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Emerald Group Publishing Limited
Copyright © 2006, Emerald Group Publishing Limited
Are we prepared?
In the early 1980s we were faced with a new disease, which, although apparently confined to one particular sector of world-wide society, by the early 1990s had become pandemic and by the end of 2004 had infected 39.4 million globally adults and children. Of them, more than 95 percent were living in low- and middle-income countries.
During 2004, 4.9 million people were newly infected with HIV, and there were 3.1 million adult and child deaths due to HIV/AIDS. (http://hivinsite.ucsf.edu/InSite).
Since the beginning of the epidemic, there have been more than 20 million AIDS deaths. That is right, more than 20 AIDS related deaths in just over 25 years.
If that is not considered a global disaster, then what could be?
A disease that transferred from a primate host to humans through mutation of the associated virus has produced over 20 million deaths in 25 years. Currently, the world is holding its breath to see if H5N1 will make the mutation that will allow human to human transmission.
Since the virus was identified in humans three years ago in China, 80 of the 150 people infected have died from the disease. At present, there has been no recorded case of those infected with H5N1 infecting any other person, but how long will this last. Scientists are optimistic that the virus will not make the jump which would allow person to person infection, but the truth is nobody knows whether or not it will have the opportunity to mutate in that way. It does mutate between infected birds, but as yet has not mutated within those unfortunate humans who have contacted the disease.
The questions are as follows:
Should we prepare for another pandemic disease?
With the initial outbreaks of HIV infections there was world-wide acceptance that it would not spread through the global family. Will we do the same again?
Are we willing to allocate the resources to defend the global population?
The resources that will be required to fend off a person to person mutation should it occur will be enormous.
If we are preparing to allocate those resources, will they be targeted at the most susceptible nations?
With regard to HIV, the vast majority of the current new cases, and deaths, are within the low and middle-income communities. The outbreak of H5N1 is occurring within the same income groups.
Who will direct the resource allocation?
With regard to HIV reduction programmes, the performance of the usual responders appears to be somewhat lacking if the figures for new cases in 2004 are correct. I think it would be somewhat foolhardy to trust so blindly again.
At the moment the risk of the necessary mutation occurring is in the low-to-moderate category, but nature has a nasty way of surprising us. So, are we prepared, or preparing, enough to cope?
HIV is transmitted from region to region much slower that H5N1 which is believed to be carried by migrating birds.
We could, if we so wished, monitor the movement of HIV infected people, but with migratory birds the opportunity to monitor or control their movement is extremely limited.
HIV and H5N1 infections are immediate but the time between initial infection and subsequent death due to HIV is much longer than that of H5N1 related influenza.
This time we may not have the luxury of decades to defend ourselves should an outbreak occur amongst people.