Deadlier than Ebola

Ebola got so much attention in 2014 and to date it has killed about 8,000 people. Over the same period of time what period year?, however, about four million people died from AIDS, tuberculosis (TB) and malaria.

The truth is that despite great progress in health care, 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 is an extraordinary good investment.

It may sound cold-hearted to set health priorities based on cost-effectiveness, but it is actually the best way to do the most good in the world with limited resources. One hundred and ninety three governments are working on a set of priorities for the world to focus on by 2030 (including health), and the final list will be decided in New York by September 2015.

Health is a big topic, and the Copenhagen Consensus Centre (CCC) has had the perspectives of five expert groups plus a number of commentaries. They make a strong case for tackling killer diseases like tuberculosis (TB).

Two billion people worldwide carry the bacterium that causes it, and one in 10 of them will go on to develop the disease. TB probably killed about 100 million people during 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. In Ethiopia the risk of contracting TB dropped by 64pc since 1990 with 30,000 people still 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 four percent of total development assistance spent on health, compared with 25pc for HIV.

TB can be difficult to detect, particularly in countries with poor health systems, and the World Health Organisation (WHO) recommends a preventative course of drugs, costing just 21 dollars per person, for high-risk populations. Treatment is highly effective and on average can give people a further 20 years of productive life. Each dollar spent this way will generate 43 dollars worth of benefits.

Malaria is another killer disease. About 90pc of those it kills are in sub-Saharan Africa, and 77pc are children under five. Ethiopia had nearly 1.7 million confirmed cases in 2012.

By far, the most effective treatment is a drug called Artemisinin, which is derived from the plant Artemisia annua. It is crucial to use this drug in combination with other malaria medicines to prevent parasites becoming resistant to it. The likely cost of providing Artemisinin is about half a billion dollars but there benefits may be valued at twenty billion dollars, or about 36 dollars worth 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 the virus continues to cause large-scale human suffering in sub-Saharan Africa, where 70pc of the global population of people living with HIV reside.

Globally, 35 million people live with HIV, out of which 790,000 live in Ethiopia. The team studying HIV and AIDS 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 dollars annually, but reaching 90pc 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 dollars. And this is not the only option.

Male circumcision is a one-off treatment, which could reduce the transmission of HIV to men during intercourse by 60pc and, with some delay, also reduce transmission to women. Although not as effective as widespread drug treatment, the cost would be about 30 million dollars annually but each dollar spent would return 28 dollars 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, is building 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 four million killed by AIDS, TB and malaria. Working-age injury and trauma kill almost six million each year.

In the health sector, we can make better choices to spend money efficiently and transform people’s lives. Now it is up to the world’s governments to look at the evidence and make good choices on priorities for the next fifteen years.






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