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$142 million to prevent, control, and treat communicable diseases (including US$40 million for HIV/AIDS) during fiscal year 2008 (July 1, 2007-June 30, 2008).
- 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.
Overview 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 occurring 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) that 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 in 2008 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 is especially serious in parts of Eastern Europe, the former Soviet Union, and Sub-Saharan Africa TB control is a wise investment In 2007, 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 continue to raise global attention to the health and development threat posed by TB while mobilizing support for its control on a larger scale. [To read the report, The Economic Benefit of Tuberculosis Control, please visit: http://go.worldbank.org/0EYGT458V0] The challenge of TB in Africa TB represents an acute problem in Sub-Saharan Africa, where 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 increase laboratory capacity to test and detect TB infection, which has long been a weakness in TB control programs on the continent. 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 Support for country-led operations to reduce illnesses and avoidable deaths from malaria. In 2005, the World Bank articulated a Global Strategy and Booster Program, which renewed its commitment to malaria control. The Africa Region launched the Booster Program for Malaria Control in Africa, with planned commitments of up to US$500 million from IDA in 2005-2008. As of September 2008, US$470 million has been committed (IDA and multi-donor trust funds) in 19 African countries. Two additional projects are under preparation. This financing represents more than a nine-fold increase in Bank support for malaria control in Africa over the past 24 months compared to the preceding five-year period. The Bank is also financing capacity building efforts to support health systems, primarily in procurement and supply chain management, and monitoring and evaluation.
Emphasis on measurable results. The Booster Program for Malaria Control in Africa, in collaboration with its partners, has developed a Malaria Scorecard for tracking investments and coverage progress for key malaria control interventions. Current work focuses on turning the Scorecard into a joint tool through the development of a data warehouse that all partners and countries can use to track progress and results.
Tackling malaria in India. Malaria is still a significant health problem in India with more than two million cases reported every year. The severe form of falciparum malaria is often fatal and is rapidly increasing in India, reflecting growing resistance to chloroquine treatment, previously the primary malaria drug. In July 2008, the Bank approved a US$520.75 million IDA credit to India for the National Vector Borne Disease Control and Polio Eradication Support Project. This is a major new effort against malaria and two other diseases (polio and kala-azar) that still kill thousands of Indians each year and affect the lives of millions in poor and tribal communities. The project was designed in cooperation with the Government of India, the World Health Organization (WHO), and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
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 29,000 children under the age of five die every day, mainly from preventable causes. Thirty-eight percent of these deaths occur in the first month of life due to infections, low birth weight (because of maternal under-nutrition), and birth asphyxia. These causes are further interlinked as under-nutrition leads to lower resistance to infections. Most of the remaining deaths in children are caused by five preventable and treatable communicable diseases such as pneumonia, diarrhea, measles, malaria, tetanus and HIV/AIDS. Malnutrition and the lack of safe water and sanitation contribute to half of all these children’s deaths. Around two-thirds of both newborn and child deaths could be prevented with existing low cost, evidence-based and cost-effective measures such as vaccines, antibiotics, oral rehydration, micronutrient supplementation, insecticide-treated bed nets and improved family care and breastfeeding practices. 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 improve access to priority (existing and new) vaccines In FY 2008, Bank support for child health totaled US$112.86 million in loans and $5.41 million in grants. 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 governments to support the final push to eradication. Through the Investment Partnership for Polio, the Bank provides concessional IDA credits with the potential for “buy-downs to countries to purchase polio vaccine for eradication activities. The Gates Foundation ($25 million) and United Nations Foundation ($61 million, with funds from Rotary International and the U.S. Centers for Disease Control) have contributed a total of US$86 million to trust funds to turn these concessional loans into grants once programs have been completed successfully. The Bank has launched polio projects in Pakistan totaling US$108 million and in Nigeria totaling 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 expanded other communicable disease projects including a Bank project approved in July 2008 – 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 dual challenge: 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, the Bank plays a key role in designing the proposed Affordable Medicines Facility for Malaria (AMFm), a global buyer co-payment that would subsidize the purchase of new antimamalarials in both the public and private sectors. Since most of the poor seek malaria treatment in the private sector, the AMFm would help to maximize the points of access to affordable and effective treatment of malaria. The AMFm will require about $1.4-1.9 billion dollars in the first five years and will save about 175,000–300,000 lives per year. The Board of RBM has endorsed the initial technical design of AMFm, and the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is considering hosting the AMFm as a new business line in that institution. In addition to its leadership in designing the AMFm so far, the Bank is expected to support country-level implementation of the AMFm in collaboration with partner agencies. 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. It also increases the predictability for governments of funds to purchase the vaccine if the government decides to introduce it into the national immunization program. 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 support the purchase of future vaccines for a period of time, if the vaccine meets certain standards and if the manufacturer agrees to supply the vaccine at affordable prices into the future. 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 one 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 Media Contact: Phil Hay, (202) 473-1796 phay@worldbank.org Updated September 2008 |
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