Why Treatment?

From William Easterly's "White Man's Burden":

"The total amount of foreign aid for the world's approximately three billion poor people is only about $20 dollars per person per year. Is the money for AIDS treatment going to be 'new money' or will it come from these already scarce funds?

President Bush's 2005 budget proposal increased funding for the American AIDS program (especially treatment), but cut money for child health and other global health priorities by nearly a $100 million dollars (later reversed after protest)...

Bush's cut in other health spending was particularly unfortunate when two and a half times as many Africans die from other preventable diseases as die from AIDS...

Granting life though prevention of AIDS itself costs far less than AIDS treatment.

• The medicines that cure TB cost about ten dollars per case of the illness.

• A package of interventions designed to prevent maternal and infant deaths costs less than three dollars per person per year.

• Worldwide, 3 million children die a year because they are not fully vaccinated, even though vaccines cost only pennies per dose.

• One in four people worldwide suffers from intestinal worms, though treatment cost less than a dollar per year.

• A full course of treatment for a child suffering even from drug-resistant malaria costs only about one dollar.

• In fact, Vietnam, a relatively poor country, reduced deaths from malaria by 97% from 1991-7 with a campaign that included bed nets and antimalarial drugs.

• A bed net program in Tanzania also reduced mortality significantly.

• The availability of such cheap remedies makes it all the more tragic that malaria is still so widespread-we are back to the second tragedy of the world's poor.

The $4.5 billion the WHO plans to spend on antiretroviral treatment for one more year of life for 3 million could grant between seven and sixty years of additional life for five times that many people -- 15 million.

Michael Kremer noted in an article in The Journal of Economic Perspectives in 2002: "for every person treated for a year with antiretroviral therapy, 25 to 110 Disability Adjusted Life Years could be saved through targeted AIDS prevention efforts or vaccination against easily preventable diseases."

A group of health experts wrote in the prestigious medical journal The Lancet in July 2003 about how 5.5 million child deaths could have been prevented in 2003, lamenting that "child survival has lost its focus." They blamed in part the "levels of attention and effort directed at preventing the small proportion of child deaths due to AIDS with a new, complex, and expensive intervention."

The WHO expects the added years of life to AIDS patients from antiretroviral treatment to be only 3 - 5 years-not exactly a miracle cure...

We see here again the bias toward observable actions by aid agencies...

Rich-country politicians want to convince rich-country voters that 'something is being done' (SIBD) about the tragic problem of AIDS in Africa. It is easier to achieve SIBD catharsis if politicians and aid officials treat people who are already sick, than it is to persuade people with multiple sexual partners to use condoms to prevent many more people from getting the disease...

Alas, the poor's interests are sacrificed to political convenience...

When the U.S. Congress passed Bush's $15 billion AIDS program (known as the President's Emergency Plan for AIDS Relief, or PEPFAR) in May 2003, it placed a restriction that no more than 20% of the funds be spent on prevention, whole 55% was allocated for treatment."

??I must ask, who is selling the treatment and how are they connected to the Bush administration??

More excerpts from William Easterly's "White Man's Burden":

"Thailand has successfully implemented prevention campaigns targeting condom use among prostitutes, increasing condom usage from 15% to 90% and reducing new HIV infections dramatically.

Senegal and Uganda have apparently also had success with vigorous prevention campaigns promoted by courageous political leaders (although the Ugandan government is now backing off from condom promotion under pressure from religious leaders)...

If money spent on treatment went instead to effective prevention, between 3 and 75 new HIV infections could be averted for every extra year of life given to an AIDS patient. Spending AIDS money on treatment rather than on prevention makes the AIDS crisis worse, not better...

For the same money spent giving one more year of life to an AIDS patient, you could give 75 to 1,500 years of additional life (say 15 extra years for each of 5 to 100 people) to the rest of the population through AIDS prevention...

But it does show how politicians and aid bureaucrats react passively to dramatic headlines and utopian ideals rather than according to where the small aid budget will benefit the most people...

The most charitable view is that this statement is commission's strategy to get the money it wants. Otherwise, this refusal to make choices is inexcusable. Public policy is the science of doing the best you can with limited resources-it is dereliction of duty for professional economists to shrink from confronting trade-offs...

The WHO's 2002 World Health Report contains the following common sense: "Not everything can be done tin all settings, so some way of setting priorities needs to be found. The next chapter identifies costs and the impact on population health of a variety of interventions, as the basis on which to develop strategies to reduce risk." ...

Many deaths can be prevented more cheaply than treating AIDS, thus reaching many more suffering people on a limited aid budget."

"The only way to stop the threat to Africans and other is prevention, no matter how unappealing the politics or how uncomfortable the discussion about sex. The task is to save the next generation before it is again too late."

For those who propose treatment instead of prevention argue that it's their human right, but that argument is idealistic and can be dismissed on the account of other necessary rights. Others argue that if treatment is not offered, then people are not willing to come forward and be tested.

"Some bits of evidence support this intuition, but the notion has not really been subject to enough empirical scrutiny. Moreover, it is also plausible, and there is also a little evidence, to support the idea that treatment makes prevention more difficult.

Prevention campaigns did work in Senegal, Thailand, and Uganda without being based on treatment...

Finally, there remains the risk that treatment with imperfect adherence will result in emergence of resistant strains of HIV, so that treatment itself will sow the seeds of its own downfall...

"weak links in the chain" that leads from the donor's dollar to the person's treatment. The second tragedy of the world's poor means that many effective interventions are not reaching the poor because of some of the follies of Planners…

The treatment of AIDS with drugs is vastly more complicated and depends on many more "links in the chain.""

"Spending money on a mostly futile attempt to save all the lives of this generation of AIDS victims will take money away from saving the lives of the next generation, perpetuating the tragedy."