIDS so far was 2005, when 2.1 million people died.   The latest figure is down to around 1.8 million.  

The rate of new infections in 30 of the world’s poorest countries has fallen by a quarter or more from its peak, while more than 6 million people are now getting anti-retroviral drugs in less prosperous countries against just 2 million five years ago.   A new study has shown that these drugs appear to be very effective in preventing the disease spreading.

It is not all good news, though.   For every person put on effective medication, there are two newly infected, and as the world’s economy slows down, so has the amount of money being devoted to fighting the disease.

* This is the cover of my new book – Britain’s Worst Military Disasters from the Roman Conquest to the Fall of Singapore.   Out soon.

http://www.amazon.co.uk/Britains-Worst-Military-Disasters-Singapore/dp/0752461974

Progress on AIDS

Slow but sure progress appears to be being made in fighting AIDS across the world. Last year was the 12^th in succession in which there was a fall in the number of deaths, and in the number of new cases.

Even so, according to the United Nations, about 2.6 million people contracted the HIV virus last year, though this is nearly 20 per cent fewer than the figure in 1997, the worst year ever recorded. The worst year so far for deaths was 2004, when the total was 2.1 million. Last year, it was down to 1.8 million.

The executive director of the UN’s AIDS programme, Michael Sidibe said: ‘We have halted and begun to reverse the epidemic.’ There are more than 33 million people living with HIV; two-thirds of them in sub-Saharan Africa, still the worst affected region. (See also my blogs of Sept 4, 2009 and Sept 18, 2010.)

*For the history of AIDS, see A Disastrous History of the World. Reviews of the new paperback edition:-

http://www.independent.co.uk/arts-entertainment/books/reviews/a-disastrous-history-of-the-world-by-john-withington-2149559.html

http://www.longridgenews.co.uk/news/book_review_a_disastrous_history_of_the_world_by_john_withington_1_2789974

AIDS - some progress in Africa

More than 20 countries in sub-Saharan Africa – the world’s worst affected region – have seen a reduction of over 25% in new cases of HIV infection. The United Nations says it is because of greater awareness and wider use of condoms. On the other hand, says the UN, cases are on the increase in Eastern Europe and Central Asia, and among gay men in developed countries.

Anti-AIDS drugs are having an increasing impact, with more than five million people now taking them – a 12-fold increase over the last six years. This has meant there were 200,000 fewer deaths in 2008 than in 2004.

Worldwide, though, there are still 7,400 new cases every day – with 40% of them among young people aged 15 to 24. Of every five people newly infected, only two get treatment. Tuberculosis remains one of the main causes of death among people infected with HIV, even though it is preventable and curable. Over half a million died this way in 2008.

The UN is calling for another £6 billion to be invested in the worldwide fight against the disease. (See also my blogs of Feb 18 and Sept 4, 2009.)

Battling malaria

Fourteen African countries have joined forces to fight malaria, which still kills nearly 900,000 people a year – most of them young children in sub-Saharan Afirca – that’s more than AIDS and tuberculosis combined in those areas. No less than 86% of all the world’s malaria cases, and 91% of the deaths happen in the Dark Continent.

The African Leaders Malaria Alliance has raised nearly £2 billion to buy 240 million mosquito nets treated with insecticide. The aim, which cannot be faulted for ambition, is to stop nearly all malaria-related deaths within six years.

The announcement came just as the World Health Organisation was reiterating the concern that the malaria parasite was growing increasingly resistant to artemisinin, regarded as the most effective drug for combatting the disease.

Malaria is one of the oldest illnesses known to man, and has been infecting human beings for at least 50,000 years. (See also my blogs of April 11th and May 30th)

AIDS - some (kind of) good news

On April 11, I wrote about a new drug that may offer us hope against malaria, now there are grounds for some optimism in the global battle with AIDS. Researchers have discovered two powerful new antibodies against the virus.

They are found in only a minority of those infected and are the first of their type to be identified in more than a decade. It is hoped that the discovery may speed up the search for an effective vaccine, though Keith Alcorn, of the HIV information service NAM, warned that that prospect was still a long way off.

He said this was an extremely complex project and that “we certainly shouldn't expect these findings to lead to a vaccine in a few years.”

Across the world last year, the World Health Organisation said that there were 33 million people living with the AIDS virus, and that 2 million had died from the disease during 2007. About 1.6 million of those deaths were in sub-Saharan Africa - the region that is worst affected with two thirds of the world’s cases. Countries such as Botswana, Swaziland, South Africa and Zimbabwe all have infection rates of over 15 per cent. (see my blog of Feb 18th)

AIDS in China + it's only money (6)

AIDS has now been officially recognised as China’s deadliest disease. It killed nearly 7,000 people in the first nine months of last year, overtaking tuberculosis and rabies. The figure represents a big increase, but there are suspicions that the real total may be much higher, as many local officials are thought to be reluctant to report cases. According to UN figures, 700,000 Chinese people were infected with the virus by the end of 2007.

AIDS victims used to have a difficult time in China. A human rights activist was put under house arrest after exposing the failure of the authorities in Henan province to carry out HIV tests on blood donations in the 1990’s, which resulted in an estimated 55,000 people being infected. Other activists were said to have been beaten up with the connivance of the authorities.

Across the world last year, the World Health Organisation said that there were 33 million people living with the AIDS virus, and that 2 million had died during 2007. About 1.6 million of those deaths were in sub-Saharan Africa - the region that is worst affected with two thirds of the world’s cases. Countries such as Botswana, Swaziland, South Africa and Zimbabwe all have infection rates of over 15 per cent.

It’s only money. Has Labour completely lost the plot? We are being told that it is a great victory for the taxpayer that RBS is now going to pay out only £340 million in bonuses instead of the £1 billion it originally planned. That is still a forced contribution of more than £10 from every taxpayer, some of whom will be earning as little as £6,000 a year. RBS is broke. It is only being kept afloat by a huge hand-out of our money. There is no justification for paying any bonuses of any sort. End of story. When will Labour and the bankers get it?