Infectious Diseases: Analysis of Eradication or Elimination Estimates
(Testimony, 05/20/98, GAO/T-NSIAD-98-183).

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.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-NSIAD-98-183
     TITLE:  Infectious Diseases: Analysis of Eradication or Elimination 
             Estimates
      DATE:  05/20/98
   SUBJECT:  Infectious diseases
             Health care services
             Immunization programs
             Cost analysis
             Developing countries
             Immunization services
             International cooperation

             

Infectious Diseases: Analysis of Eradication or Elimination Estimates
(Testimony, 05/20/98, GAO/T-NSIAD-98-183).

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.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-NSIAD-98-183
     TITLE:  Infectious Diseases: Analysis of Eradication or Elimination 
             Estimates
      DATE:  05/20/98
   SUBJECT:  Infectious diseases
             Health care services
             Immunization programs
             Cost analysis
             Developing countries
             Immunization services
             International cooperation