Eradication of Diseases
Economic analysis can have an important role in eradicating and eliminating certain infectious diseases. It can provide guidance and inform important decisions that will lead to the elimination and eradication to these debilitating diseases.
Disease elimination should be thought of as a reduction to zero of incidences of infection caused by a pathogen within a geographic area. After elimination there are required interventions to prevent the reestablishment of transmission. On the other hand, eradication is a permanent reduction to zero of global incidence and does not require additional interventions after eradication.
An integrated financial and economic analysis of planned investments to eradicate infectious diseases can confirm the best use of resources that will maximize net social benefits. It will also provide insights on the design as well as the optimal financing structure. Finally, it can provide a clear analysis of the distribution of the benefits.
Economics has an important role in elimination and eradication, as the initial investments tend to be larger than the existing control programs. Since there are limited resources the role of economics can be fundamental to making informed choices.
The idea of eradication and elimination have often been challenged, but too often with poorly informed opinions, such as arguments that mass vaccination campaigns underway can lower the incidence of measles, mumps, rubella in poor countries to a range that is similar to rich-world levels. The argument is that these are ‘good enough’ levels. The counter argument is that disease can bounce back and have much more dire consequences, as we saw with malaria in the 1960s. The point is simply that misinformed decisions don’t have to be the case. There are tools that can be effectively used to make these critical decisions.
We have been able to learn from the experience of small pox (human disease) and rinderpest (cattle disease), as well as from polio and dracunculiasis, a parasitic worm. There is strong rationale as to why we can eradicate many more diseases. Improved communication has provided technological responses to locating and monitoring cases of diseases in poor countries. The use of mobile phones and apps has changed the manner in which disease can be monitored. Medical technology and advances in drug production have been a huge game changer. The turning point for NTDs came about when Merck/MSD made the drug ivermectin available to poor countries. This is a drug that kills the worm that causes filariasis. As such, eradication of filariasis is now possible. Increasingly, there is political support within poor countries to eradicate diseases, especially those that are extremely cost effective, such as river blindness.
The benefits of eradicating diseases by exterminating the pathogens and parasites that cause them can be seen immediately, especially by those who are suffering from these diseases, but the benefits can have a country-wide impact for many poor countries. It is now thought that one of the reasons Japan and South Korea developed so quickly after World War II is that both ran country-wide deworming programs.
Ken Gustavsen, the Senior VP of the Merck Foundation, mentioned that eradication is not easy and that “sometimes the last mile is the hardest.” Mr. Gustavsen is right, but with the right set of tools including those required for the selection and structuring of financing instruments, the last mile can be the most rewarding, as we watch diseases that have caused disabilities to so many people be eradicated.