Global Strategies for the Prevention and Control of Infectious Diseases and Non-Communicable Diseases

Nakatani, Hiroki

In the first 15 years of the 21st century, global health has become a central agenda of international communities. After the 9/11 terrorist attacks, the G7 leaders felt it critical to address the root issues of terrorism by interrupting the vicious cycle of poverty and ill health. During this era, the number one disease burden for the working population in developing countries was HIV/AIDS, followed by tuberculosis. MDGs were already chosen, at the UN Assembly in 2000, and served as an excellent platform for attracting international commitments and resources to fight against poverty and ill health through investment in priority disease-control efforts. This led to the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Furthermore, two other important outcomes arose from the response to 9/11 which have shaped today's global health landscape. One is strengthening of health security, triggered by the severe acute respiratory syndrome (SARS) experience in Asia in 2003. While 9/11 was physical terrorism, it is natural to be concerned about bio-terrorism as well. These combined concerns over terrorism and unusual new infections drove the world to drastically overhaul the quarantine system, resulting in the agreement of the International Health Regulations (IHR) public health treaty in 2005. Since then, all countries are requested to report unusual health events. Japan has reported a few incidents, such as the Tohoku Earthquake and Tsunami, the Fukushima nuclear accident in 2011, and more recently, dengue fever in 2014. WHO receives some 300 reports annually and assesses each for its significance to global health. Major influence also came from the report of the National Academy of America: Making the Nation Safer, 3 which shaped the health research agenda for health security. Reflecting these and related developments, health ODA has increased massively. Chris Murray 2 studied the growth of health ODA and found that it increased from some 5 billion United States Dollars (USD) in 1990 to 27 billion USD in 2010. It should be noted that the composition of providers for this health ODA is changing. Resources from bilateral donors grew after 9/11, but contributions from international organizations remained quite modest. In contrast, the largest growth was observed from the private sector and from new funding mechanisms, such as the Global Fund, Global Alliance for Vaccines and Immunization, and the Bill and Melinda Gates Foundation (BMGF). The growing activities of non-state actors in global health are noteworthy. For example, the annual budgets of the BMGF and Médecins sans frontiers (MSF) are almost equal to the budget of WHO. Global health has evolved from the individual or philanthropic efforts of outstanding individuals and international organizations acting in this high-profile domain within international communities, and now represent a multi-polar field with many actors, particularly non-state actors.