AT A GLANCE: - The World Bank continues to work closely with governments and partners to achieve better health results through strengthening financial and delivery systems that enable governments to control and prevent communicable diseases.
- We committed US$274 million to prevent, control, and treat communicable diseases during fiscal year 2007 (July 1, 2006-June 30, 2007).
- We continue to help relieve the disruption caused by the Avian Influenza by working with partner agencies to provide technical and financial assistance to needy countries.
- We fight diseases such as HIV/AIDS, TB, malaria, river blindness and other tropical diseases, and are working to expand immunization programs.
Summary Communicable diseases are the world’s biggest killers of children and causes of preventable deaths among adults in the developing world. Collectively, they claim more than 15 million lives a year with over 80 percent of these deaths in developing countries. Reversing communicable disease epidemics is one of the Millennium Development Goals. Results depend on strong health systems able to assure predictable and sustainable financing and service delivery of all priority interventions. The importance of strengthening the capacity of health systems to detect, monitor, and mitigate the spread of communicable diseases has been dramatically illustrated by emerging new communicable diseases such as Highly Pathogenic Avian Influenza (HPAI) and severe acute respiratory syndrome (SARS) which have threatened human life and the global economy. Sustained gains in preventing and controlling these diseases and other major killers such as HIV/AIDS, malaria, and tuberculosis can be achieved through health systems that deliver effective interventions and work with multiple sectors in addition to health. There is growing consensus that insufficient and poorly managed human resources for health capacity are a key constraint. Specific efforts to improve country capacity to achieve communicable disease outcomes must be integrated with the country’s overall health program and be aligned with efforts in other sectors that influence health, including water and sanitation, education, and agriculture. Tuberculosis The World Bank Group is working with countries and partner agencies to control tuberculosis (TB) at global, regional, and national levels. Despite some recent progress in parts of the world, TB remains a massive global public health problem, with nearly 9.2 million new cases and 1.7 million deaths each year. This situation is compounded by the growing emergence of Multi-drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB). New threats require urgent action. The release last month of the WHO report—Anti-TB Drug Resistance in the World —appealed to the international community and national governments to do much more to strengthen TB control efforts. In this era of increasing globalization, drug-resistant TB is a global problem, and especially serious in parts of Eastern Europe, the former Soviet Union, and Sub-Saharan Africa TB control is a wise investment The World Bank recently commissioned a new study—The Economic Benefit of Tuberculosis Control —which highlights the high returns on investment in TB control and underscores the productivity and economic losses associated with TB. The World Bank hopes that this report will raise global attention to the health and development threat posed by TB while mobilizing support for its control on a larger scale. The challenge of TB in Africa TB represents an acute problem in Sub-Saharan Africa. “Multi-drug resistance in Southern Africa is becoming an increasing threat to the hard-won health and development gains in the region” said World Bank Group President, Robert Zoellick. “Given the stakes involved, we need to step up our efforts in concert with our African partners, as part of our drive to strengthen health care systems.” In Sub-Saharan Africa, HIV/AIDS, malnutrition, malaria and TB combine to weaken resistance and then overwhelm the struggle for survival. The World Bank has renewed its commitment to tuberculosis control in Africa and is scaling- up efforts to mainstream TB control into health and HIV/AIDS operations, along with better costing and budgeting of TB needs. In line with the Bank's focus on global public goods, the Africa region is working in close partnership with partners to bolster laboratory capacity to test and detect TB infection, which has long been a weakness in TB control programs on the continent. To read the report—The Economic Benefit of Tuberculosis Control—please visit:
http://go.worldbank.org/0EYGT458V0
Malaria Malaria afflicts millions of people in poor and middle-income countries. It causes more than one million deaths and more than 500 million clinical cases each year. The disease also takes a high toll on household earnings and economic development. Yet, it is preventable and curable. The Bank is a founding partner of the Global Partnership to Roll Back Malaria (RBM).
The Booster Program for Malaria Control —in 2005 the World Bank renewed its commitment to malaria control with a Booster Program for Malaria Control in Africa. From 2005-2008, the Bank expects to commit up to US$500 million of International Development Association (IDA) resources to support the program in approximately 20 countries in Africa. As of September 2007, US$452.1 million has been committed (IDA and MDTF) – with 15 Board-approved projects and two multi-donor trust funds in Sudan as well as two additional projects under preparation. This financing represents a nine-fold increase in Bank support for malaria control in Africa over the past 24 months.
By the end of 2007, the World Bank expects that Program funds will help distribute at least 20 million long-lasting insecticidal nets (LLINs) and more than 15 million doses of artemisinin-based combination therapy (ACT). In total, more than 21 million LLINs and over 42 million doses of ACT will be distributed under these projects. The Bank is also financing indoor residual spraying where appropriate as well as capacity building efforts to support health systems, primarily in procurement and supply chain management and monitoring and evaluation. About 240 million people—including more than 42 million children under age five and nearly 10 million pregnant women—are in areas covered by Booster projects.
