Formal campaigns were initiated against dracunculiasis and leprosy in 1991, and against polio and lymphatic filariasis in 1988 and 1997, respectively. In April 1997, WHO provided the House International Relations Committee with estimated costs and target dates for eradicating or eliminating the seven diseases. Our review focuses on the estimates that WHO provided to us as of December 1997. WHO officials estimated that about $7.5 billion would be needed to eradicate or eliminate the seven targeted diseases. We used this information to assess whether the data underlying WHO’s estimates were sound. Soundness of Estimates Varies by Disease

WHO officials and other experts identified the following as the key factors to consider in estimating direct costs for eradicating or eliminating diseases: (1) the funds needed to purchase the required intervention products, such as vaccines, drugs, insecticides, or water filters; (2) the prevalence and incidence of the disease and the population targeted for intervention; (3) the administrative costs for delivering products to the target population (for example, transportation, setting up local infrastructure, administering vaccines or treatment, spraying, and technical assistance); (4) the costs for surveillance activities, such as diagnosing the disease, testing blood or other specimens at laboratories, and monitoring and reporting disease incidence; and (5) for eradication, the costs of certifying that each country is free of the disease. Potential Cost Savings for Polio and Measles

			Polio

The overall savings to the United States as a result of polio eradication are estimated to be at least $304 million a year, including about $230 million in public and private expenditures for controlling polio within U.S. borders and about $74 million for the global eradication effort. Experts Suggest Other Diseases as Possible Candidates for Eradication

International public health experts at CDC and Johns Hopkins University and a 1993 report by the International Task Force for Disease Eradication (ITFDE) revealed a number of diseases that pose threats to the United States and that are technically possible to eradicate. Diseases commonly mentioned include rubella, mumps, hepatitis B, and Hib. They noted that other diseases could be considered as eradication candidates after success with the currently targeted diseases is achieved. Other infectious diseases pose a growing threat to the United States but do not have characteristics that make them amenable to eradication. Smallpox Eradication Showed That Success Was Possible

According to the literature and experts with whom we met, the primary lesson learned from the smallpox initiative was that disease eradication can be technically feasible. For the United States, cumulative savings from smallpox eradication are estimated at $17 billion. For the other diseases, complete data are unavailable so the estimates are more speculative. The United States is spending a significant amount to combat these diseases domestically and overseas, most of which could be saved if eradication and elimination efforts are successful. The treatment programs are largely community based. Objectives, Scope, and Methodology

Our objectives were to examine (1) the soundness of WHO’s cost and time frame estimates for eradicating or eliminating seven infectious diseases, (2) U.S. spending related to these diseases in fiscal year 1997 and any potential U.S. savings as a result of eradication or elimination, (3) other diseases that may pose a risk to Americans and that could be candidates for eradication, and (4) historical information on U.S. costs and savings from smallpox eradication and whether experts view smallpox eradication as a model for other diseases.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the World Health Organization's (WHO) efforts to eradicate seven infectious diseases--dracun culiasis, polio, leprosy, measles, onchocerciasis, Chagas' disease, and lymphatic filariasis--worldwide, focusing on: (1) the cost and timeframe estimates developed by WHO for eradicating or eliminating these diseases; (2) U.S. spending related to the seven 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 candidates for eradication; and (4) historical information on 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) the soundness of WHO's cost and timeframe estimates for eradicating or eliminating the seven diseases varied for each disease; (2) cost and timeframe estimates for dracunculiasis, polio, and leprosy were the most sound because campaigns against them have been under way for several years and are largely based on firm data about target populations and intervention costs from ongoing initiatives; (3) for the other diseases, WHO's estimates are more speculative because data underlying the cost and timeframe estimates are incomplete or unavailable; (4) WHO officials acknowledge that the costs and timeframes provided to the House Committee on International Relations are not exact and that they must continually be refined as new information becomes available; (5) the United States spent about $391 million in 1997 on programs to combat these diseases; (6) potential savings to the United States if eradication or elimination of these diseases were achieved could be substantial; (7) most of the savings would result from eliminating the need to vaccinate U.S. children against polio and measles; (8) the experts GAO interviewed and its review of the literature identified several other diseases that pose health threats to the United States and that meet the scientific criteria for eradication used by health experts; (9) four diseases were frequently mentioned: rubella, mumps, hepatitis B, and Hemophilus influenzae type B; (10) WHO officials stated that while it is technically possible to eradicate these diseases with existing vaccines, it is unlikely that other diseases will be considered for eradication before achieving success with currently targeted diseases; (11) using Centers for Disease Control and Prevention data, GAO estimated that the United States has saved almost $17 billion to date from the eradication of smallpox in 1977; (12) the savings are due to the cessation of vaccinations and related expenditures such as surveillance, treatment, and loss of productivity; (13) experts agree that several lessons can be learned from the smallpox effort, but the primary lesson is that a disease can actually be eradicated; and (14) however, they also suggested that smallpox has limitations as a model for other diseases because it had characteristics that were uniquely amenable to eradication.