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

Nakatani, Hiroki

In the communicable disease area, the Global Health Sector Strategy on HIV/AIDS 2011-2015 was adopted by the World Health Assembly in 2011. The adoption of this strategy carries much weight because it means that the health ministers of all 194 member countries agree with it. This is very important. This strategy defines who and how many to treat. Because the target set by the MDGs expired at the end of 2015, WHO started to produce new-generation strategies and plans aimed at the post-MDG era. A new strategy was adopted for tuberculosis in 2014 and for malaria in 2015. In 2016, a new strategy will be developed for HIV/AIDS. Strategy building is a resource-intensive process. WHO needs to consult with the member states, bring in scientific communities, and listen to civil societies. Informally, WHO has conversations with donors to determine whether they will financially support the proposed new strategy, in order that it be rendered a useful tool for affected countries, in terms of both resource mobilization and for the donors in terms of investment planning. Figure 2 shows my view of the global health circle, taking the example of HIV/AIDS, which has functioned very well to date. First, we need global consensus. In the case of HIV/ AIDS, the UN General Assembly adopted relevant resolutions in 2000 and 2010. If you recall the year 2000, HIV treatment had become standard in the northern hemisphere, but patients in the southern hemisphere were left behind because the drugs were very expensive. The standard regimen used in most Western countries cost about 10 000 USD per year. This treatment gap attracted attention from political leaders and was discussed at the Kyushu-Okinawa Summit in 2000. However, political will alone could not solve the practical bottleneck of the high cost of the standard treatment regimen. Practical technical guidelines that accounted for the availability of technology and other resources in developing countries were lacking. At that time, HIV testing was expensive and difficult, and WHO faced the challenge of diagnosing HIV without sophisticated tests and treating patients with a cost-effective combination of generic drugs. WHO's technical leadership was expected to overcome such challenges and see that the political commitments were successfully implemented in the field. This is a typical example of the norm/standard-setting function of WHO. Having established the norm and standard, we then need a global strategy to define how many patients to treat, how they should be treated, and when treatment should be initiated. Resources must then be mobilized to support the targeted disease-control efforts. Finally, monitoring is also very important, because sometimes resources are invested in the wrong place. For example, in many countries, the largest segment of health education on HIV still targets the general population, in which the likelihood of being affected by AIDS is relatively low. For different reasons, those who are at very high risk of HIV infection, such as sex workers, intravenous drug users, and the transgender population, are left behind. This is an important area where WHO and UNAIDS work in collaboration and blow whistles for public health authorities.