Learning curve. A new strategy has slashed the number of malaria deaths in Vietnam from over 2500 to about 100 per year.

Healthy Hope in an Uphill Battle

WASHINGTON, D.C.--The world should not give up hope in defeating widespread infectious diseases, five United Nations (U.N.) organizations* and the World Bank said today. According to a joint report, substantial progress in fighting sickness and death from infectious diseases is possible over the next decade with drugs, vaccines, and other strategies that are already available. To back up that claim, the study documents success stories of 21 developing countries--some of them among the poorest in the world--that have greatly reduced their disease burden.

With AIDS ravaging Africa, malaria on the rise throughout the tropics, and burgeoning resistance to antibiotics, the war on infectious diseases sometimes seems all but lost. Many scientists think the most promising way to stamp out the world's major scourges is to develop new drugs and vaccines (Science, 2 June, p. 1563); but the pharmaceutical industry has been reluctant because therapies for diseases of the poor are considered bad investments. Besides, developing a new vaccine for most diseases takes at least 10 years, says Nils Daulaire, president of the Global Health Council, a nonprofit in Washington, D.C. "But we have tools in hand to make a major impact now," he adds.

For instance, the report shows how the use of insecticide-treated bednets and the widespread introduction of a cheap, locally produced drug called artemisinin allowed Vietnam to reduce the number of deaths from malaria by 97% between 1992 and 1997. In Bangladesh, a massive immunization program has led to a 90% drop in neonatal deaths from tetanus since 1986, at a cost of just $1.20 per mother immunized. And Uganda stands out as a country where the government has actively promoted health education and condom use that have helped to contain the HIV epidemic.

But such successes are still "patchwork," says David Heymann, executive director for communicable diseases of the World Health Organization; other developing countries should follow these examples, with financial help from richer nations. Indeed, the new report should help to make infectious diseases the "nexus" of developed countries' foreign policy, says Jordan Kassalow, a researcher at the Council on Foreign Relations in New York City. "Hopelessness often fuels political inaction," Kassalow says. "This report shows there is hope."

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*The report was sponsored by the World Health Organization, UNICEF, UNAIDS, UNESCO, The United Nations Population Fund, and the World Bank.

The full report