The World Health Organization considers them the big three killers: AIDS, tuberculosis and malaria. Leaders in medicine, public policy and business gathered in New York this week for the Global Health Summit sponsored by Time Magazine and the Bill and Melinda Gates Foundation to explore why these deadly diseases continue to challenge medical science.
The figures from the U.S. Centers for Disease Control are telling. Two million people die of tuberculosis every year. Another two-point-seven million succumb to malaria. And some 40 million people are living with HIV/AIDS. Many people from developed countries believe malaria and TB are curable and can be controlled. But malaria has become resistant to mainstay forms of treatment, particularly in Sub Sahara Africa where 90 percent of malaria deaths occur. The oil company Exxon-Mobil started putting its resources behind malaria research after employees died while working on the corporation's Chad-Cameroon pipeline.
Dr. Paul Farmer, whose work with poor patients was documented in a book by the American author Tracy Kidder, says despite its prevalence, malaria disease can be tricky to diagnose. "Someone comes into the clinic, a mother and child, and will say 'Well I was OK, and then suddenly I started having a fever and a shaking chill.' The clinician is hearing about this extremely non-specific problem. The drama of malaria is if you don't act quickly it can be rapidly fatal. A kid comes in, two hours later they're dead," he said.
A U.S. study shows simply sleeping beneath a mosquito net treated with insecticide can reduce malaria transmissions by 90-percent. But often the poor cannot afford nets. Treating tuberculosis, doctors say, is even more daunting. Patients must go to a clinic every day for six months. During two of these months the patient takes 11 pills a day. The cost of treatment is high. During the early 1990s, New York City suffered a TB breakout. The city spent one billion dollars to treat four thousand cases. In Africa, the figures are much higher.
Dr. Marie Freire, head of the Global Alliance for TB Drug Development, remembers that in the early 1990s the World Health Organization predicted tuberculosis would be eradicated or at least controlled by the year 2000. "And all of a sudden it boomed. And why did it boom? We have a very clear symbiosis with HIV. HIV lowers the immune system. TB becomes a huge killer of people, of patients with HIV, and it's an airborne disease. So there we are," she said.
HIV/AIDS was one of the main focuses at the Global Health Summit. Stephen Lewis, the U.N. Secretary-General's special envoy for HIV/AIDS in Africa, believes that the response to AIDS has been so insufficient that it has caused irreparable damage to nations where the disease is rampant.
"Everything has moved so slowly and so painfully incrementally that we are indeed compromising the very nature of some of these states. And if I were predicting, I would say that by 2015 or 2020, three or four countries will be struggling for survival and they may lose. Just think of it if you will, we now have a country like Zambia where the life expectancy is 30," he said.
But good news also came out of the conference. The pharmaceutical company Bayer is researching a drug that may cut the treatment time for tuberculosis down to two-months, with patients taking only one pill a week. Two other drug manufacturers, Merck and Bristol Meyers-Squibb, after conducting successful tests on monkeys, are teaming up with a non-profit institute to develop a vaginal gel, which would protect women from HIV infection if their partners refuse to wear condoms. According to the companies such a gel could prevent two-point-five million infections over three years.
During three days of discussing current pandemics, the summit also addressed the next potential plague, avian flu. Although many assailed the world's lack of preparation, Stephen Lewis was hopeful the medical community has learned something.
"I think the lesson of AIDS for the avian flu is that unless you respond instantaneously on an emergency basis it engulfs you. It grabs you by the throat and never lets you go. And the preparation now being done for the Avian Flu, at least the heightened consciousness, I hope is explained in part by the sense of the failure around AIDS. You just cannot take your time or it is a catastrophe, that's the one thing AIDS has really taught us," he said.
This Global Health summit sounded a warning and solutions. How governments, policy makers and health professionals respond, remains to be seen.