Formal campaigns were initiated for dracunculiasis and leprosy in 1991, and for polio and lymphatic filariasis in 1988 and 1997, respectively. Soundness of Estimates Varies by Disease

WHO’s cost and time frame estimates, with the exception of measles, addressed all five of the relevant factors. Generally, estimates for those diseases with long-standing eradication or elimination campaigns are more complete, as the underlying data are based on actual experience in endemic countries. For the other diseases, WHO is still gathering data and refining its assumptions. Dracunculiasis (Guinea Worm Disease)

WHO’s cost estimate of $40 million for eradicating dracunculiasis included data on each of the five key factors and appears to be sound. Experts also point to the need for continued national and donor support. Polio

WHO’s cost estimate of $1.6 billion for eradicating polio is generally sound. However, experts generally agreed that WHO’s cost and time frame estimates appeared reasonable. Essentially, data are incomplete regarding the number of children to be vaccinated, administrative costs, the number of mass campaigns that may be needed, and the costs of surveillance in less developed countries. WHO officials noted that they used information from their previous experience with polio eradication in developing the measles estimate. WHO and CDC estimate the cost of eradicating measles in less developed countries at up to $1.8 billion. It incorporates data on all key cost elements, but data on the size of the target population are incomplete. U.S. Spending on These Diseases and Potential U.S. Savings Associated With Their Eradication or Elimination

The United States currently spends about $391 million a year on these diseases. This includes about $300 million on polio and measles prevention programs and leprosy treatment in the United States and about another $91 million abroad for all the diseases under discussion except leprosy. Most of this amount would be saved if eradication and elimination goals were met and efforts to combat the diseases were ceased or reduced. The overall savings to the United States as a result of eradicating measles are estimated at about $61.7 million a year, including about $50 million for domestic vaccine costs and about $11.7 million for global measles efforts. The United States does not currently track domestic costs related to Chagas’ disease. Other Diseases as Possible Eradication Candidates

International public health experts identified several diseases that pose health threats to the United States and that are technically possible to eradicate with existing vaccines: rubella, mumps, hepatitis B, and Hib. The major barrier to an eradication initiative is that some people are chronic carriers and would have to die before the disease could be considered eradicated. WHO told us that rubella, hepatitis B, and Hib could be eventual candidates for eradication due to their associated public health burdens and the success in controlling these diseases in some parts of the world. For the United States, cumulative savings from smallpox eradication are estimated at almost $17 billion. Smallpox had characteristics that experts consider desirable for eradication. However, certain differences exist that may limit the usefulness of smallpox as a model for other eradication efforts. Dracunculiasis differs from smallpox in that is a parasitic disease and not vaccine preventable. World Health Organization Estimated Target Dates and Costs for Eradicating or Eliminating Selected Diseases as of December 1997

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Why GAO Did This Study

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.

What GAO Found

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.