Addressing the infectious diseases problem: policy and capacity

ALTHOUGH the DOTS treatment strategy for tuberculosis (TB) cures patients, saves lives and reduces disease transmission, only 30% of active TB cases are being diagnosed and treated under DOTS programmes, says the World Health Organisation (WHO).

WHO says that TB continues to kill approximately two million people each year world-wide and that World TB Day can play a crucial role in increasing the awareness of various stakeholders on the symptoms, diagnosis and treatment of TB, and the importance of effective TB control.

Professor Wieland Gevers, Interim Director of UCT's Institute of Infectious Disease and Molecular Medicine (IIDMM), says diseases such as tuberculosis, malaria and HIV/AIDS are largely out of control because current strategies and resources to lessen the rates of new infections and to lower morbidity and mortality are meeting with insufficient or little success.

“A well-co-ordinated and appropriately targeted partnership between Government and the private sector may bring these diseases sufficiently under control to 'level the playing fields' for global competitiveness of the region. For this, existing knowledge and insights about the diseases and their prevention and therapy must be applied in a very purposeful and effective manner.

“Almost certainly, this will entail large companies and organisations taking most of the responsibility for their own employees and associated communities, while Government agencies will have to cope with those not in employment, including children and the indigent. In the case of businesses, self-interest will dictate that agreements are made with unions and other worker bodies to permit voluntary but near-universal anonymous testing for the presence of infection, against offers of appropriate monitoring and treatment in order to sustain the work capacity (and the life) of skilled workers,” he said.

According to Gevers, the likelihood of success, in the case of both businesses and Government-led campaigns, will depend on specific expertise that can provide advice on matters ranging from educational programmes to the economics of alternative policy options; lower costs (for example, through inventions that make the monitoring of the immune or disease status of patients less expensive); produce and test vaccines; and clinical protocols that prevent or ameliorate the effects of infectious diseases; and can deal directly with the problem of drug resistance (which is important in all three of these major infectious diseases).

“It can be said with certainty that no large enterprise in Southern Africa will be able to achieve control of TB, HIV/Aids and malaria without the country having local research capacity and expertise at a high level,” he noted.

The institute is coordinating its efforts with similar but complementary research institutes established in Johannesburg (in the previous South African Institute for Medical Research), the Nelson R Mandela School of Medicine of the University of Natal in Durban, the Centre for Molecular and Cellular Biology at the University of Stellenbosch, and elsewhere.

The institutes will work together and will ensure synergy and avoidance of overlaps and competition. The concentration of strengths in this way may be decisive in providing the intellectual support for the campaigns of large organisations, businesses and government agencies against the three killer infectious diseases, tuberculosis, HIV/Aids and malaria.

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