An Update on the Millennium Development Goals

Over the last month, many of us have set out to make a change in our lives. Drink more water, exercise X-days per week, read more books, drink less soda, do more good deeds, etcetera, etcetera, etcetera. Some succeeded in achieving their goals for 2013 and went into 2014 with more power and motivation. Others faltered halfway through the year, yet are feeling re-energized and hopeful for 2014. And alas, there are others who abandoned all efforts by this time last year and didn't even bother to set a goal for the new year. My goal was to restart this blog--for real. So while we are stranded at home during this arctic blast/polar vortex/frozen world, here are some people who are fighting relentlessly to carry their achievements through 2014, in a fierce attempt to achieve a set of goals many would consider entirely unattainable.

What are the Millennium Development Goals?

In 2000 the UN General Assembly resolved to lessen poverty and starvation, increase gender equality, and save the environment. Sounds pretty lofty, no? They developed a strategic plan and a deadline. The deadline is the year 2015. With one year to go, here’s an update on the progress of each goal. The green text indicates the goal has been achieved; blue indicates that they are on track or that significant progress has been made, and a concerted effort should result in attaining the goal; red indicates progress has been made and with a concerted effort there remains a possibility of achievement; and brown indicates that despite the progress it is unlikely the goal will be met.

      1.       Reduce extreme poverty by half and reduce hunger by half

          a.       Achieved 5 years ahead of schedule! In developing regions, the proportion of people living on less than $1.25 a day fell from 47% in 1990 to 22% in 2010.

          b.       The proportion of undernourished people in developing regions decreased from 23.2 per cent in 1990–1992 to 14.9 per cent in 2010–2012. Given reinvigorated efforts, the target of halving the percentage of people suffering from hunger by 2015 appears to be within reach.

2.       Achieve universal primary education

          a.       Between 2000 and 2011, the number of children out of school declined by almost half—from 102 million to 57 million.

3.       Promote gender equality and empower women through primary education, paid employment, and representation in national parliaments.

          a.       Whether in the public or private sphere, from the highest levels of government decision-making to households, women continue to be denied equal opportunity with men to participate in decisions that affect their lives.

4.       Reduce mortality of children under 5 by two-thirds and increase measles immunizations

          a.       Worldwide, the mortality rate for children under five dropped by 41 per cent—from 87 deaths per 1,000 live births in 1990 to 51 in 2011. Despite this enormous accomplishment, more rapid progress is needed to meet the 2015 target of a two-thirds reduction in child deaths. Increasingly, child deaths are concentrated in the poorest regions, and in the first month of life.
b.       Since 2000, measles vaccines have averted over 10 million deaths.

5.       Reduce maternal mortality by three-fourths

          a.       Globally, the maternal mortality ratio declined by 47% over the past two decades, from 400 maternal deaths per 100,000 live births in 1990 to 210 in 2010.

6.       Halt and reverse spread of HIV/AIDS, halt and reverse spread of malaria, halt and reverse spread of tuberculosis.

          a.         Worldwide, the number of people newly infected with HIV continues to fall, dropping 21% from 2001 to 2011. With continued efforts, close to 15 million people may be receiving antiretroviral therapy by the end of 2015.

          b.         Between 2000 and 2010, mortality rates from malaria fell by more than 25% globally, with 1.1 million deaths averted.
c.         TB prevalence rates and associated deaths are falling in most regions, and
                         successful treatment is exceeding global targets.

      7.       Reverse loss of forests, halve proportion without improved drinking water, halve proportion without sanitation, and improve the lives of slum-dwellers.

          a.       The growth in global emissions of carbon dioxide (CO2) is accelerating, and emissions today are more than 46 per cent higher than their 1990 level. Forests continue to be lost at an alarming rate. Overexploitation of marine fish stocks is resulting in diminished yields. More of the earth’s land and marine areas are under protection, but birds, mammals and other species are heading for extinction at an ever faster rate, with declines in both populations and distribution.
                         b.       Achieved 5 years ahead of schedule, despite population growth! Over 2 billion
                         people gained access to improved sources of drinking water.
                         c.       From 1990 to 2011, 1.9 billion people gained access to a latrine, flush toilet or other
                         improved sanitation facility.
                         d.     Between 2000 and 2010, over 200 million slum dwellers benefitted from improved
                         water sources, sanitation facilities, durable housing or sufficient living space, thereby
                         exceeding the 100 million MDG target. Many countries across all regions have shown
                         remarkable progress in reducing the proportion of urban slum dwellers.

