Are double-disease initiatives global health's low hanging fruit?

Baby Moges was diagnosed with pneumonia when he was only 2 months old. Pneumonia is one of the leading causes of death for children under 5. Photo by: Getachew / UNICEF Ethiopia / CC BY-NC-ND

In the developing world, people who are diagnosed with malaria, HIV or cancer — and a host of other parasites, viruses and bacterial infections — all have something in common: They often contract pneumonia or diarrhea — and die faster because of it.

U.S. vaccine developer PATH announced this week that a new vaccine for bacterial diarrhea is in the pipeline. The news bodes well for UNICEF, which will add the vaccine to an arsenal of treatments in their double-disease initiative tackling pneumonia and diarrhea. The diseases are the two leading killers of children under 5, and claimed almost 2 million last year, mostly in the developing world.

“Integrated initiatives are the way forward in public health,” Hayalnesh Tarekegn, a UNICEF program officer, told Devex.

If all goes well, battling pneumonia and diarrhea together will not only reduce the mortality rate of the two diseases — but hopefully of five, six or even 10 other diseases. The structure is similar to that of other dual-disease initiatives, whose tumble-down effect often saves lives of patients who contract curable illnesses while battling incurable or chronic ones.

“High diarrhea burden can interfere with the effectiveness of important lifesaving treatments, such as anti-malaria and anti-HIV treatments,” Dr. Richard Walker, director of the enteric vaccine initiative at PATH, told Devex.

Health workers hope that as mortality rates of pneumonia and diarrhea drop as a result of the joint-illness effort, so will those of malaria, tuberculosis and drug-resistant tuberculosis, as well as deaths due to AIDS-related complications, chemotherapy and malnutrition.

In the case of AIDS, it’s not an approach you don’t see much in the developed world, where health professionals focus on slowing the disease and its symptoms.

But in the developing world, access to drugs and treatment is more scarce. Even if an HIV-positive person is able to locate a clinic and get a diagnosis, they face a lifetime of treatment. According to a 2013 UNAIDS report, more than 60 percent of HIV-positive individuals are untreated, and 70-80 percent of those untreated patients will be infected with pneumonia. One in four AIDS deaths are caused by tuberculosis, which is approximately 25 times more likely to occur in HIV-positive individuals.

Similar relationships exists between chemotherapy patients and diarrhea, and the same again for viral infections and pneumonia. In that case, many health professionals argue, why not go for the curable disease that will kill patients first? And beyond that, why not take them two at a time?

While tackling two of the world’s leading killers at once sounds like an unfair fight, certain disease pairs have similar causes and preventatives, so medical professionals can use similar techniques and resources to combat them. Also, treatments for many of these diseases are more available, more mobile, more affordable and require less follow-up than the higher-maintenance illnesses they will concomitantly affect.

And training staff in both illnesses will also guard against confusing the two diseases, Tarakegn added, “making misdiagnosis less likely.”

“Will there be other dual approaches?” asked Rita Wallace, a communications officer with UNICEF. “We think undoubtedly, as the links between different diseases and causes become clearer.”

In conversations with Devex, experts also stressed the importance of addressing the underlying issues behind the spread of curable diseases. Poor water, sanitation and health infrastructure and overcrowding create ideal conditions for these diseases to wreak havoc. Integrating that knowledge into their initiatives means, Walker noted, “promoting hand-washing, use of latrines, and clean water,” as well as “educating mothers and health workers in how to take care of children suffering from these diseases when they appear.”

With the addition of awareness campaigns, these dual-disease initiatives could mean living longer with a disease. They could mean expanding the treatment window for a patient AIDS, cancer or diabetes and bringing prognoses closer to those in the developed world.

Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

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About the author

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    Molly Anders

    Molly Anders is a U.K. Correspondent for Devex. Based in London, she reports on development finance trends with a focus on British and European institutions. She is especially interested in evidence-based development and women’s economic empowerment, as well as innovative financing for the protection of migrants and refugees. Molly is a former Fulbright Scholar and studied Arabic in Syria, Jordan, Egypt and Morocco.