Committee: WHOWHO is the directing and coordinating authority for health within the UnitedNations system. It is responsible for providing leadership on global health matters,shaping the health research agenda, setting norms and standards, articulatingevidence-based policy options, providing technical support to countries andmonitoring and assessing health trends.In the 21st century, health is a shared responsibility, involving equitable access toessential care and collective defense against transnational threats.Topic A) Deliver of vaccines/ medicines in undeveloped countriesInfectious diseases are thought to account for nearly 25% of all deathsworldwide, and extract a disproportionate toll in developing countries1.Moreover, infectious diseases are now appreciated to be major causes of thepoverty and economic underdevelopment that characterize the worldspoorest countries2. Development and deployment of new vaccines to preventinfectious diseases in developing countries have therefore become highpriorities in the global health agenda.Modern biology has yielded a large array of promising new vaccineapproaches and candidates with breathtaking potential for disease preventionin developing countries. A recent survey of new vaccine candidates underdevelopment found that over 350 candidates against 88 different pathogensare being developed by companies, universities and research institutions, andmany of these new vaccine candidates are directed against diseases of theThird World3. In this Commentary, we review current trends that may affectwhether the most promising of these vaccine candidates will eventually be usedin programs for the poor in developing countries, and how the generation ofevidence has become an increasingly important determinant of vaccineintroduction.
Obstacles to vaccine introductionAt the end of the last millennium several worrisome trends suggested that manynewly developed vaccines might never be used in public health programs indeveloping countries. First, although in the late 1980s delivery of basic childhoodvaccines—bacille Calmette-Guérin (BCG) against tuberculosis, polio vaccine,diphtheria-tetanus-pertussis vaccine and measles vaccine—by the ExpandedProgramme on Immunization (EPI) had risen to achieve worldwide coverage ofabout 80% of infants, these gains faltered thereafter, especially in sub-SaharanAfrica, where in 2000 less than 50% of infants had received their third dose ofdiphtheria-tetanus-pertussis vaccine4. This trend underscored the difficulties thatwould be encountered in adding new vaccines to programs in settings such asdeveloping countries.Second, an increasing divergence between vaccine products used in theindustrialized versus developing worlds arose in the 1990s (Table 1)5. Thisdivergence included newer generation vaccines, such as vaccines againsthepatitis B and Haemophilus influenzae type b (Hib). Such vaccines hadbecome commonplace in the industrialized world, yet were not being usedwidely in the developing world largely because of their expense6, creatingpessimism about the likelihood that newly developed vaccines would beintroduced in the developing world. Moreover, several vaccines and vaccineformulations that had formerly been used jointly in industrialized and developingcountry populations ceased to be recommended in industrialized countries. Forexample, whole-cell pertussis vaccine had largely been replaced by acellularpertussis vaccine in the industrialized world, but continued to be used in thedeveloping world, because of its low cost. This trend threatened to reduce thesupply of many vaccines recommended for the developing world, as majorvaccine producers tailored their portfolios to vaccines for the industrializedworld.Opportunities for vaccine introduction Against this backdrop of obstacles, there have been several encouragingrecent developments. To overcome the disincentives to industry of creating newvaccines for the developing world, governments in the industrialized world havetraditionally used push mechanisms. Push mechanisms are aimed at loweringthe risks and costs to industry of research and development, and include suchactions as providing grants for product development, supporting the costs ofclinical trials, strengthening of field sites in developing countries, providingresearch and development tax credits and expediting the regulatory andlicensing process11. Recently, these push mechanisms have been infused withincreased funding, partly because of the recognition that infectious diseases aremajor threats to global security, that infectious diseases can spread rapidly from
the tropics to the industrialized world and that several diseases of importance tothe developing world are also potential bioterrorism threats.In addition, foundations have recently become major contributors to theseefforts. Particularly noteworthy is the Bill and Melinda Gates Foundation, which inrecent years has funded major research and development programs for newvaccines against HIV/AIDS, malaria, tuberculosis, hookworm, leishmaniasis,group A meningococcus, cholera, shigellosis, typhoid fever, dengue fever,Japanese encephalitis, rotavirus, Hib, and pneumococcusAnother hopeful development has been the emergence of public-privatepartnerships (PPPs)12. PPPs are typically coordinated by freestanding nonprofitorganizations that raise money from the public sector and use this money toleverage efforts by both the public and the private sectors to develop andproduce affordable vaccines for the developing world. PPPs have achievedseveral successes, including accelerating the development of vaccines againstsuch scientifically daunting challenges as malaria.Topic B) The effects of pollution and infectious diseasesIt is a well-known fact that clean water is absolutely essential for healthy living.Adequate supply of fresh and clean drinking water is a basic need for all humanbeings on the earth, yet it has been observed that millions of people worldwideare deprived of this.Freshwater resources all over the world are threatened not only by overexploitation and poor management but also by ecological degradation. Themain source of freshwater pollution can be attributed to discharge of untreatedwaste, dumping of industrial effluent, and run-off from agricultural fields.Industrial growth, urbanization and the increasing use of synthetic organicsubstances have serious and adverse impacts on freshwater bodies. It is agenerally accepted fact that the developed countries suffer from problems ofchemical discharge into the water sources mainly groundwater, whiledeveloping countries face problems of agricultural run-off in water sources.Polluted water like chemicals in drinking water causes problem to health andleads to water-borne diseases which can be prevented by taking measures canbe taken even at the household level.
