Wins, losses, and draws in global health in past 10 yearsBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l7025 (Published 30 December 2019) Cite this as: BMJ 2019;367:l7025
Much has happened in the past 10 years. There’s a new international interest in the value of primary care in rich and poor countries, and the universal health coverage movement is growing. Both are key to achieving the United Nations’ 2030 sustainable development goals, set in 2015. New vaccines were introduced, at the same time that the antivaccination movement’s activities led to a return of vaccine preventable illnesses such as measles. And mental illnesses and the effects on health of climate change made it onto the global health agenda.
For decades outbreaks of Ebola, a haemorrhagic fever virus that spreads through contact with bodily fluids, were relatively small, killing scores or at most hundreds of people, mostly in Africa. Then in 2014 Ebola jumped to a whole new level. It emerged for the first time in West Africa and spread rapidly across three countries, killing more than 11 000 people. The disease caused chaos on the ground and fears of a global epidemic before it was brought under control. The crisis exposed the weakness of the health systems in some of the world’s poorest countries,1 and brought attention to the World Health Organization’s “egregious failure”—as a panel of global health experts called it—to detect the outbreak, respond, and save lives fast enough.2 The silver lining was that the outbreak’s scale meant that experimental vaccines could be tested for the first time, two of which were approved in record time.3 They are now being used in the Democratic Republic of the Congo, where armed conflict and mistrust of aid workers has foiled efforts to control what is now the second largest outbreak. This time, though, there has been no global panic.
While the decade may be remembered for being when the climate change crisis finally began to receive the attention it deserved, as the decade closed WHO warned that no one was thinking or doing enough about the effects of global warming on health.
“WHO considers that climate change is potentially the greatest health threat of the 21st century,” said WHO expert Diarmid Campbell-Lendrum at the Madrid COP25 climate change summit in December. “Unless we cut our carbon emissions, then we will continue to undermine our food supplies, our water supplies, and our air quality—everything that we need to maintain the good health of our populations,” he said. The 2015 Paris agreement set out what needs to be done to avert a climate catastrophe, and already in 2016 there were 2.9 million premature deaths related to increasing pollution.4 The world could save a million lives a year if it met the Paris agreement targets on air pollution alone, WHO has said. Yet the US, one of the biggest polluters, announced in 2017 it would withdraw from the agreement. To date only 51 countries have a policy in place to manage the health crisis caused by climate change,5 and less than 1% of international financing for climate action goes to the health sector.6
If the first decade of this century was when technology changed the way we live and communicate, the second decade was when technology began to transform health and care. From activity trackers (Fitbit launched in autumn 2009) to apps for cognitive behavioural therapy and diabetes management,7 new technology allowed patients to monitor their health, manage their conditions, and enjoy a better quality of life. At the same time artificial intelligence reached the point where it could perform some tasks until now carried out by healthcare professionals, such as analysing eye scans.8 Rapid and cheap DNA testing paved the way for a new era of personalised medicine.9 Perhaps most significantly, the masses of data now gathered opened up new potential for research to improve care.1011
Public awareness of antimicrobial resistance grew during the decade as the numbers of people dying from diseases that no longer respond to antibiotics rose from 50 000 in 2010 to 700 000 in 2019. In 2013 the US Centers for Disease Control and Prevention announced that the human race had moved into the “post-antibiotic” era.12 In 2015 WHO launched a global plan of action calling on countries to raise awareness of the problem and reign in the excessive and often pointless use of antibiotics in healthcare and in food production or face a return to a time when anything from tuberculosis to a caesarean section or a hip operation could be fatal because drugs no longer stop infections.13 The UN has warned that without urgent global efforts to tackle this “profound threat to human health,” in a worst case scenario as many as 10 million people could die each year by 2050.14 A review commissioned by the UK government estimated that the cost to the world’s economy could be as much as US$100 trillion in lost earnings.15 Yet the EU admitted by the end of 2019 that its push for action to contain antimicrobial resistance had had little effect.1617 Sally Davies, the former chief medical officer for England who became the UK’s lead on antimicrobial resistance in June 2019, warned that the problem was as big a threat to humanity as climate change but was getting far less attention.18
New gene editing techniques, most notably CRISPR-Cas, opened up exciting potential for genetic modification to prevent or cure disease more efficiently and in new ways. For example, multiple projects involving modification of mosquito genes made progress this decade, offering the potential to make malaria, Zika, and other infectious diseases a thing of the past by eliminating the mosquitoes that spread them.19 However, the field is ethically fraught.20 In 2018 there was controversy when Chinese scientists declared that they had edited the genes of two babies born in 2018 after in vitro fertilisation to make them genetically resistant to HIV.21 WHO called for all countries to prevent any births of gene edited humans until the ethical implications are fully understood.22
Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.