Preparing For Infectious Diseases

The Pacific Islands were not hit by the global outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, but they did take part in the preventative battle. That experience demonstrated how crucial it is to be prepared for infectious disease outbreaks, with effective surveillance and response systems in place.

An analysis conducted for the Asian Development Bank found that the total cost of the SARS outbreak for East and Southeast Asian economies is likely to be close to US$60 billion, including lost business revenue. That amounts to about US$6 million for every person infected with SARS.

Understanding the cost implications of infectious diseases is important and can help build political support for taking the necessary preparedness measures. SARS has clearly shown that prevention and early detection are very cost effective, as the savings generated can be enormous.

Although the epidemic was stopped, SARS does have the potential to return. The vulnerability of Pacific Islands countries and territories (PICTs) to future epidemics of SARS or other similar emerging diseases is quite high, due to the limited resources and response capacity of most PICTs. Their vulnerability is heightened by the risk of exposure or importation resulting from international travel. Proper preparedness is therefore a must. The Pacific Public Health Surveillance Network (PPHSN), with the SARS Taskforce, played an essential role in the Pacific Islands region in the timely dissemination of updated information and guidance on SARS, and successfully coordinated the regional response. The threat of SARS and other outbreaks led Fiji and the Secretariat of the Pacific Community (SPC) to jointly select "the Pacific's response to infectious diseases" as the theme of the November 2003 meeting of the Conference of the Pacific Community. This reflects the new priority being given to infectious diseases at the regional level. Non-communicable diseases (NCDs) remain an important regional health issue, and were the focus of an SPC and World Health Organisation (WHO) meeting of regional health ministers in March 2003, the same week a global alert for SARS was issued by WHO.

PICTs currently face a double burden of disease. Communicable diseases such as acute respiratory infections, diarrhoeal diseases, sexually transmitted infections (STIs) and epidemic diseases (e.g. dengue) cause considerable damage in the region. At the same time, NCDs such as diabetes, heart disease and cancer are becoming the leading cause of sickness and death in many PICTs. It is worth noting that NCDs increase the susceptibility to severe forms of infectious diseases, such as influenza and SARS.

In general, acute respiratory infections and diarrhoeal diseases are the leading communicable diseases, causing ill-health throughout the region. Diarrhoeal diseases are a major cause of mortality in young children, and are caused by contaminated water supplies and food safety, hygiene, and sanitation problems. These can be prevented through proper environmental health programmes. Acute respiratory infections are more difficult to prevent, except in the case of specific infections such as influenza, where immunisation has a key role. Both acute respiratory infections and diarrhoeal diseases are important routine targets for primary health care services in PICTs.

HIV/AIDS and STIs are also preventable, but nevertheless pose a growing public health threat in the region. In Papua New Guinea (PNG), AIDS is now the major cause of death at Port Moresby General Hospital.

Tuberculosis (TB) was declared a crisis in the Pacific Islands region in 1999. Every year, 5000 people become sick with TB, yet only three out of every 10 people have access to proper TB treatment. TB rates in PNG and Kiribati are higher than some of the rates reported from 22 countries in the world where TB impact has reached emergency levels. As HIV/AIDS increases in the Pacific region, TB will cause more deaths. Worldwide, TB kills one out of every three people with HIV, and TB is the most common cause of the severe infections that kill 50 percent of the people with AIDS. As a consequence, TB/HIV co-infection could soon become the leading cause of death in the Pacific Islands region. Some countries:Kiribati, PNG, New Caledonia, French Polynesia and Guam: are reporting high levels of HIV/AIDS, some of which also have high levels of TB. Multidrug-resistant TB (MDR-TB) is an emerging problem in the region, and is the result of poorly managed TB treatment. Treatment of MDR-TB is 100 times more expensive and in some cases may be incurable.

Malaria is among the leading illness in Papua New Guinea, Solomon Islands and Vanuatu, where it is endemic. In 2003 only, dengue outbreaks occurred in Fiji, New Caledonia, Tonga and Wallis and Futuna; measles outbreaks in Marshall Islands and Guam; rubella outbreaks in Samoa, Niue and Tokelau; and influenza outbreaks have been reported in New Caledonia and in other PICTs. The battle against infectious diseases is a priority for SPC. In partnership with WHO, SPC has taken a regional lead in addressing HIV/AIDS, STIs, tuberculosis, malaria and other epidemic diseases. Infectious diseases are a heavy burden wherever they occur, with high costs to both governments and communities. For example in 1996, an outbreak of influenza cost New Caledonia around US$3 millions, not including hospitalisation costs, and caused 14 deaths. As a result, New Caledonia introduced immunisation against influenza for groups at high risk from complications due to this disease. Preparedness and prevention are always more effective and less costly than a late and expensive response. This implies a political commitment to sharing information from the early stages of outbreaks, in order to allow other PICTs to be informed, aware and prepared before the outbreak spreads. Sustainable funding, appropriate legal and strategic frameworks and multi-sectoral approaches are other key elements that determine our future capacity to respond to the international threat of infectious diseases.

€ Dr Tom Kiedrzynski is an Epidemiologist; Christelle Lepers, Suveillance information officer; and Dr Janet O'Connor, is a TB specialist based at the SPC headquarters in Noumea, New Caledonia.