8.       Establishing a global partnership for development through financial aid, debt relief, expanding trade, providing employment for youth, and providing access to disease-fighting drugs.

        a.     In 2012, net aid disbursements from developed to developing countries totalled $126 billion. This represents a 4% drop in real terms compared to 2011, which itself was 2 per cent below 2010 levels. This decline affected least developed countries disproportionately. In 2012, bilateral official development assistance to these countries fell by 13 per cent, to
                           about $26 billion.
                          b.    The debt service to export revenue ratio of all developing countries stood at 3.1% in
                          2011, down from nearly 12 per cent in 2000. Their duty-free market access also improved in
                          2011, reaching 80 per cent of their exports. The exports of least developed countries
                          benefitted the most. Average tariffs are also at an all-time low.

It is important to remember that the goals highlighted in red or brown do not indicate failure, but that greater advocacy is needed. With strengthened international collaboration, further progress can continue to be made beyond 2015.

Thank you for reading,

AKB

A day of awareness and advocacy

1 December 2009: World AIDS Day

On Tuesday UNAIDS—a joint UN program which seeks to fight HIV/AIDS through the partnership of 10 different non-governmental programs—will remember those affected by HIV/AIDS; raise awareness about the effects of HIV/AIDS; advocate for increased HIV/AIDS research, treatment, and prevention; and celebrate their accomplishments in the battle against HIV/AIDS. According to the WHO, the purpose of World AIDS Day is to “draw[s] together people from around the world to raise awareness about HIV/AIDS and demonstrate international solidarity in the face of the pandemic.” After reading several personal accounts, posted on the World AIDS Campaign site, regarding the effects of HIV/AIDS, I could not help but post a response to my October 22 post relating to the continuance of HIV vaccine research.

On November 24 a news release was published by UNAIDS stating a 17% reduction in new HIV infections since 2001. As stated in the press release, HIV prevention programmes are making a difference!

· An estimated 33.4 million people are currently living with HIV worldwide. There were approximately 2.7million people newly infected in 2008. Additionally, an estimated 2million people died of an AIDS related illness in 2008

· A higher amount of HIV-infected people are currently living than ever before, due to the increased life-expectancies of HIV-infected individuals as a result of the benefits of antiretroviral therapy.

· The number of AIDS related deaths has declined by over 10% in the past 5 years, as treatments become more available worldwide

· HIV prevention programs are not commonly made available to married couples, individuals over the age of 25, or widowers and divorcees, in many countries. However, the highest population of HIV-infected individuals falls under one or more of those categories, in most countries.

This just goes to show how important and beneficial HIV/AIDS research is. In relation to the last bullet point, it is critical that HIV/AIDS research continues and that more HIV prevention programs are either established or expanded. In the words of Dr. Margaret Chan, Director General of WHO, “We cannot let this momentum wane. Now is the time to redouble our efforts, and save many more lives."

Progress in the war against invisible killers

In 2000, world leaders met at the UN in New York, to set up some Millennium Development Goals (MDGs) to be fulfilled by 2015. These goals included plans to eradicate malaria, HIV/AIDS, and Tuberculosis (TB). Upon reconvening in 2008, the assembly realizes the latter two of the 3 goals unrealistic and unattainable by 2015.

Malaria Current Goals: The leaders still seek to cut cases by 75%, 2000—2015, and malaria-caused deaths to zero. Progresses: Insecticide-treated use of bed nets has tripled in 16 of 20 sub-Saharan African nations since 2000. Free Artemisinin-based combination therapy (ACT) distributed at all public health facilities in Zanzibar, Tanzania, has reduced novel cases reported by 70%. Genomes of three major mosquito vectors have been sequenced. RTS S vaccine is going into phase III trials across large areas of Africa. Problems: It has been estimated that $900 million more per year is required to develop vaccines and novel insecticides.

