Sunday, June 5, 2011

Ah, Optimism

Everyone is quite certain HIV/AIDS is quite beatable, for logical reasons, though I’m not quite sure about this. Here’s The Economist’s take:
Not enough people—some 6.6m of the 16m who would most quickly benefit—are getting the drugs. And the pills are not a cure. Stop taking them, and the virus bounces back. But it is a huge step forward from ten years ago.

It concludes that it is a question of money:
Such a programme would take years and also cost a lot of money. About $16 billion a year is spent on AIDS in poor and middle-income countries. Half is generated locally and half is foreign aid. A report in this week’s Lancet suggests a carefully crafted mixture of approaches that does not involve treating all those without symptoms would bring great benefit for not much more than this—a peak of $22 billion in 2015, and a fall thereafter. Moreover, most of the extra spending would be offset by savings on the treatment of those who would have been infected, but were not—some 12m people, if the boffins have done their sums right. At $500 per person per year, the benefits would far outweigh the costs in purely economic terms; though donors will need to compare the gain from spending more on knocking out AIDS against other worthy causes, such as eliminating malaria.

It’s somewhat surprising to see The Economist so blithe about the exigencies of execution here—typically the classical liberal/libertarian line here is to be skeptical of the efficacy of these types of big programs with grand interventions (they’re hard to execute the vision, they’re rife with unintended consequences, etc.). Here the problems are pretty obvious—it’s hard to get people to take drugs that consistently.

That’s a comment on everyone, by the by—ask a doctor, and the doctor will tell you it’s hard to get patients to do the right thing (by the doctor). This is one of the reasons we have an incipient antibiotics problem. But it’s also especially difficult to get people in developing countries to take drugs consistently, as the work of Esther Duflo shows. So aid to beat AIDS might have a positive effect, but I wouldn’t expect it to beat AIDS by any stretch of the imagination. We still haven’t beaten polio, and that’s something we have a vaccine for. Probably best to tone down the triumphalism a bit.

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