PREFACE

The InterAcademy Medical Panel is a voluntary association of the world's medical academies or the medical divisions of science academies. The IAMP is committed to improving health around the world. This includes collaboration to strengthen the role of all academies to alleviate the burden of the poorest, to build scientific capacity for health, and to provide independent scientific advice on promoting health science and health care policy to national governments and global organizations.

This is the first global meeting of the IAMP, addressing an issue of critical importance in every country. The InterAcademy Medical Panel calls for a renewed commitment by its member organizations, their membership of health science professionals, and representatives of other scientific and medical disciplines to provide leadership within each of their countries, as well as globally, to combat infectious diseases and antimicrobial resistance.

THE BURDEN OF INFECTIOUS DISEASE THROUGHOUT THE WORLD

In spite of many advances in prevention, diagnosis, and treatment of infectious diseases, ailments produced by infectious agents account for a very substantial proportion of the burden of disease in the developing and developed worlds. Although the catastrophic HIV epidemic deserves increasing global attention, there are many other infectious diseases such as tuberculosis, malaria, diarrhea, hepatitis and respiratory infectious diseases that continue to kill or disable hundreds of millions of children and adults around the world. The increase in international travel contributes significantly to the spread of infectious diseases between developing and industrialized countries. Antibiotic resistance is growing and increasingly threatens effective treatment in all countries. The recent use of anthrax as a lethal weapon of bioterrorism calls attention to a grotesque distortion of the science of infectious disease by human actors.

There is a substantial gap between what is known about the prevention and treatment of these infectious diseases and the application of that knowledge through the world. The growth of antibiotic resistance is a poignant and frightening example of this worldwide challenge.

For many low income countries the infrastructure to deliver effective programs of prevention and treatment remain inadequate. This is true for lower income people whether they live in developed or developing countries.

AN ACTION AGENDA

Addressing these challenges requires a comprehensive approach by the health professions, academies of medicine and science, governments, the private sector and international organizations.

• Governmental health agencies must make continuous improvement in the surveillance of infectious illnesses, mapping the spread of infectious agents, the incidence of antimicrobial resistance, and the burden of subsequent illness. Governments as well as international organizations must improve the training of infectious disease surveillance officers to address these tasks. Surveillance requires more accurate and comprehensive reporting systems and strengthened information systems so that accurate, comparable, and complete surveillance information is available to individual communities, countries, and internationally. Surveillance is as relevant to combating naturally emerging infections as it is to bioterrorism.
• Pharmaceutical companies and governments must find ways to offer drugs and vaccines at costs that can be afforded not only by the rich but also by poor countries. Additional efforts must be made to decrease the cost of production and distribution of these agents. Substantial investments in research to identify new and effective agents that are appropriate to the needs of local communities and individual countries are essential. This includes the requirement for developed countries to facilitate the establishment or expansion of indigenous research capacity throughout the developing world.
• Governments and international agencies must strengthen policies to ensure the use of the most effective vaccines and drugs. Making proper drug combinations available and enhancing the technical capacity for the manufacture, preservation, transport, administration of vaccines are important issues in this area. Bioterrorism emphasizes this need. Health professionals and the public require increased professional education regarding proper dosages, drug combinations, and the use of the most cost-effective methodologies for applying these programs.
• The resistance of infectious organisms to antimicrobials is a worrisome and worsening problem. Scientific evidence indicates that antimicrobials are more effective and the risk of microbial resistance is decreased with high dose, short course treatments in contrast to low dose long course regimens. This important information must be disseminated throughout the world by the scientific community, governmental health agencies, pharmaceutical companies, physicians, pharmacists, and an educated public to retard the development of resistance to antimicrobials by eliminating the inappropriate use of these agents.
  
• As research is critical and often a pre-requisite for any sustainable development, collaboration between developing and developed countries is urgent and essential to build or expand research capacities in the low-income countries, as well as establish research facilities and hospital-based stations to test such products. Specific investments in research are essential to identify new and effective drugs that are appropriate to the needs of low-income communities.
  
• Research and demonstration projects should be launched to find improved ways to create public health and treatment infrastructures in countries currently limited by the available infrastructures.
  

THE ROLE OF ACADEMIES OF MEDICINE AND SCIENCE

For these efforts to succeed, scientists, physicians, health professionals, and public health personnel must be more actively engaged in providing evidence-based, scientifically valid, cost-effective recommendations to their governments, to professional organizations, and to other public and private entities. We recognize that the greater part of these efforts will involve developing countries. We seek to strengthen the capacity of these countries, which will entail advances for surveillance, public health infrastructure, capacity building and accessibility to drugs and vaccines. In this context, promotion of multi-disciplinary networking, forums, collaborative projects between scientists, physicians, health care professionals and public health personnel, in confronting these challenges, will be encouraged by IAMP. The world's academies must assist in the global efforts for biosecurity and to ensure that medical research is not subverted for terrorist purposes. At the same time the central importance of free and open communications between scientists as well as the legitimate exchange of scientific materials for the advancement of science and improvement of health must be recognized and protected.

Member organizations within the IAMP will individually initiate projects in these areas, and join with other academies, regionally or internationally, in order to identify ways to accomplish the aims described above. Medical and scientific academies are ready not only to provide decision-makers with recommendations based on the best science, public health measures, and the education needed to cope with these threats but also to provide credible scientific information to the public. We seek to promote research in biomedical sciences throughout the world.