New initiatives to combat chronic diseases.

UN "3 x 5" Plan Launched Treating 3 Million HIV-infected by 2005

In a step towards providing universal access to AIDS treatment to all who need it, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) released on I December 2003 the 3 by 5 Initiative, a detailed plan to train tens of thousands of community health workers in developing and transition countries to provide life-long antiretroviral treatment to 3 million people living with HIV/AIDS by the end of 2005. "The lives of millions of people are at stake. This strategy demands massive and unconventional efforts to make sure they stay alive", said WHO Director-General Dr. Lee Jong-wook.

With 40 million people worldwide infected with HIV, the global AIDS epidemic shows no signs of abating. "We firmly believe that we stand no chance of halting this epidemic unless we dramatically scale up access to HIV care. Treatment and prevention are the two pillars of a truly effective comprehensive AIDS strategy", said Dr Peter Piot, UNAIDS Executive Director.

Under the 3 by 5 Initiative, WHO and UNAIDS will focus on teaching the use of simplified, standardized tools for delivering antiretroviral therapy, monitoring their effects and ensuring a reliable supply of medicines and diagnostics. The Initiative has added lamivudine. stavudine and nevirapine to its fixed-dose, triple therapy combinations. It will also focus on global leadership, strong partnership and advocacy, urgent and sustained country support, and rapidly identifying and reapplying new knowledge and successes.

The Initiative complements: the ground-breaking commitments made by the United States under its HIV/AIDS Initiatives ($15 billion for an enhanced AIDS response); the work of non-governmental organizations, including Medecins Sans Frontieres and faith-based groups; efforts of pharmaceutical companies to reduce the cost of treatment; contributions of international foundations, including the Bill and Melinda Gates Foundation; initiatives of many national and international agencies; and the contributions of nations which are increasing their people's access to treatment. WHO said that advisory teams had gone to Kenya, Burkina Faso, Malawi and Zambia, while other teams had done preparatory work in Ukraine and India; many other countries, including the Russian Federation and Djibouti, had requested assistance.

According to Dr. Paulo Teixeira, Director of the HIV/AIDS Department at WHO, the availability of treatment encourages people to learn their HIV status and receive counselling, and reduces the stigma for people Jiving with AIDS. UN Population Fund Executive Director Thoraya Ahmed Obaid said that stigma and discrimination keep the infected from seeking to learn their HIV status and receive counselling--essential aspects of prevention--out of fear that they will be ostracized, rejected and even harmed by their communities and families.

Reaching the 3 by 5 target will require substantial new funding from countries, donor governments and multilateral funding agencies. WHO has estimated that this funding will amount to approximately $5.5 billion over the next two years. "We know what to do, but what we urgently need now are the resources to do it. We must waste no time in building strong alliances immediately to implement this strategy Three million people are counting on it," said Dr. Lee Jong-wook.

Health Report Diet, Nutrition and Disease Prevention

A joint expert report--"Diet, Nutrition and the Prevention of Chronic Diseases"--was launched by the Director General of the World Health Organization (WHO), Dr. Gro Harlem Brundtland, and the Director General of the Food and Agriculture Organization of the UN (FAO), Jacques Diouf. They stressed that solutions to the surge in chronic diseases worldwide would require stronger cooperation between the health and agriculture sectors at the global, regional and national levels.

The WHO/FAO report will be used as the science-based foundation for the WHO Global Strategy on Diet, Physical Activity and Health, to address the growing toll of death and disability from chronic diseases. WHO is currently preparing the Global Strategy for presentation to the World Health Assembly in May 2004.

In 2001, approximately 59 per cent of the total reported deaths and almost half of the disease burden worldwide contributed to the burden of chronic diseases. According to WHO and FAO, most developing countries simply do not have the resources in their health systems and cannot afford to manage this growing burden. "The majority of chronic disease cases are occurring in the developing world", said Dr. Brundtland.

The report examines cardiovascular diseases, certain types of cancer, type-2 diabetes, obesity, osteoporosis and dental disease. It contains scientific evidence of the relationship of diet, nutrition and physical activity to chronic diseases and makes recommendations with a global perspective for public health policies and programmes. These include limiting fat to between 15 and 30 per cent of total daily energy intake, and saturated fats to less than 10 per cent. Carbohydrates should provide between 55 and 75 per cent of daily energy intake, but added sugars should remain beneath 10 per cent. Daily intake of salt, which should be iodized, should be less than 5 grams a day, and fruits and vegetables at least 400 grams. The recommended protein intake should be 10 to 15 per cent.

