Infectious Diseases

Infectious diseases place an enormous burden on the developing world, killing more than 17 million people a year and afflicting hundreds of millions of others. If polio, measles, and other infectious diseases were eliminated, the United States could save hundreds of millions of dollars, primarily because it would no longer need to vaccinate U.S. schoolchildren against polio and measles. Although the cost estimates and time frames developed by the World Health Organization (WHO) for eradicating some infectious diseases are based on firm information, others are more speculative because complete data are unavailable on target populations, disease prevalence, and other factors. Other diseases also pose health threats to the United States and could be potential candidates for eradication. Four diseases were frequently mentioned in the literature and by experts whom GAO interviewed: rubella, mumps, hepatitis B, and Hemophilus influenzae type b. WHO officials said that although it is technically possible to eliminate these diseases with existing vaccines, it is unlikely that other diseases will be considered for eradication before success is achieved with currently targeted diseases. GAO estimates that the United States has saved nearly $17 billion so far from the eradication of smallpox in 1977. Experts agree that several lessons can be learned from the smallpox effort, but the main lesson is that a disease can actually be eradicated. However, they caution that smallpox has limitations as a model for other diseases because it has characteristics that are uniquely amenable to eradication. GAO summarized this report in testimony before Congress; see: Infectious Diseases: Analysis of Eradication or Elimination Estimates, by Benjamin F. Nelson, Director of International Relations and Trade Issues, before the House Committee on International Relations. GAO/T-NSIAD-98-183, May 20 (13 pages).

GAO noted that: (1) the soundness of WHO's cost and timeframe estimates for eradicating or eliminating the seven diseases varied for each disease; (2) cost and timeframe estimates for dracunculiasis, polio, and leprosy were the most sound because campaigns against them have been under way for several years and are largely based on firm data about target populations and intervention costs from ongoing initiatives; (3) for the other diseases, WHO's estimates are more speculative because data underlying the cost and timeframe estimates are incomplete or unavailable; (4) WHO officials acknowledge that the costs and timeframes provided to the House Committee on International Relations are not exact and that they must continually be refined as new information becomes available; (5) the United States spent about $391 million in 1997 on programs to combat these diseases; (6) potential savings to the United States if eradication or elimination of these diseases were achieved could be substantial; (7) most of the savings would result from eliminating the need to vaccinate U.S. children against polio and measles; (8) the experts GAO interviewed and its review of the literature identified several other diseases that pose health threats to the United States and that meet the scientific criteria for eradication used by health experts; (9) four diseases were frequently mentioned: rubella, mumps, hepatitis B, and Hemophilus influenzae type B; (10) WHO officials stated that while it is technically possible to eradicate these diseases with existing vaccines, it is unlikely that other diseases will be considered for eradication before achieving success with currently targeted diseases; (11) using Centers for Disease Control and Prevention data, GAO estimated that the United States has saved almost $17 billion to date from the eradication of smallpox in 1977; (12) the savings are due to the cessation of vaccinations and related expenditures such as surveillance, treatment, and loss of productivity; (13) experts agree that several lessons can be learned from the smallpox effort, but the primary lesson is that a disease can actually be eradicated; and (14) however, they also suggested that smallpox has limitations as a model for other diseases because it had characteristics that were uniquely amenable to eradication.