WHO Background Guide
Topic 1: Vaccinations in Developing Countries
I.
Background and Causes
Vaccines and immunizations by definition are harmless strains of a disease that are injected into
one’s immune system. In turn, the immune system will react as if it has to fight off a harmful
disease and will produce antibodies against the disease. Because the body has been exposed to
this agent before, it will remember the next time a similar disease affects one, hence protecting
one from a debilitating and possibly deathly sickness. Because children are the most exposed to
diseases, it is better to have as many vaccinated as possible. The more children vaccinated, the
less likely a disease will find a host and spread through a community.
Vaccinations are very difficult to coordinate and supply to regions with minimal healthcare
services. Children in developing countries constantly face the threat of multiple diseases such as
tetanus, measles, and polio to name a few as they do not have the proper resources to fight off
these diseases. In fact, the main diseases that kill children in developing countries today are
pneumonia, diarrhoea, malaria, measles, and HIV/AIDS. They are poverty stricken and do not
the ability to receive immunizations or health checkups. Additionally, they are malnourished,
lacking essential nutrients such as Vitamin A and C that are vital to fight off multiple infections.
Moreover, in many underdeveloped countries, their living conditions remain unsanitary and
overcrowded, increasing a child’s chance of catching an illness. Mortality rates have reached as
high as 40 percent in some countries especially during natural disasters or times of conflict.1
1
UNICEF, “Immunization”
UNICEF, a humanitarian organization, attempts to arrange vaccination delivery among
international communities, immunization suppliers, and local governmental and nongovernmental agencies. UNICEF helps citizens of developing nations in multiple ways. They
predict vaccine needs for each year for various countries and find possible ways to help fund the
necessary materials. Unfortunately, funding methods, such as fundraising and donations, do not
always provide enough money to provide vaccinations to everyone. Additionally, UNICEF also
trains workers and health centers in order to provide proper administration of various health
services.
Advocating for immunizations since the 1940s, UNICEF has appealed to countries around the
world to make vaccines a priority for their citizens. It has also assisted in financing vaccine
distribution in multiple countries, such as Kenya, that cannot afford a mass operation on its own.
To specify, WHO and UNICEF collaborated to create a tetanus vaccination program in Kenya in
order to prevent the spread of the disease as well as create awareness of the dangerous
possibilities of not being vaccinated. With programs all around the world, UNICEF now now
provides approximately 40 percent of the global supply of vaccines for children.2
Because of the large demand of vaccines in high risk countries, UNICEF also researches the best
method to produce and supply vaccines so as not to have to restrict supply at any given time.
Vaccines need at least one year to be produced and therefore it is very important to track the
process in order to maintain a consistent supply. Additionally, when transporting vaccinations,
they have to be properly stored. Vaccinations must be set in a temperature between two and eight
degrees Celsius. Unfortunately, with the lack of paved roads or infrastructure, transporters have
2
UNICEF
to improvise in keeping vaccines cool. Oftentimes, they will attach the supplies to horses or
small vehicles and use solar panels to provide power to keep the vaccines cool. However, if the
destination is a rural area without any electricity or means to refrigerate the vaccines, storing
these supplies long-term becomes problematic.
II.
Current Issues/Looking Ahead
Many issues have affected organizations’ ability to provide vaccinations in developing countries.
Issues such as conflict, lack of proper resources, lack of knowledge or education, and apathy
towards health issues to name a few. Unfortunately, it can be hard to provide countries with
vaccinations when various circumstances prevent supplies from reaching the population.
Suppliers have to “maintain the cold chain” where vaccines must be kept cool so as to not spoil
before reaching their destination. In some areas where it is very hard to reach citizens, especially
children, due to conflict or lack of infrastructure, organizations have negotiated with various
countries to maintain cease-fires for certain periods of time so that health workers can bring
vaccinations to villages. During these “Days of Tranquility,” members technically are guaranteed
safety to distribute vaccines, but the possibility of conflict erupting is continuous. Furthermore,
in emergencies UNICEF workers have to negotiate with local officials in order to supply proper
health supplies to prevent any epidemics erupting during conflicts or natural disasters.
Conflict in many developing countries has been a large reason behind why many citizens do not
receive proper vaccines. With fighting, most villagers will not come into the city to receive their
vaccinations in fear of being captured or being hurt through the conflict. Additionally,
infrastructure can be commandeered during war, including health facilities where medical
supplies are kept. During conflict, medical workers are also afraid of their safety and cannot
enter every region that requires medical services. As stated previously, several negotiations must
occur in order to provide vaccinations during conflict.
