With new UN development goals, focus shifts away from infectious disease
By Justine Calma
Earlier this month, after nearly three years of planning and negotiations, 193 member states of the United Nations agreed upon ambitious new global development goals for the next 15 years, with “ending poverty in all its forms everywhere” at the top of the list.
The Sustainable Development Goals, or SDGs, continue efforts first mapped out in 2000 with the Millennium Development Goals, which expire later this year.
The new goals reflect a changed landscape for top global health priorities, with an emphasis on the rising threat of non-communicable diseases like heart disease and cancer over that of infectious diseases like HIV and malaria. And so the goals have some in the international public health community concerned that years of progress on infectious disease control could become undone and leave the world vulnerable to epidemics.
“The difference with infectious disease is they can go from being, in the case of Ebola, nonexistent to something that affects tens of thousand or millions of people…in a very short time frame,” said Dyann Wirth, chair of the immunology and infectious diseases department at Harvard University.
If the global health community becomes overconfident in its ability to tackle infectious disease because of the success it has met in the last 15 years, Wirth cautioned, “we could lose that progress very rapidly.”
The 17 SDGs include just one goal for health: to ensure healthy lives and promote wellbeing for all at all ages. That goal encompasses a number of specific health-related targets ranging from reducing child and maternal mortality to decreasing deaths from chronic diseases, environmental degradation and traffic accidents.
These targets reflect a global rise in non-communicable diseases, which were responsible for 68 percent of all deaths in 2012, up from 60 percent in 2000. Cardiovascular diseases alone killed 2.6 million more people in 2012 than in the year 2000, according to the World Health Organization.
And on some levels, this can be seen as a good thing. Non-communicable chronic health problems are leading causes of death in high-income countries, whereas infectious disease kills more people in low and middle-income countries.
“The last 20 years have been fantastic for global health compared to most of history and that’s despite the immense challenges of the AIDS epidemic,” said Charles Kenny, senior fellow at the Center for Global Development. “The challenge for the next 20 years… is going to be bigger because people are dying of more complicated things.”
But the danger with infectious diseases is in their ability to spread any time there’s a change in environment, like when people lose access to vaccines or viruses develop antimicrobial resistance.
Tuberculosis, for example, is the second leading cause of death from an infectious agent after HIV. The mortality rate for tuberculosis fell by 45 percent between 1990 and 2013, according to the World Health Organization. More recently, however, Doctors Without Borders has reported an alarming resurgence of tuberculosis, with close to half a million people developing drug-resistant strains of the disease a year.
An attempt was made earlier this year to include another development goal that would mitigate the consequences an infectious disease epidemic would have on global security.
In March, Dr. Ilona Kickbusch, director of the global health program at the Graduate Institute of International and Development Studies, Geneva, published a proposal in The Lancet for an 18th Sustainable Development Goal that would address global health security, and by extension, infectious disease. There will be other epidemics and health security crises beyond the recent Ebola outbreak, the proposal contended, citing resistance to antimicrobial medicines used to treat infections as one major threat.
Drug resistance “is a very deep and basic threat,” said Kickbusch. “I think it is comparable with issues of sustainable development if medicine as we know it is not possible anymore.”
To Kickbusch and her coauthors, the SDGs presented an opportunity to create an effective global health security framework that could protect against rapidly spreading risks like antimicrobial resistance. Goal 18, however, did not make it into final documents. The proposal came after member states had already been in discussion for years and were nearing adoption of the 17 existing goals.
Still, the push was successful in making sure the final agenda better addresses new global health threats and explicitly mentions antimicrobial resistance, which was not mentioned in previous drafts.
The previous eight Millennium Development Goals included three separate health goals, including one that specifically tackled HIV/AIDS, malaria and other diseases.
“Many health advocates were disappointed that you had three out of eight Millennium Development Goals focused on health and this time around there’s one health goal out of 17,” said Kickbusch.
On the other hand, she said, many determinants of health are connected to other goals, like ending poverty and stopping climate change.
Others who work in global health were optimistic about the new health goal. In the past, the response to AIDS was not always clearly linked to other sectors and the broader health agenda, said Marielle Hart, Policy Manager with the International HIV/AIDS Alliance.
“Now that we have an overarching health goal with AIDS as at target, we hope that we will have a more comprehensive, integrated approach to health in the next 15 years,” she said.
Although the sustainable development agenda does not explicitly outline a separate goal on infectious disease, its sub-targets include a bold statement to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.”
The broader health goal also calls for universal health coverage and access to quality and affordable medicines and vaccines.
“We made the case that having a strong health system that is universally accessible is an absolute prerequisite to help a country deal with an infectious disease outbreak,” said Simon Wright, Head of Child Survival with the nonprofit Save the Children.
All 17 goals will be formally adopted this September during the United Nations General Assembly.
Justine Calma is a 2015 GroundTruth-Kaiser Family Foundation global health reporting fellow.
This story is presented by The GroundTruth Project.