Economic Liberals: Prolonging The Disease
However, two problems arise when liberal systems attempt to tackle disease, particularly international epidemics like AIDS and “fringe diseases” like ebola.
The first problem facing liberal systems is that people affected by the disease are many, and exceed the number of people infected by the disease, who are comparatively few. To understand this phenomenon, one may simply look to the bird flu. The avian flu scare rerouted airplanes, changed airport security procedures, cancelled thousands (tens of thousands?) of in-person business meetings, and had enormous economic effects. Yet the number of people who actually died from avian flu (influenza A-H5N1) remains low, with zero deaths in the United States and only livestock deaths in Europe (including the UK). Needless to say, the economic effects of such a disease are vast, but the economic gains from curing the disease do not necessarily equal the prevention of all these costs plus surplus productivity from the activities otherwise prevented.
The reason the people solving the disease don’t directly or immediately enjoy the solution to the disease is threefold. First, geography and patterns of travel prevent even a broadly endemic disease in Congo from spreading to Boston. Second, the additional marginal productivity of non-infected people does not appear in the same places (geographically, nationally, demographically, or by economic sector) as the discovery of treatment or cures. Third, the added productivity of people is generally low, even in aggregate, as the diseases involved (often in places like DRC or Uganda) afflict people who have low lifespans and low economic productivity even when not infected with any communicable disease.
It is no doubt difficult for employees or shareholders to become particularly excited about remediating or curing a disease that results in little increased productivity among the afflicted group (and little decrease in risk among anyone the employees or shareholders might know personally). While scientific accolades often accompany these advances, other awards are available for things that might serve to protect the wealthy, Western parts of the world in which most medical research is conducted.
The latter problem for liberal systems is that the communities and areas that act as reservoirs of disease are not particularly good target markets for expensive treatment regimes. Take the area where I lived in Northern Uganda. This area has an HIV problem, and has for more than a generation. But the local people are impoverished and hence not a good target market for HIV drugs, even at a low pricepoint.
This problem is further exacerbated by intellectual property treaty provisions. Many drugs can be reverse-engineered and copied from a single tablet. Fear of this illegal pharmapirating leads manufacturers to avoid markets where a local, low-cost competitor is likely to make small profits while shouldering none of the research and development cost. Both India and South Africa have seen substantial pharmapiracy in the past fifteen years, and the pace appears to be increasing.
Even with no piracy concerns, it is difficult to argue that purely economic reasons justify the availability of drugs in many of these regions. With incomes of $1 to $3 per day, most of the world’s poor (and the poor are, incidentally, most of the world’s population) cannot afford to pay for the variable manufacturing cost of a daily tablet, let alone some portion of the amortization of the research and development costs, packaging costs, quality control process, and machinery costs. While many other areas, from telecommunications access to transportation challenges, present fertile ground for market-driven solutions, the number of billionaires who have made fortunes curing disease among the world’s poorest remains at zero.
At present, curing the sick remains firmly within the jurisdiction of philanthropy and altruism, while extending the lives of the wealthy remains a profitable venture. Writers, from H.G. Wells to Harlan Ellison to Philip K. Dick have struggled with this enigma. But until there is significant economic value created by giving the “other” six billion people an extra year, or five, or ten of productive life, the world of sick people will continue to be bifurcated into two categories: victims and customers, with a ratio of approximately six to one between the two.
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