No disease comes close to the AIDS epidemic in threatening every aspect of development for dozens of countries. Unfortunately, it is also in many ways the hardest to tackle. Jamison’s team draws on research created for the Copenhagen Consensus and Rush Foundation project RethinkHIV to identify priorities against this disease. The most effective preventive interventions against HIV are those targeting sex workers and those most likely to contribute to increased transmission, as has been done successfully in India and other Asian countries. Voluntary counseling and testing has reduced unsafe behavior in some studies, although the duration of this change is not clear. Prevention of mother-to-child infection is cheap and effective, and needle exchange and blood safety programs can reduce other modes of transmission.
An HIV vaccine is the ultimate preventative tool. The researchers use RethinkHIV research by Robert Hecht and Dean Jamison on the costs and benefits of increasing research funding to speed up the arrival of a useful vaccine. Jamison concludes that there is a strong case for increasing HIV vaccine research and development by $100 million annually. Even with conservative assumptions, each dollar spent would generate benefits worth 20 times the costs.
It is striking that most of the top five investments would largely save the lives of children. This points to a broader issue, which is inequality in health conditions. As Jamison’s team notes, from 1990 to 2001, the under-5 mortality rate remained stagnant or increased in 23 countries. In another 53 countries, including China, the rate of decline in child mortality was less than half of that required to reach the Millennium Development Goal. We have had many real successes in high- and middle-income countries in the battle against infectious disease; our real challenge is spreading this success to low-income countries.
There are strong arguments to increase spending on infectious diseases. But what priority should these initiatives be given by policymakers and philanthropists? How could limited money best be spent to combat global challenges? Have your say by voting below.
Tomorrow, we turn to Water and Sanitation. We’ve made great strides getting drinking water to the farthest reaches of the world—why are we lagging behind on sanitation, and how can we step up our efforts?