Smart Post-2015 Targets to Tackle Infectious Diseases

Ebola has gotten much of the attention in 2014, and it has killed about 8,000 people. Over the same period of time, however, about 4 million people died from AIDS, tuberculosis (TB) and malaria. 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 that tackling these diseases turns out to be an extraordinary good investment.

Health is a big topic, and we’ve had the perspectives of five expert groups plus a number of commentaries. They make a strong case for tackling killer diseases. Take TB. Two billion people worldwide carry the bacterium that causes it, and 1 in 10 of them will go on to develop the disease. TB probably killed about 100 million people over the 20th century, and was one of the 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. Unfortunately in Nigeria, the risk of TB dropped by only 5% since 1990, with 160,000 people dying from TB in 2013.

The global risk of dying from TB has been reduced by more than one-third over the past twenty years, and since 1995, the progress is estimated to have saved 37 million people from dying. Yet, further progress has been hampered by weak health systems, poverty and multi-resistant strains of TB. Despite the toll it takes, TB treatment receives just 4% of total development assistance 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 Organization recommends a preventative course of drugs, costing just $21 per person, for high-risk populations. Treatment is highly effective and on average can give people a further 20 years of productive life, and each dollar spent this way will generate $43 worth of benefits.

Malaria is another killer disease. 90% of those it kills are in sub-Saharan Africa, and 77% are children under five. By far the most effective treatment is to use a drug called artemisinin and it's crucial to be used in combination with other malaria medicines to prevent parasites getting resistant to it. In total, this will likely cost about half a billion dollars but have benefits of twenty billion dollars, 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. 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 each dollar spent would return $28 worth of benefits.

However, one of the economists working on this project has proposed a radically different approach. Her argument is that focusing on a handful of key diseases has created islands of excellence in a sea of dysfunction. Much better, she suggests, to build up strong health systems which can deal with all medical problems. The problem is that the cost is phenomenally higher and the efficiency per dollar likely much lower. However, it is worth remembering that there are bigger problems than the 4 million killed by AIDS, TB and malaria – take working-age injury and trauma, which kills almost 6 million each year.
In the health sector, we are spoilt for choice 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 fifteen years.

You can read all of the reports at post2015consensus.com/health-infectious-diseases

Here, Copenhagen Consensus Center has released its latest research on Infectious Diseases targets for the post-2015 development agenda. Neha Raykar and Ramanan Laxminarayan, from the Public Health Foundation of India write the report on malaria. Anna Vassal, from the London School of Hygiene and Tropical Medicine, writes the main report on TB. Paul Geldsetzer and colleagues from the Harvard School of Public Health write the main report on HIV/AIDS. Additionally, Maria Wang and Regina Osih of the Clinton Health Access Initiative contribute a viewpoint paper on TB and Peter Ghys, Director a.i., Strategic Information and Evaluation and José-Antonio Izazola-Licea, Division Chief, Evaluation and Economics of UNAIDS contribute a viewpoint paper on HIV/AIDS.

For more on infectious diseases, please see Global Policy's recent ebook pulished in collaboration with the Observer Research Foundation; ‘Eradicating TB in India: Challenges, Perspectives and Solutions’, edited by Harsh Sethi.