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The global threat of infectious diseases came into focus with the onset of the Coronavirus pandemic, but there is a positive outlook overall.
In 1990, communicable diseases like malaria and tuberculosis accounted for nearly a third of the global health burden. However, by 2019, only a sixth of the disability-adjusted life years (DALYs) lost were due to infectious diseases.
This shift is partly due to the increasing burden of non-communicable illnesses such as heart disease and cancer. It is also the result of global efforts, including initiatives like the United Nations Sustainable Development Goals, which aim to reduce infection and mortality rates. Over the past three decades, the number of healthy years of life lost to infectious diseases, adjusted for population size and age, has more than halved.
Prior to the Covid-19 pandemic, only a few infectious diseases were deadlier than they were in 1990. These diseases include HIV and invasive non-typhoidal salmonella, which disproportionately affect people with HIV and malnourished children.
However, when examining a shorter timeframe, the situation appears more positive. From 2010 to 2019, very few infectious diseases caused a significant increase in DALYs at a global level.
Most countries experienced a decline in the burden of communicable diseases. Dr. Haidong Wang, unit head for monitoring, forecasting, and inequalities at the World Health Organization (WHO), attributes this shift to the decreasing burden of HIV. “Through concerted efforts by countries and the international community, we can actually decrease the burden of specific diseases, especially infectious ones,” he says. Progress has even been made in Africa, which faced a disproportionately large burden of HIV.
However, HIV remains a major problem in certain parts of the African continent. Three out of four countries where age-adjusted DALY rates increased between 1990 and 2019 were African nations with high rates of HIV.
The most severely affected country was Lesotho, a landlocked nation surrounded by South Africa, where DALY rates from communicable diseases doubled during this period.
This situation reflects a larger disparity between sub-Saharan Africa and the rest of the world. In addition to HIV, the region had the highest rates of DALYs lost from other sexually transmitted diseases and respiratory infections between 1990 and 2019.
Sub-Saharan Africa is the only region where these types of illnesses still contribute significantly to the overall burden of ill-health. In 2019, infectious diseases accounted for 44 percent of DALYs lost in the region, compared to 18 percent in South Asia, which had the next highest share.
Wang explains that the region is still in the early stages of its demographic and epidemiological transition from high to low mortality and fertility rates compared to other regions. “Infectious diseases tend to account for a much higher proportion of the disease burden at the initial stages of the transition,” he says. “Over time, it shrinks, and non-communicable diseases increase. Most countries in Africa are still in that transition period, but we would expect the burden of communicable diseases to decrease in the next few decades.”
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