Although various organizations such as UNICEF and WHO attempt to find methods to fund
vaccinations for developing countries, shortages still occur due to to a lack of monetary outlets or
corruption within the government. There are thousands of children that need immunizations that
do not receive them due to shortages in supplies as there is only so much money available if the
government does not or cannot provide any support. Many governments also do not allocate
money set aside for health services properly, with some of this money often going to other
interests such as in increasing the wealth and power of high government officials.
Various people do not always have the means to go to a health clinic to receive vaccinations. The
clinic could be miles away and parents may not have time between working to provide for their
children to travel far to give their children proper immunizations. Furthermore, many families
are not aware of the effects of having their children immunized. They do not believe it is
necessary or will help their child’s health. It may also be too expensive (if not provided for free
or subsidized in some areas). Lastly, some religions such as Catholicism are against vaccinations
for various reasons. Some vaccines contain cells of aborted fetuses, which the church is
tremendously against.3
Moving forward, the world is challenged with providing vaccines to over 30 million children that
go without basic health services every year. Main goals include finding long-term funding for
3
Resources, Jan. 31, 2015
vaccine production and supply as well as finding methods to decrease the prices of certain
vaccines that are crucial but unaffordable in many developing areas.
Topic 2: Antibacterial Resistance
I.
Background
In 1928, antibiotics first came into medical usage with the discovery of penicillin. Since
then, they have been used to save millions of lives from infection. However, they have also
been used as a precautionary measure in healthcare settings, farms, and even in water to
prevent algae growth. In the past 70 years, over 100 antimicrobial compounds have been
discovered, though the past few decades have seen a precipitous drop off in new drug
discoveries. Recently, public health officials have warned of growing resistance to these
drugs. The drugs, when used, inevitably fail to kill every bacterium, and those bacteria that
survive the drug adapt and reproduce, creating entire strains of bacteria resistant to one or
multiple drug compounds. Now, despite all of the miraculous advances in modern medicine,
the world runs the risk of returning to pre-19th century medicine, where simple infections or
small surgeries can kill, because of this issue. Sexually transmitted diseases, MRSA, and
other fairly common infections have been found to have antimicrobial resistance.
II.
Causes
As mentioned briefly in the previous section, antimicrobial resistance is conferred on a
strain of bacteria when a few of the bacteria survive antibiotic treatment. Their immunity to
the drug is then passed on to their offspring, creating a strain of “superbugs.” Some of these
strains become resistant to multiple drug compounds when a second- or third-class antibiotic
is used to treat infections that are already resistant to one type of drug.
Aside from the biological cause of antibiotic resistance, there are socio-political factors
that contribute to the problem as well. The most problematic cause may simply be
complacency. Because scientists were discovering new compounds regularly, drug resistance
was largely underestimated as a problem because it was assumed that any time a strain
demonstrated resistance to a drug, a new drug could be invented. However, since 1987, only
one new drug compound has been discovered, which means that antimicrobial resistance is
growing faster than we can find new drugs to treat infection.
Within the medical community, there is a lot of finger-pointing. Officials blame drug
companies for creating too many compounds in the beginning, creating a false sense of
security regarding the issue. Drug companies blame doctors for overprescribing antibiotics
when they weren’t necessary instead of saving them for a last resort. Doctors blame patients
for failing to finish entire courses of prescribed antibiotics, which increases the chance of
bacteria developing resistance. The availability of antibiotics over the counter in some
countries has made it easier for people to take the drugs without direction and oversight by
doctors. Likely, it is fair to assign some blame to all of these actors.
Additionally, the rampant use of antibiotics on livestock in order to minimize
unprofitable animal deaths. The problem with this is not only that the bacteria in the animals
can gain resistance, but also that the antibiotics fed to the animals enter our bodies through
the food we eat, conferring resistance on our bacteria. This is also the case with drinking
water, as it often contains antibiotics due to poor environmental regulations, particularly in
LMICs.
III.