Groundwater and its contaminationMany areas of groundwater and surface water are now contaminated withheavy metals, POPs (persistent organic pollutants), and nutrients that have anadverse affect on health. Water-borne diseases and water-caused healthproblems are mostly due to inadequate and incompetent management ofwater resources. Safe water for all can only be assured when access,sustainability, and equity can be guaranteed. Access can be defined as thenumber of people who are guaranteed safe drinking water and sufficientquantities of it. There has to be an effort to sustain it, and there has to be a fairand equal distribution of water to all segments of the society. Urban areasgenerally have a higher coverage of safe water than the rural areas. Evenwithin an area there is variation: areas that can pay for the services have accessto safe water whereas areas that cannot pay for the services have to make dowith water from hand pumps and other sources.In the urban areas water gets contaminated in many different ways, some ofthe most common reasons being leaky water pipe joints in areas where thewater pipe and sewage line pass close together. Sometimes the water getspolluted at source due to various reasons and mainly due to inflow of sewageinto the source.Ground water can be contaminated through various sources and some of theseare mentioned below.Unfortunately, the air is never pure. Many natural and man-made impurities,called aerosols, are adrift. Suspended particles of a natural origin are sea salt,sand, organic dust, pollen and smoke. Millions of years ago, the naturalpollutants of volcanoes and the dust from meteor strikes were enough to poisonthe air and change the earth’s climate, altering much of life on earth. Manyspecies perished, while others evolved. Today, however, it is the man-madepollution that is of great concern.The unprecedented population explosion of the modern age brought with it theneed for energy. Almost all this energy required around the world is still createdby burning fossil fuels. The resulting industry and transport create pollution thatmakes air in some areas unhealthy. As a consequence, affected people sufferfrom diseases and die prematurely. Pollution damages agricultural crops,destroys historical monuments, and changes the climate. Relevant terms, suchas ‘acid rain’, ‘smog alert’, ‘global warming’ and ‘greenhouse effect’, arecommon today.National and international legislation resulted in a reduction of certainpollutants. Since the ban of lead as an additive to automotive fuel, it is no
longer a major concern in most cities. Countries agreed to phase out the‘greenhouse’ gases chlorofluorocarbon (CFC) and halon, but other damaginggases are still increasing in volume, especially in developing countries.As an interim measure, or perhaps as a token gesture, health authorities issuesmog alerts and air-quality warnings to the public. While you can’t stopbreathing the filthy air, if you do have lung or heart problems, you can considerprecautionary measures, such as the avoidance of strenuous exercise. Somecities experience levels of pollution that even require emergency action plans.Governments have set certain standards for each pollutant: nitrogen dioxide,sulphur dioxide, ozone, carbon monoxide and particulate matter (smallsuspended particles). They form the basis for an air quality index (AQI). Thestandards, however, vary around the world, as does the index, Global aircirculation ensures that long-life pollutants spread to all parts of the world. Theypose a threat to us when their numbers overwhelm the self-cleaning ability ofour respiratory system, or our immune system can’t defend against the intruders.Breathing isn’t the only way that we are exposed to airborne pollutants anddisease-causing microbes. These substances are continually deposited in the soilas dry fallout or precipitation. From the soil they enter the food chain and,ultimately, your body. Overall, your body absorbs more of a particular chemicalvia intake of food than through breathing. But some harmful substances onlyexist in gaseous form, and others, such as particulate matter, are only a healthrisk while airborne.There is no doubt that airborne impurities bring illness and death. Air pollutiondisasters, such as London’s ‘killer smog’ in 1952 that killed about 4000 people,are thankfully rare today. Nevertheless, the ill effects are still with us (see table)and even just a few hundred deaths are too many.The body is like a storage cabinet for toxic substances. A drawer may containlead or mercury, while another may store modern chemical compounds, suchas dioxins or pesticides. Each individual substance accumulates over the yearsuntil the drawer is full and eventually overcomes the body’s tolerance. Yetresearch suggests that an interaction of even low levels of several chemicalscan produce Multiple Chemical Sensitivity (MCS).