Despite the grim statistics, the World Health Organisation (WHO) is bullish about winning the war against many of the killer diseases ravaging the planet. But however upbeat the Geneva-based WHO may be, there are those who remain sceptical, writes John Madeley in London.

JOHN MADELEY

LONDON, 10 JANUARY - Despite the grim statistics, the World Health Organisation is bullish about winning the war against many of the killer diseases which still ravage the planet.

But however upbeat the Geneva-based WHO may be it remains a huge undertaking and there are those who remain sceptical.

Seventy per cent of childhood deaths in developing countries are caused by five conditions: pneumonia, diarrhoea, malaria, measles and malnutrition. Almost two million people die from TB every year - 98 per cent of them in developing countries and newly-released figures show that AIDS killed an estimated 3 million people in 2000. Meanwhile, malaria kills more than one million people each year, mostly in Africa and most of those children.

A new report from the Geneva-based World Health Organisation (WHO) and five other United Nations agencies, however, gives grounds for hope that this tide of death can be turned back. Others however have their doubts.

The WHO report states boldly that the main diseases that cause and perpetuate poverty can be successfully controlled and that worsening Aids, TB and malaria epidemics are not inevitable.

The report - Health, a Key to Prosperity; Success Stories in Developing Countries - points to strategies that are turning back these diseases. In Senegal, Uganda and Thailand, for example, strategies have been successfully developed reducing HIV infection rates, while in Azerbaijan and Vietnam the number of deaths from malaria have been halved.

China, India and Peru have cut TB deaths by half, while Sri Lanka has drastically reduced the numbers of women who die in child-b irth. These successes are being seriously talked up by the WHO's Director- General, Dr Gro Harlem Brundtland.

'The prospects of intervening to prevent death in developing countries have never been better,' she says, claiming the evidence refutes those who doubt that the world's poorest communities can be protected from Aids, TB, malaria, childhood diseases and maternal mortality.

And her robust optimism is echoed by UNICEF, one of the other agencies involved in the report. Its executicve director Carol Bellamy argues that following the report, the widespread scepticism - she even dubbed it fatalism - about controlling disease in the developing world is simply unacceptable.

But not all are convinced and money lies at the root of the scepticism. 'There are successful initiatives, and much is being made of them,' says Kevin Watkins of Oxfam, 'but the benefits are likely to be wiped out by the application of patents to drugs, which could double their prices.'

To westerners the prices seem small - a course of anti-TB medicine which is 95 per cent effective in combatting the disease costs US dollars 10 for a course of treatment and anti-malarial drugs cost even less - roughly US dollars 0.12 per treatment. But the sceptics say all these costs soon add up.

The cost of drugs to treat AIDS, for example Watkins points out, is already beyond many poorer countries.

But it may not be all down to hard cash. Although there is no AIDS vaccine, effective prevention measures include sex education at school and beyond, access to condoms, treatment for opportunistic infections and promotion of safe injection practices and blood safety. All are possible and not necessarily at great cost.

Drawing on experiences in 20 different countries, the report identifies several important characteristics of programmes that have succeeded in controlling the diseases of poverty:

1. Political commitment at the highest level; 2. Disease prevention involving the private sector, non- governmental organisations or UN agencies;

3. Innovation;

4. Promotion of the home as the first hospital, especially for training and educatiogn of mothers.

The devil remains in the detail however and it is here the doubters and sceptics so derided by Carol Bellamy as unacceptable rest their case. The report says that the widespread availability of supplies, medicines and other low-cost tools at community-level is essential, and that it all comes down to money in the end, even though management has its part to play as well.

The path to better health never did run smoothly though, and even in developed western countries the health message is often hard to get across. Besides excessive smoking, drinking and eating, some Western countries are running into problems with immunisation too.

In the UK, for example, health authorities are increasingly concerned that too few British children are being immunised with a single vaccine against measles, mumps and rubella (MMR). Parents in Britain have been concerned that the triple vaccine may have side effects such as autism and have been reluctant to bring their children forward for their jab. Now, serious outbreaks of measles have been predicted.

Overall, it's likely that the WHO is correct in deeming political will as one of the key factors in a successful health campaign. Indeed without sustained political will, there can be no way forward in dealing with the world's major killer diseases or providing the necessary resources to combat them.

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