Current Issues/Looking Ahead
There is a rise of carbapenem-resistant Enterobacteriaceae (CREs), bacteria that can
cause blood, lung, and bladder infections that lead to septic shock and, in 50% of patients,
death. CREs, MRSA, and other common infections with antimicrobial resistance are now
responsible for roughly 23,000 deaths each year in the US and 25,000 in Europe. It is
estimated that, by 2050, antibiotic resistance will be responsible for at least ten million
deaths. In order to fight these bacteria with multiple drug resistance, second- or third-class
drugs must be used, causing patients unnecessary suffering (as these drugs are usually less
effective) and increased cost. At this point, most scientists would agree that antibiotic
resistance now amounts to a serious threat. Scientists at Northwestern University have
recently discovered a new compound they hope will give us some more time to find viable
solutions to this problem, but actionable, viable solutions are needed.
The CDC and WHO, along with many other organizations and individual nations
themselves, have begun designing programs that should limit antimicrobial resistance while
also finding alternatives to antibiotics to treat infections. This is now of the utmost
importance, and should be the focus of this topic. There is lots of debate as to which type of
program will be most useful in combating antibiotic resistance. Should they be policy-based,
such as requiring stricter environmental or drug regulations? Should programs try to screen
and isolate patients with AR bacterial infections? Should they be aimed at developing new
drug compounds? Common in many of today’s programs are AR tracking, more judicious
use of drugs, better hygiene, and the development of new drugs. It is important during this
conference to assess how feasible these targets might be, and what sort of challenges or
shortcomings these targets may have.
Not only is it important to design programs that will target the causes of antibiotic
resistance, but these programs also need to be either cost-effective, or convince governments
to underwrite the efforts. Implementation may be particularly difficult in areas where
governments are overburdened or uncooperative, or in regions with strife or outbreaks of
infectious disease.
Topic 3: Water Sanitation
I.
Background and Causes
Proper and healthy drinking water is crucial for one’s health, especially in the long-run.
However, many in developing nations do not have proper access to sanitary water as they do not
have the resources to acquire or maintain clean water. As reported by ECOSOC, “the UN
believes that refugees, asylum seekers, internally displaced people and returnees should have
access to adequate drinking water whether they stay in camps or urban areas.”4 Water quality has
deteriorated in many areas due to poor infrastructure and community planning as well as due to
maintenance and quality control measures. Because of these issues, developing nations have
various water-borne illnesses. Other issues include improper urbanization, population growth,
and deteriorating infrastructure.5
4
5
UNHCR, “Water, Sanitation, and Hygiene (WASH)”
WHO, “Drinking-water Quality”
II.
Current Issues/Looking Forward
As a form of entertainment, people play in rivers and lakes by swimming, fishing, diving, etc.
but many do not realize the health hazards these activities possibly hold. Many bodies of water in
developing countries have been polluted by sewage or are growing cyanobacteria. This could
cause various diseases as well as possible epidemics. Because those in impoverished areas do not
know how to properly dispose of their waste or do not have the means to do so, rivers and lakes
become polluted and pose harmful for nearby residents.6
Other methods in improving water sanitation include improving poverty and world hunger,
developing better maternal health practices, vaccinating children and providing larger health
centers, combatting disease outbreaks, and improving the environment long-term. According to
the World Health Organization (WHO), 2.3 billion people have received improved drinking
water from 1990-2012. Furthermore, children dying of various diseases, such as diarrhoeal
diseases, from poor water conditions has decreased from 1.5 million deaths to approximately
600,000. However, 2.5 billion people do not have proper sanitation and around 1 billion people
in rural villages defecate in public areas, causing further chances of spreading diseases. 748
million do not have access to proper drinking water and 1.8 billion drink contaminated water.
Additionally, millions do not have access to soap and water to bathe themselves.7
Developing and facilitating better environmental practices such as the cleaning of sewage and
knowledgeable practices in disposing of waste would help prevent the outbreak of diseases.
Building better infrastructure would also aid future issues of unsanitary conditions. For example,
6
7
WHO, “Water Resources”
WHO, “Water Supply, Sanitation and Hygiene Development”
building proper structures such as outhouses or improving plumbing systems would vastly help
improve water sanitation problems.
Recently, WHO has discovered new diseases that have developed due to bacteria in unsanitary
water evolving in order to survive. This has proven harmful for medication development as these
new diseases or forms of previously curable ones do not have any forms of workable
medication.8 Newer technology in rural areas has also proven ineffective as once installed
residents do not understand how to operate or maintain the machinery. To specify, water
sanitation technology does not improve any conditions in some areas as the locals do not
understand how to use the devices, regardless of whether they were educated of its use.
8
WHO, “Emerging Issues in Water and Infectious Disease”
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"Drug Companies to Blame for Antibiotic Resistance, Says Pharmaceutical Boss." The
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4
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