How would you spend $1 million to improve global health?
By Fiorenzo Conte
Imagine you have $1 million to invest in a health intervention and you want to get the best bang for your million bucks. Now imagine that you must (the argument goes that we live in a world of limited resources) chose between two options. The first option affects 1 billion people whereas the second affects 40 million worldwide. For the first one the WHO tells you that the costs for annual treatment is often less than $0.50. For the second one the cost of annual treatment is $200. Last piece of information: in the first case the treatment needs to be given only once per year and it will stop transmission; in the second case treatment is to be given everyday and transmission will not be avoided. Now what do you chose?
If you went for option one you picked neglected tropical diseases, as I think the majority did if you care about your money; if you went for option two you picked HIV/AIDS. David Molineux, an expert at the Liverpool School of Tropical Disease explains the rationale behind choosing NTDs for your $1million
“NTDs are “low-hanging fruit.” We can easily meet that objective( to tackle NTDs), because we have drugs that are effective, free (or very cheap), that have low delivery costs, and that provide add-on benefits.”
However not many people in the donor community seem to think in the same way ( see here Reuters for the lack of funding in research for neglected tropical diseases). So why tropical diseases, which offer such a potential return to our $1 million investment, remained neglected? Molineux has an idea and it has to do with the goal of our investment
“those who live on less than $2 per day – are often not considered important when a pandemic threat emerges. They do not contribute significantly to the global economy. (..)Conversely, the developed countries’ view of the diseases of the developing world is that only three are important: AIDS, tuberculosis, and malaria. This stems from the power of advocacy constituencies and the recognition that these diseases might threaten the developed world. As a result, these diseases receive a disproportionate amount of funding for research and control, while other infections kill, blind, deform, and disable many more – the “bottom billion” – who have little access to health care.”
As we noticed in another post about condoms production and procurement, foreign aid is sometimes (maybe too often) more about serving the interests and fears of those in developed countries rather than serving those of the bottom billion. Neglected tropical diseases offer another stark example of this tendency and of its consequences on the neglected poor.