HIV/AIDS, hunger and malaria are the world's most urgent problems, say economists



Judith Mandelbaum-Schmid




The top global priority for spending on international aid is combating HIV/AIDS, concluded an international panel of economists, following the week-long Copenhagen Consensus conference which took place in Denmark at the end of May. The eight economists — three of them Nobel laureates — also placed efforts to combat hunger and the eradication of malaria at the top of the list.

Their report, commissioned by Denmark's Environmental Assessment Institute and the British news journal, The Economist, concluded that 28 million cases of HIV/AIDS could be prevented by 2010 and that although the cost of this would be US$ 27 billion, the benefits could be almost forty times as high.

"Fighting disease is a good investment," said expert panelist, Bruno Frey. "Disease causes nine out of ten preventable deaths in developing countries among children and adults."

The panelists were asked to consider a list of ten global challenges established through a cost–benefit analysis: civil conflict, climate change, communicable diseases, education, financial stability, governance, hunger and malnutrition, migration, trade reform, and water and sanitation. Their task was to allocate a hypothetical US$ 50 billion to solve some of the world's most important challenges. The panelists unanimously recommended spending US$ 27 billion to fight HIV/AIDS, US$ 12 billion to fight malnutrition and US$ 13 billion to fight malaria.

"The starting point of the Copenhagen Consensus is that the world faces many problems, and we cannot afford to solve them all, here and now … HIV/AIDS, malnutrition, trade barriers, and malaria — these are problems that can be addressed effectively," said The Economist Deputy Editor, Clive Crook, who participated in the experts' meeting.

Expanding programmes to prevent the spread of HIV infection was ranked as the top priority. Distributing micronutrients to combat malnutrition came second with trade liberalization third and malaria prevention and treatment fourth. In selecting HIV/AIDS, the panel agreed with a paper presented by health economist Anne Mills of the London School of Hygiene and Tropical Medicine. In her paper, Mills argued that spending US$ 60 billion to promote condom use and distribute antiretroviral drugs — particularly in sub-Saharan Africa — would save US$ 3 trillion in health-care costs and human productivity. The panelists' recommendations focused on prevention strategies rather than treatment because of "the rapid change of drug prices and the lack of clear data on outcome, which make calculating the cost–benefit ratio of treatment difficult."

The International AIDS Society, a professional association of scientists and health workers, welcomed the Copenhagen Consensus conclusions. But the group — along with other public health organizations fighting the HIV epidemic — was troubled by the lack of focus on the potential benefits of treatment for the millions already infected. "We emphasize that all the tools available to deal with the HIV epidemic must be made available to all who need them," said Craig McClure, the group's Executive Director. And that includes "antiretroviral drugs for all those people living with HIV/AIDS," he added.

Behind HIV/AIDS prevention strategies came policies to reverse micronutrient deficiencies. The economists identified food fortification to reverse iron-deficiency anaemia as the measure with the highest benefit–cost ratio. "We were delighted with their conclusion, which confirmed what we have been saying for years," said Ibrahim Daibes, Communications Manager for the Canadian based non-profit Micronutrient Initiative.

The US$ 13 billion for malaria prevention and treatment was spread across three strategies: making insecticide-treated mosquito nets available to an additional 60 million children under five years, providing two-stage anti-malarial treatment to 90% of women in their first pregnancy and giving artemisinin-based combination therapy (ACT) to 280 million infected people annually with the objective of halving malaria prevalence by 2015. Together, these anti-malarial measures would deliver benefits of more than US$ 400 billion, according to the report.

Dr Fatoumata Nafo-Traore, director of WHO's Roll Back Malaria Department, said she was quite happy to see malaria ranked as it was. "The panel acknowledged that malaria prevention and treatment have a high benefit–cost ratio. Their proposal would make a huge difference. From our viewpoint, however, we should be allocating even more resources. Most countries are ready to tackle this problem. They just lack the financial means," she said.

Information on the Copenhagen Consensus is available from:

World Health Organization Genebra - Genebra - Switzerland