Feb 28, 2007

Forgotten Diseases and Economics

by Laura Starita

The recent debate about whether or not it should be mandatory to innoculate young girls against Human Papillomavirus (HPV) - which is believed to account for the nearly half-million new cases of cervical cancer diagnosed worldwide every year - illustrates the strange dynamics and economics of investing in global health issues. Experts in the field will tell you that vaccination (or other “permanent cures") are far and away the most cost-effective investment possible. A comprehensive study published today by the Centers for Disease Control and Prevention shows that only 2.2 percent of American women are infected with the HPV strains likely to cause cancer. Still, the cost of widespread vaccination is dwarfed by the annual costs of care related to detecting and treating cervical cancer (not to mention the cost in deaths of those who do not receive adequate treatment). Rather than being a slam dunk however, the debate on whether to invest in a vaccination campaign is contentious.

The same dynamics play out for many diseases that afflict far more people, and where the economics are even more compelling: guinea worm, river blindness, trachoma, elephantiasis, bilharzia, leishmaniasis, etc. These diseases are now known collectively as “Neglected Tropical Diseases” because virtually no resources have been dedicated to their prevention and cure despite the toll they take, which numbers in the billions. Most of the 13 NTDs can be permanently cured via drugs that cost 50 cents per person.

Yet not everyone has forgotten. Recently, New York Times columnist Nicholas Kristof wrote two pieces focusing on the efforts of former President and Nobel Prize winner Jimmy Carter to eradicate some of the forgotten diseases through his philanthropic efforts. Guinea worm disease may disappear from the map substantially because of funding from the Carter Center. This is exciting news for a world that hasn’t eradicated anything since 1977, when the last case of smallpox was diagnosed.

Although we know that getting medicines to people who need them is more a function of logistics and avoidance of corruption than money, part of the battle against the world’s forgotten diseases is ensuring funds to purchase drug supplies for victims whose countries cannot afford them. To this end, a recent article in The Economist highlighted an effort by the GAVI alliance to create Advance Market Commitments (AMCs) for the purchase of drugs not yet available. These AMCs would theoretically encourage pharmaceutical companies to develop drugs to combat developing world diseases by providing guarantees that rich nations will buy them. Though it has many critics, this initiative is at least trying to tackle one hurdle to curing the world’s forgotten diseases.

New York Times:
Let’s Start a War, One We Can Win

Torture By Worms

Economist: Immunization and the Market

The Global Network for Neglected Tropical Disease Control website