How to tackle infectious diseases

How to tackle infectious diseases

Ebola has received much of the attention in 2014, and has killed about 8,000 people. In the same period of time, about 4 million people died from Aids, tuberculosis (TB) and malaria.

The truth is that despite great progress in healthcare, much of the world is still blighted by preventable disease, with the poorest people suffering the most. The good news is tackling these diseases turn out to be an extraordinarily good investment.

It may sound cold-hearted to set health priorities based on cost-effectiveness, but it's the best way to do the most good with limited resources. Some 193 governments are working on a set of global priorities for 2030, and the final list will be decided in New York by September 2015.

To help the right decisions to be made, my think tank, the Copenhagen Consensus Center, asked over 60 teams of top economists to assess key targets proposed and make the case for those which should be on the final list.

Health is a big topic, and five expert groups have given their perspectives. The case for tackling killer diseases is a strong one.

Take TB. Two billion people worldwide carry the bacterium that causes it, and 1 in 10 will go on to develop the disease. TB probably killed about 100 million people over the 20th century, and was a major killers before antibiotics became available.

The success of this treatment has almost wiped out TB in rich countries, but it continues to be a disease of the poor, and kills about 1.5 million each year, 8,100 of them in Thailand.

The global risk of dying from TB has been reduced by more than one-third over the past 20 years, and since 1995, the progress is estimated to have saved 37 million lives. Yet, further progress is hampered by weak health systems, poverty and multi-resistant strains of TB.

Despite the its toll, TB treatment receives just 4% of total development aid spent on health, compared with 25% for HIV.

TB can be difficult to detect, particularly in countries with poor health systems, and the World Health Organisation recommends a preventative course of drugs, costing just $21 (710 baht) per person, for high-risk populations.

Treatment is highly effective and on average can give people a further 20 years of productive life. Helping almost everyone who's sick will cost about $8 billion a year, but provide benefits worth almost $350 billion. Each dollar spent this way will generate $43 worth of benefits.

Malaria is another killer disease. Around 90% of those it kills are in sub-Saharan Africa, and 77% are children under five. Yet, Thailand still saw an estimated 140,000 malaria cases in 2013. By far the most effective treatment is to use a drug called artemisinin.

Like all widely-used drugs, there is a danger that malarial parasites will develop resistance to it, so it is crucial to delay resistance by using artemisinin in combination with one or more other malaria medicines. In total, this will likely cost about half a billion dollars but have benefits of $20 billion, or about $36 worth of benefits for each dollar spent.

But what about HIV/Aids? Treatment with anti-retroviral drugs has made an enormous difference to people with HIV infection, but it continues to cause large-scale human suffering in sub-Saharan Africa, where 70% of the global population of HIV positive people live. Globally, 35 million people live with HIV, 440,000 live in Thailand. The team studying this disease estimates that the current use of anti-retroviral drugs should be expanded — doubling the amount spent on it — to reach all those people with significantly weakened immune systems.

This is not a cheap option, needing another $10 billion annually, but reaching 90% of the target group of patients would save many lives and be cost-effective. Every dollar spent would give benefits (extra years of life) valued at $10.

And this is not the only option. Male circumcision is a one-off treatment, which can reduce the transmission of HIV to men during intercourse by 60% and, with some delay, also reduce transmission to women. Although not as effective as widespread drug treatment, the cost would be about $30 million annually but provide benefits of almost a billion dollars per year. Each dollar spent would return $28 worth of benefits.

In the health sector, we are spoiled for choices of good projects to spend money efficiently — and transform people's lives. Now it's up to the world's governments to look at the evidence and make good choices on priorities for the next 15 years. The lives of millions of people depend on it.


Dr Bjorn Lomborg is the president of the Copenhagen Consensus Center. www.copenhagenconsensus.com.

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