Infectious Diseases:

Analysis of Eradication or Elimination Estimates

T-NSIAD-98-183: Published: May 20, 1998. Publicly Released: May 20, 1998.

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Pursuant to a congressional request, GAO discussed the World Health Organization's (WHO) estimates for eradicating or eliminating seven infectious diseases--dracunculiasis, polio, leprosy, measles, onchoceriasis, Chagas' disease, and lymphatic filariasis--worldwide, focusing on: (1) the soundness of WHO's cost and timeframe estimates; (2) U.S. spending related to these 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 eventual candidates for eradication; and (4) U.S. costs and savings from smallpox eradication and whether experts view smallpox eradication as a model for other diseases.

GAO noted that: (1) WHO and other experts it contacted generally agreed on five factors necessary to estimate the cost of eradicating or eliminating a disease: (a) product costs; (b) information on disease incidence, prevalence, and the size of the target populations; (c) administrative and delivery costs; (d) disease monitoring and surveillance costs; and (e) primarily for eradication, the costs of certifying that countries are free of the disease; (2) GAO focused its assessment on the accuracy and completeness of the underlying data for these five factors; (3) WHO's estimates and GAO's analysis did not include an assessment of opportunity or indirect costs that may be incurred as a result of eradication campaigns; (4) the soundness of WHO's cost and timeframes varied by disease; (5) generally, the estimates were most sound for those diseases closest to meeting eradication or elimination goals, including dracunculiasis, polio, and leprosy; (6) estimates for these three diseases were based on firm data about target populations and intervention costs from ongoing initiatives; (7) for the other diseases, WHO's estimates are more speculative because underlying data are incomplete or unavailable; (8) WHO officials acknowledged this fact and said that estimates are continuously revised as better data become available; (9) the United States spent about $391 million in 1997 to combat these diseases; (10) the United States spent $300 million on polio and measles prevention and on leprosy treatment in this country; (11) about another $91 million went for overseas programs, primarily the polio eradication campaign; (12) savings to the United States from eradicating or eliminating these diseases would result primarily from not having to vaccinate U.S. children against polio and measles; (13) experts GAO contacted identified four other diseases that pose health threats to the United states and could be possible candidates for eradication; (14) WHO told GAO that, while it may be technically possible to eradicate these diseases with existing vaccines, the international community cannot support too many eradication initiatives at one time; (15) the United States has saved almost $17 billion as a result of the eradication of smallpox in 1977; (16) the savings were due to the cessation of vaccinations and related costs of surveillance and treatment; (17) experts generally agreed that the primary lesson from smallpox is that a disease can actually be eradicated; and (18) however, smallpox had unique characteristics that made it particularly vulnerable to eradication and therefore has limitations as a model for current efforts.

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