1. Regional Situation

Issues and challenges

Regional health security is repeatedly threatened by the emergence of new or newly-recognized pathogens, the resurgence of known epidemic threats, and the possible deliberate or accidental release of either of these. Although biological weapons represent the most direct security threat, emerging and epidemic-prone communicable diseases also threaten global health security because they frequently and unexpectedly challenge national health services and disrupt routine control programmes, diverting attention and funds.

The majority of outbreaks and epidemics are caused by known pathogens. Some of these are re-emerging due to poverty, civil strife and environmental change; others have been neglected over recent decades. The increasing resistance of micro-organisms to antimicrobial drugs is undermining available therapy, reducing treatment opportunities and increasing the costs of health care.

In addition to known epidemic threats, new infectious diseases continue to emerge, many of which appear to originate as diseases of animals. Unverified and inaccurate information on disease outbreaks often results in excessive reactions by both the media and politicians, leading to panic and inappropriate responses. These may in turn result in significant interruptions of trade, travel and tourism, thereby placing further economic burden on affected countries. Outbreaks and epidemics do not recognize national boundaries and, if not contained, can rapidly spread to become international problems.

For Regional health security preparedness is critical. There is a need to improve preparedness through national surveillance and response systems which provide ongoing surveillance of priority diseases, and also function effectively to provide information for alert and response to outbreaks and epidemics (whether these are natural or deliberate in origin). To be sustainable, such systems require trained staff, good communications, appropriate infrastructure, reliable provision of good quality supplies and links to international networks, needs which for too long have been underestimated and under-funded.

The International Health Regulations continue to provide a powerful tool for harmonizing public health action among Member States. In their revised form they will provide a framework for the notification, identification and response to public health emergencies of international concern.

	Advocacy for sustained political will in support of disease surveillance and response, establishment of national task forces to help strengthen disease surveillance and monitoring of antimicrobial drug resistance. Revised International Health Regulations will be increasingly used to cover major international concerns.
	Capacity building at national and regional levels through training courses (FETP short courses and two-year course, epidemic preparedness and response training), strengthening of laboratories and WHO collaborating centres and information-sharing using information technology.
	Adoption of multi-disease surveillance using an integrated approach. The response component will be stressed with reference to poor and vulnerable populations, including women and children, migrants and refugees.
	Establish networks of institutions comprising laboratories, WHO collaborating centres and others to collaborate in disease surveillance, including emerging diseases, zoonoses and antimicrobial drug resistance.
	Increase the use of databases on priority communicable diseases and adoption of GIS for better preparedness to predict, recognize and respond to epidemics.

Issues and challenges

Communicable diseases continue to contribute a heavy toll of deaths in the countries of the SEA Region. They are estimated to account for up to 45% of mortality in developing countries, which includes a large number of children and young adults. Besides high mortality associated with communicable diseases, the burden of disability is also increasing. These factors affect human development and worsen poverty, which affects about one-third of the population. The threat of antimicrobial drug resistance and insecticide resistance is posing new problems, making communicable disease control operationally and financially more difficult. In addition, there are major constraints like insufficient political commitment, inadequate resources, inadequate and/or poor quality of services and poor accessibility to diagnosis, treatment, prevention and control of communicable diseases.

Apart from global threats like HIV/AIDS, TB and Malaria, some of the countries in the Region are also heavily burdened with leprosy, kala-azar, lymphatic filariasis, soil-transmitted helminthiasis, rabies and increasing epidemics of dengue/DHF and japanese encephalitis. The experience gained in the Region in combating these diseases can be useful in other regions facing similar problems.

Issues and challenges

All Member Countries are implementing nation wide programmes for control of vector-borne diseases, tuberculosis, HIV/AIDS, and leprosy. Despite significant inputs of resources over the last three decades by governments, WHO and other organizations, communicable diseases remain a major burden. The Special Programme for Research and Training in Tropical Diseases (TDR) has made important contributions in the control of communicable diseases and has now expanded its mandate to include dengue and tuberculosis, in addition to the previously identified eight diseases.

New technology and concepts in health care are not finding significant application since they are expensive, and therefore poor countries cannot afford to use them widely. Transfer of technology requires enormous resources and trained manpower, which are scarce. As a consequence, very useful findings have not been utilized optimally.

Public health is facing the challenge of developing synergy between researchers, policy makers and those responsible for disease control programmes. Expertise in public health, which includes researchers, public health specialists and health policy planners, is scattered in the Region and lacks functional linkages. These linkages need to be established in a cost-effective manner.

	Strengthen national institutions through capacity building, training, increased use of information technology, and identification of problems and research priorities.
	Support operational research, including field testing of new products and technologies for cost-effective and sustainable control measures. Collaboration will be established with TDR and other funding agencies for field operational research. Technical support will be provided with the goal of serving the poor and marginalized.
	Establish network of researchers, institutions at national and regional levels. Database of researchers, technical resource groups and institutions will be established to facilitate information exchange and transfer of technology.
	Promote linkage of research activities with policy makers and disease control programmes. Periodical reviews of research priorities to determine how and to what extent the research is impacting the control programmes.

Issues and challenges

The Region accounts for 38% of the global burden of tuberculosis. It is one of the main causes of death in the Region and is a serious impediment to human development. The disease afflicts people mainly in the 20-45 year age group and is estimated to result in an annual loss in excess of US $ 6 billion. This despite the availability of DOTS, a cost-effective strategy recommended by WHO. The main concerns in TB control are its association with HIV/AIDS, and the development of multidrug resistance.

All the countries in the Region have adopted the DOTS strategy. The coverage with DOTS in the countries increased remarkably from 14% in 1998 to 56% by December 2001, despite resource constraints and the countries’ weak health infrastructure. Over 1.5 million patients have been treated with cure rates exceeding 80%. The WHO targets of 85% cure rate and 70% case detection in newly-infected persons are likely to be reached by or before 2006. Nonetheless, sustaining and intensifying implementation while continuing to expand simultaneously, remain the greatest challenges for the programme.