Finally, in the South Asia Region, the Bank is working with the Government of India and partner agencies to prepare a Vector Borne Disease Control Project (US$250 million), which includes malaria control. Highly Pathogenic Avian Influenza For more information, see separate issue brief on Avian Influenza HIV/AIDS See separate issue brief on HIV/AIDS Fighting Communicable Diseases in Children About half of all deaths in children under five are caused by five preventable and treatable communicable diseases (pneumonia, diarrhoea, measles, malaria and HIV/AIDS). Roughly 1 million of these deaths are newborns. Malnutrition, poverty and poor health systems all increase a child’s health risks. Immunization is a very cost-effective way to improve children’s health. Roughly 3 million deaths are prevented each year thanks to vaccines against diseases such as measles, tetanus, diphtheria and yellow fever. Of the 130 million children born each year, weak health systems and unpredictable financing will mean that nearly 40 million will not be immunized—a tragedy resulting in the deaths of over 2 million children. New vaccines are being introduced against pneumonia, meningitis, and acute diarrhea, diseases that cause an additional 1 million child deaths a year. The benefits of these vaccines will only be felt if the systems are in place to deliver them to the poorest, most isolated communities. Through its project work and its engagement with partners, the Bank is supporting governments to strengthen health systems to deliver immunization services and to improve access to priority existing and new vaccines. A Final Push to Eradicate Polio from the World Through coordinated global action, the world is close to eradicating poliomyelitis virus from the face of the earth. Working in partnership with the Bill & Melinda Gates Foundation, Rotary International, the U.S. Centers for Disease Control and Prevention, and the United Nations Foundation, the Bank has provided additional funds to support the final push to eradication. Through the Investment Partnership for Polio, the Bank provides concessional IDA credits to countries to purchase polio vaccine for eradication activities. The Gates Foundation and United Nations Foundation (with funds from Rotary International and the U.S. Centers for Disease Control) have contributed over US$77 million to trust funds to turn these concessional loans into grants once programs have been completed successfully. The Bank has now launched polio projects in Pakistan totaling US$88 million and Nigeria US$80 million. The first project in Pakistan has now closed, having achieved the performance targets. The IDA credit was “bought down,” turning this credit into a grant. The lessons of “IDA buy-downs,” an innovative financing mechanism to address global public goods are being explored for other communicable disease projects including a Bank project – through the International Bank for Reconstruction and Development (IBRD) –to support HIV/AIDS prevention in Botswana. Innovative Financing for Priority Health Technologies
Affordable Medicines Facility —a key reason for the resurgence of malaria is the development of resistance to traditional first-line antimalarial treatments, such as chloroquine (CQ) and sulfadoxine pyrimethamine (SP or Fansidar ®) by the parasite that causes a severe form of malaria. But the new and highly effective drugs, the artemisinin-based combination therapies (ACTs), are 10–40 times as expensive as the failing first-line treatments. Poor people, however, cannot afford them and lives are needlessly lost to malaria despite the new drugs being widely available.
In addition, there is a risk that malaria’s toll could rise even higher if resistance to artemisinin were to spread. The challenge dual: to save lives with these effective drugs and to preserve their effectiveness for as long as possible. A notable 2004 study by Professor Kenneth Arrow and colleagues, and a subsequent report by the World Bank and the Roll-Back Malaria (RBM) Partnership, concluded that a sustained global subsidy of ACTs was the most economically and biomedically sound means to meet the dual challenge. The delay of resistance to ACTs creates benefits for all —“a global public good.” With financing from the Bill & Melinda Gates Foundation, extensive work is being undertaken by the Bank and international partners to design the architecture and management arrangements for a facility (AMFm) to provide the subsidy.
Advance Market Commitments (AMC) —offer a market-based financing vehicle to speed up the development and availability of priority new vaccines against diseases that currently kill millions of children in developing countries each year. An AMC for vaccines is a financial commitment to subsidize the future purchase (up to a pre-agreed price) for a vaccine not yet available if an appropriate vaccine is developed and if demanded by developing countries. Bound by legal agreements, donors agree to provide financial commitments to subsidize the purchase cost of future vaccines for a period of time, and vaccine manufacturers agree to meet criteria for vaccine effectiveness and to provide the vaccine at affordable prices in the long-term. An AMC is not a purchase guarantee, as industry will only receive the subsidized price if the product meets targeted standards and countries demand the product. The governments of Italy, the UK, Canada, Norway, and Russia and the Gates Foundation committed a total of US$1.5 billion to finance the pilot AMC for pneumococcal vaccines, a disease killing 1.6 million people every year, more than 90 percent in poor countries including 1 million under the age of five. Donor governments are now expressing interest in a second pilot AMC, potentially targeting a vaccine in early development –such as a vaccine against malaria or TB. - ### - For more information on the World Bank and HIV/AIDS, visit www.worldbank.org/aids
For more information on HIV/AIDS and the AIDS Epidemic Update, visit www.unaids.org
For more information on TB, visit www.worldbank.org/tuberculosis
For information on Malaria, visit: www.worldbank.org/malaria
For information on AMCs, visit: www.vaccineamc.org Updated April 2008 Contact:
Phil Hay, (202) 473-1796
phay@worldbank.org | 
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