Soundness of World Health Organization Estimates for Eradication or Elimination
NSIAD-98-114: Published: Apr 23, 1998. Publicly Released: May 20, 1998.
Pursuant to a congressional request, GAO reviewed the World Health Organization's (WHO) efforts to eradicate seven infectious diseases--dracun culiasis, polio, leprosy, measles, onchocerciasis, Chagas' disease, and lymphatic filariasis--worldwide, focusing on: (1) the cost and timeframe estimates developed by WHO for eradicating or eliminating these diseases; (2) U.S. spending related to the seven diseases in fiscal year 1997 and any potential cost savings to the United States as a result of eradication or elimination; (3) other diseases that international health experts believe pose a risk to Americans and could be candidates for eradication; and (4) historical information on U.S. costs and savings from smallpox eradication and whether experts view smallpox eradication as a model for other diseases.
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.