Infections, epidemics, and pandemics

• Author: Professor Angus Nicoll
• Position: Health Protection Agency London
• Pages: 2

Page 2

In the March 2004 issue, Bloom, Canning, and Jamison argue persuasively that greater investment in health is necessary to achieve development goals. They highlight the devastating economic impact that HIV is having in sub-Saharan Africa and could have in Asia. Control of these and other infections (such as tuberculosis and malaria) is increasingly hampered by emerging resistance to therapies. However, the article doesn't fully acknowledge the importance of infections in prejudicing development.

The social and economic history of humanity has been punctuated by damaging encounters with microorganisms. Europe from the Middle Ages onward was swept by epidemics of the black death (bubonic plague), smallpox, syphilis, cholera, and tuberculosis. Each epidemic had a devastating impact and often resulted in societal change. Any strategy for global health and development not only has to factor in epidemics of emerging and reemerging infections. It also has to expect the unexpected.

Technology offers some hope but only when combined with resources and political will. When infections emerge or reemerge, sharply focused responses can be highly effective. Investment in surveillance and control is much more cost-effective than a "wait and see" strategy. The United Kingdom mounted a robust political response to AIDS in the 1980s that alerted the entire population to the risk. As a result, sexual behavior improved, rates of sexually transmitted infections plummeted, and the early spread of HIV was blunted. For a decade, the United Kingdom had significantly lower HIV levels than comparable European...