Medical Device Daily National Editor

As the world considers, and is increasingly anxious about, the global threat of Swine flu, another, much larger epidemic/pandemic has been building over recent years, and clearly with much greater threat to grow.

Six health agencies representing four continents of the world have just unveiled a collabration to fight what might be considered a kind of World War III, this one against cardiovascular diseases (mainly heart disease and stroke), cancers, respiratory illnesses, and Type 2 diabetes, which they defined, as a group, as "chronic non-communicable diseases."

The Global Alliance for Chronic Diseases was unveiled by the Australia National Health and Medical Research Council (Canberra); the Canadian Institutes of Health Research (Ottawa); the Chinese Academy of Medical Sciences (Beijing); the UK Medical Research Council (London); and the National Heart, Lung, and Blood Institute (NHLBI) and Fogarty International Center of the National Institutes of Health (Bethesda, Maryland).

Representatives of the organizations said that without efforts to stem the tide of what they termed a "world epidemic" of these noncommunicable diseases, 388 milllion people will die of one or more of these illnesses within the next decade.

During a Monday webcast, Abdallah Daar of the McLaughlin-Rotman Centre for Global Health at the University of Toronto and the University Health Network (Toronto) said that the collaboration will focus, in particular, on the needs of low and middle income countries, and on those of low income populations of developed countries.

He and other group representatives said that among the major work of the alliance will be the coordination of large research efforts.

"One question that arises is what can this alliance achieve that the individual partners cannot do alone?" Daar said. The answer, he explained, is that "you can do very large-scale studies that you wouldn't otherwise be able to do on a global scale."

Priorities for the alliance were identified in a collaborative paper, "Grand Challenges in Chronic Non-Communicable Diseases," published in Nature in November 2007. The alliance representatives said that, based on a global survey, the paper has been acknowledged as a "sound" and "systematic" framework for reaching achievable solutions targeting the prevention of these diseases, considered the largest threats to humanity.

The particular research projects will be coordinated with the World Health Organization (WHO; Geneva, Switzerland).

The effort will be backed by the collective clout of the participating agencies. They say that, together, they manage about 80% of all of the world's public health research funding, and that other public health groups are expected to join.

The Indian Council of Medical Research (New Delhi) will be invited to join as a member, South America is described as "interested" in joining, and research agencies from other countries and private funders may be invited to join in a second wave.

Daar said that he expected other expansions of The Alliance's efforts will be to attract "research funders, including philanthropic foundations, from around the world that have an interest in this agenda."

WHO will serve as an observer to facilitate support the alliance's support of the World Health Assembly-approved "Action Plan for the Global Strategy for Prevention and Control of Non-communicable Diseases."

(www.who.int/entity/nmh/NCD%20Action%20Plan%20Resolution.pdf)

The alliance will hold its inaugural scientific meetings in November to discuss their initial proposals." These include:

• Testing of ways to prevent cardiovascular diseases and complications of diabetes.

• The identification and promotion of public health measures for controlling obesity.

• The characterization and quantification of the key risk factors for chronic obstructive airway disease (both tobacco and environmental pollution), and the development of control measures.

• The advancement of research into tobacco use and its relationship to cancer, heart diseases and other disorders.

• The development of interventions to address the above priorities.

A future research priority will likely be realted to mental health, the allliance representatives indicated.

Elizabeth Nabel, MD, director of NHLBI, said that the alliance will work not only to do widespread research but to translate research findings "into sustainable solutions."

For instance, she said, "We know about preventing heart attacks and strokes associated with smoking or high blood pressure, but how should we best put these ideas into practice, especially in low-resource settings or on a large scale?" These translations, she added, will include "rearranging healthcare delivery in the most cost effective way."

The Nature paper on which the alliance will base its worked identified NCDs as causing the greatst "share" of the world's death and disability, at least 60%, with four-fifths impacting the low and middle-income companies. And these deaths are twice that of the combined total of HIV/AIDS, tuberculosis, malaria, maternal and peri-natal conditions, and nutritional deficiencies.

Besides citing 388 milllion potential deaths from NCDs over the next 10 years, The alliance put that loss also in monetary terms. It said that without preventive action against NCDs, China, India and the UK will lose, respectively, $558 billion, $237 billion and $33 billion over that period.

Stig Pramming, director of the Oxford Health Alliance (London), issued a challenge to the private sector, seeking support to augment the proposed public-sector efforts. He said that industry has "an important role" in developing the necessary healthcare solutions, and that the alliance "intends to work with the commercial sector as appropriate."

Ala Alwan, MD, assistant director general for noncommunicable diseases and mental health at WHO, said that WHO "hopes that this new initiative will assist with the implementation of the Global Strategy Action Plan. Prevention and implementation research ... particularly in low- and middle-income countries. It is crucial to have close coordination between this initiative and the work underway in WHO to develop a prioritized research agenda focusing on strengthening prevention interventions and promoting national capacity in NCD prevention research."