The report concludes that these recommendations, together with regular physical activity, can reduce the threat of a global epidemic of chronic diseases. "Today, only a minority of people in the world is eating the amounts of fruits and vegetables recommended by this report. Our organizations are facing a strong challenge on how to increase supplies of fruits and vegetables in a way that will allow all people everywhere in the world to have access to them", said Mr. Diouf.

Member States specifically asked WHO to develop the Global Strategy, in consultation and collaboration with all major stakeholders involved in food, diet, physical activity and chronic disease. According to Dr. Brundtland, they see this as a priority health issue, stating that food and related companies are a critical element in developing a long-term solution. The first formal round-table meeting between WHO and senior executives from major food and beverage companies was held on 9 May.

Surveillance Tool Controlling Chronic Disease Epidemics

WHO on 14 May launched "The Surveillance of Risk Factors Report 1" (SURF 1), which captures for the first time chronic disease country-risk-factor profiles from 170 WHO State Members. This is the first step in a major ongoing initiative to bring chronic diseases under control.

The Report has some key risk-factor data and a CD-ROM containing current information available by age and sex for each country. These include tobacco and alcohol use, patterns of physical inactivity, low fruit/vegetable intake, obesity, blood pressure, cholesterol and diabetes.

Dr. Kate Strong, Data Manager of the WHO Global Non-communicable Diseases (NCD) InfoBase, said it is hoped that the publication of key risk-factor data will encourage Member States to send regular updates to help fill in the gaps in this important data collection. The NCD InfoBase also holds more than 47,000 pieces of data from over 1,400 sources, including non-governmental organizations such as the World Heart Federation and its member organizations. The Report also highlights the gaps and deficiencies in the data, which make difficult comparisons between countries. The next step, SuRF 2, will harmonize the data to enable such comparisons. According to Dr Ruth Bonita, Director of Surveillance, Non-communicable Diseases and Mental Health, comparable WHO data are needed by researchers, doctors and policy makers to help put into place preventive measures to combat the rise of chronic diseases worldwide.

Drug Initiative Fighting Neglected Diseases

In an effort to find solutions to ease the plight of the deeply impoverished suffering from the world's most neglected diseases in developing countries, the Indian Council of Medical Research (ICMR), Medecins Sans Frontieres, Institut Pasteur in France, the Kenya Medical Research Institute, the Ministry of Health of Malaysia and the Oswaldo Cruz Foundation in Brazil have founded a drug research organization to develop medicines to combat these diseases.

The Drugs for Neglected Diseases initiative (DNDi) was registered as a not-for-profit in Geneva on 3 July 2003 and is the first such organization to focus exclusively on these diseases It will work in close collaboration with the Special Programme for Research and Training in Tropical Diseases (TDR), co-sponsored by the United Nations Development Programme, the World Bank and the World Health Organization. "We are excited about collaborating with DNDi and hope that it will play a key role in raising awareness and investment, and in speeding up the process of turning research into usable drugs for the most neglected diseases", said Dr. Carlos Morel, TDR Director.

DNDi plans to spend around $250 million over twelve years to develop drugs to combat: Human African Trypanosomiasis (sleeping sickness), which threatens 36 countries in sub-Saharan Africa; Visceral leishmaniasis (kala-azar), in the rural areas of India, Nepal, Bangladesh, Brazil and the Sudan; and Chagas disease in 21 Central and South American countries. Altogether, these parasitic diseases threaten 350 million persons every year, but this does not represent a market profitable enough to attract research and development. Only 10 per cent of health research worldwide goes into diseases that account for 90 per cent of the global disease burden, including the most neglected. The treatments currently available are often toxic and painful and have become less effective because of parasite resistance. If left untreated, these diseases are fatal. DNDi will support the research and development of new, affordable, accessible, less toxic and effective drugs and alternative treatments.

The 3 by 5 Initiative was created because 6 million people currently infected with HIV in the developing world need access to antiretroviral therapy (ART) to survive; so far only 400,000 have this access. The failure to deliver ART to the millions who need them is a global health emergency, and to address this, WHO is fully committed to achieving the 3 by 5 target: getting 3 million people on ART by the end of 2005.