HIV/AIDS Current Goals: Universal access to HIV-AIDS treatment by 2010 Progresses: Rate of new infections fell from 3 million in 2001 to 2.7million in 2007. AIDS death rate dropped from 2.2 million in 2005 to 2 million in 2007. Approximately 3 million people living in low income nations are now receiving anti-retroviral treatments. World leaders pledged another $500 million to achieve goals. Problems: Demand for treatments far exceeds supply. Prevention is exceedingly difficult due to scientific, political, and cultural reasons.

TB Current Goals: Treat 50 million TB-infected people and prevent 14 million deaths Progresses: Incidence has slightly decreased. Global TB-prevalence rate fell by 2.8% and the corresponding death rate fell by 2.6%. Problems: TB detection is lagging, particularly in Africa, China, and India. Drug treatments are difficult to control.

Stone, M. 2009. Determined Progress in War against Malaria, HIV-AIDS, and TB. Microbe 4:115—118.

The cost-effectiveness of the continuance of HIV vaccine research

In recent years much scientific literature has reported the repeated failures of potential HIV vaccines to pass the phase II and phase III trials. In 2008 a potential vaccine, developed by Merck, failed its phase III trial, for the second time. As a result, the NIAID (National Institutes of Allergy and Infectious Diseases), among others, began to debate and reconsider the cost and benefit of HIV vaccine research and development. In 2007-2008 Elisa Long, Margaret Brandeau, and Douglas Owens conducted a study assessing “the outcomes for a broad range of vaccine efficacy and costs, and the outcomes associated with either universal vaccination or vaccination targeted to high-risk groups.”

Demographic information of currently reported HIV-positive individuals in the U.S, including behavioral patterns, was extrapolated using a set of differential equations to establish a model simulating the HIV epidemic over a 20 year period. This model depicts the proposed transmission and progression of HIV/AIDS and the cost-effectiveness for various vaccine strategies. They took into account several variables, such as the thought that antiretroviral therapy would decrease an individual’s infectivity thus possibly reducing transmission probability; however, increased life-expectancy of individuals would also increase measure of sexual activity and/or needle-sharing behaviors thus potentially increasing transmission.

They estimated that without any vaccine program in place, 1.29 million new HIV cases would occur over a 20 year period. They projected that a universal vaccination program, with a 75% efficacy and lifetime duration, would prevent 912,000 cases (71%) over the 20 year period, with 196 million individuals being vaccinated. A vaccination program targeting uninfected high-risk groups could result in 774,000 cases (60%) being prevented, with 9 million individuals being vaccinated. Finally, the less efficient strategy, by targeting low-risk individuals, 187 million individuals would require vaccination in order to return a reduction by 110,000 cases (12%). The model also suggests that for only a 5 to 10-year protection period, still with 75% efficacy, and universal vaccinations, approximate 420,000 — 610,000 cases can be prevented. Vaccinating high-risk groups would, obviously, greatly reduce the prevalence of HIV among those individuals, but could also significantly decrease the prevalence among low-risk individuals, due to reduced secondary transmission. The analysis appeared to suggest that with a high-risk exclusive vaccination program, 75% efficacy and lifetime protection, the cost-savings in healthcare expenditures would approximate $31 billion.

Targeted vaccination of high-risk groups appears by far more efficient than universal vaccinations. However the authors suggest that should an effective vaccine be developed, a universal vaccine strategy should still be utilized in order to ensure most, if not all, high-risk individuals participate. As the authors only appear to take into account the cost analysis of the hypothetical 20 year period, they fail to address the costs, towards vaccine research, accrued over the previous 20+ years, as well as the costs to amount over the next indefinite number of years until full vaccine development. While I cannot speak to the cost-benefit versus sunken-costs of this research over the last 20 years, the increase in life expectancy of those HIV positive in the U.S., and the reduced transmission rate appear to be significant enough to continue research in vaccine developments.

Long, E.F., M.L Brandeau, D.K. Owens. 2009. Potential population health outcomes and expenditures of HIV vaccination strategies in the United States. Vaccine 27:5402—5410.