New, Emerging and Re-emerging Infectious Diseases oday there is ¢ growing concer at national and international levels about the problem of infectious diseases These diseases remain a leading cause of death, and are @ major public health problem worldwide. The specttum of these diseases is expanding with the occumrence of new diseases, and the re-emergence of those once thought to have been eliminated. The examples of plague in India last yeor and of the Ebola epidemic in Zaire early this year are still fresh in our minds, They highlight the need for a hard look ol these new, emerging and re-emerging diseases and for solutions to combat the growing problem Many factors account for the present Rapid and uncontrolled urbanizotion in resulting in overcrowding, situation POOF sanitation, environmental degradation and occurrence of natural disasters have resulted in altering the ecological balance that existed previously. Incteased and rapid both within and outside countries, and inadequate resource allocations for communicable disease contol have further contributed to the problem. Duting i's frst 30: years, WHO's efforts were focussed primarily on the control of communicable diseases though the development of action-oriented programmes. These efforts culminated in the eradication of smallpox in 1977. Since then, the interest in communicable diseases has waned, portly due to changes in hecith development priorities ond a consequent reduction in allocation of resources for the control and prevention of these diseases, Such changes have affected further progress towards the control of communicable diseases. As such, surveillance activities are not being carried out with a sense of purpose, Unforiunately, both the technical capacity as well os capability to respond effectively to @ public health emergency have weakened All this has hoppened despite the fact that infectious diseases still take a heavy toll of life. The situation is getting further complicaled with the emergence of new strains of microbial agents as ¢ result of mutation ond strains ‘esistant to the commonly available antimicrobials, The ancient scourges such as tuberculosis and leprosy are still prevalent WHO Inlercouniry Consuliorive Meeting on the Prevention ond Contiol of New, Emerging ond Rovemerging Infectious Diseases, SEARO, New Delhi, India, 21 25 August, 1995Those which were not known before, such as Vibrio cholerae 0139 and HIV/AIDS, have oppected, ond diseases which were cloimed to have been conquered such as malaria, plague and kala-azar hove reappeared. Diseases which earlier were of no public health importance, such as melioidosis, are ossuming importance in association with HIV in some countries Outbreaks of Dengue/DHF, Meningococcal Meningitis, Japanese Encephalitis and Vira! Hepatitis are also common in the Region Thove is now an urgent need to rebuild the foundations of communicable disease prevention and control. The first priority in improving surveillance systems at the country level is lo assess the exisling capacities ond capabilities, strengthen what is weak and build up mechanisms 10 quickly recognize and respond 10 these diseases in o more urgent, systematic and effective manner. Research studies will have to be undertaken to overcome technical and operational problems. All operational methods must be scientifically sound and practically feasible and affordable. !do hope thot distinguished scientists and policymakers present here would identify priority problem solving research areas The experience from recent epidemics provides important lessons. The firs! is 10 establish ond strengthen an early warning syste to help the national authorities initicie immediate control measures. In other words, emergency preparedness and response in epidemic situations requires a well coordinated plan of action, utilizing the available resources and making « nationwide effort. Training of health core workers at all levels will enhance their interest and improve efficiency, To assist in rapid response, « roster of experis should be maintained both at the regional and headquarters levels. These experis could then be available at short notice if required to assist o country either by consultation or by a visit in the event of an oulbreak of these new, emerging and re emerging infectious diseases. The second lesson was that no surveillance is effective unless ithas adequate laboratory support. Atiempts should be made to provide diagnostic reagents to the peripheral heath centres for rapid diagnostic tests, The sophisticated tesis could be conducted ot the secondary and tertiary levels ‘of health care staff. WHO will review the capabilities of its existing collaborating cenves and if necessary identify new ones and develop on effective network of such centres 10 assist in early recognition and in ropid response mechanisms. Finally, we have learned that itis crucial to provide accurate and timely information to the public and to establish good relationships with the media. The public has « tight to be informed of motters that concern their health. If accurate information is notprovided to the mass media, they will publish factually incorrect and often conflicting information which may cause panic among the population. This will not only hamper the control measures but also have an adverse effect on the economy of the country due to loss in trade and other sources of income. This wos well illustrated in the outbreak of plague in India. Inaccurate and often conflicting reports inthe mass media created unnecessary panic both nationally and internationally resuling in lravel restrictions to and from Indio.’ As a resul, the country suffered a loss of well over a billion dollars due to imposition of trade ‘estrictions. ——_y-———_—