Why it pays to invest in disease prevention

As leaders convene in Istanbul for the World Economic Forum Special Meeting on Unlocking Resources for Regional Development, it is important to remember that one of the most efficient ways to preserve and grow the public and private resources needed for sustainable development is to prevent disease.

That’s a basic tenet of public health: it is much less expensive to prevent disease than it is to treat disease. A healthy population reduces the aggregate cost of healthcare, freeing resources that can be channelled toward development. A healthy population also contributes more to development because per capita production increases as public health improves.

Take the case of polio, the paralyzing and sometimes fatal virus that has been the target of a global eradication campaign since 1988. Today, thankfully, the disease is almost completely gone, but it still persists in some parts of the world, including portions of the Middle East, Africa and Asia. And that last point should be of concern to anyone involved in development in this region.

Let’s look at the big picture in terms of economics. To date, the world – led by the Global Polio Eradication Initiative – has spent more than $11 billion to stop polio. Of that, governments worldwide have contributed about $9 billion. Other major contributors are Rotary International and the Bill & Melinda Gates Foundation.

That’s a hefty investment in health that must be protected, most international development minds would agree. But there is a much greater economic upside to polio eradication. A study published in 2010 estimated that once the burden of polio is lifted, global benefits of $40-50 billion will accrue over the next couple of decades as per capita productivity increases and polio-related healthcare expenditures fall. Also, most of those benefits will occur in developing countries. This is potentially a tremendous windfall for economic development where it is needed the most.

Now let’s look at the human side: protecting the world’s children from this terrible, incurable – but totally vaccine preventable – disease. After all, that’s the point of this entire massive endeavour.

The great news is that the incidence of polio has plummeted by more than 99%, from about 350,000 new cases a year in 1988, when the eradication initiative launched, to fewer than 420 for all of 2013. More than 2.5 billion children have been immunized with the oral polio vaccine, preventing over 10 million cases of permanent paralysis.

Today, polio remains endemic to only three countries: Afghanistan, Nigeria and Pakistan. The challenge is that the three endemic countries serve as a reservoir from which the virus re-emerges to infect children in places where the disease had previously been stopped. In 2013 and so far this year, there have been new polio cases in Somalia, Cameroon, Equatorial Guinea, Ethiopia, and – of most concern to this region – Iraq (two cases)  and Syria (36 cases) – two countries where ongoing conflict is a factor in polio’s return.

Fortunately, Turkey – polio-free since 1998 – maintains high levels of vaccination coverage, and about 98% of Turkish children are immunized against polio. Even so, Turkey remains at risk of polio reinfection due to the arrival of large numbers of refugees from Syria. And refugee camps, which too often lack clean water sources and adequate sanitation, are notoriously hospitable to polio and other infectious diseases. The Turkish government is to be commended for its strong support of and participation in the emergency immunization rounds, led by the World Health Organization, held across the Middle East region after the cases in Syria and Iraq were confirmed.

But should polio re-infect Turkey, the potential scenario darkens even more because it could lead to a reinfection in Ukraine, where ongoing conflict further compromises an already debilitated health system. Traditionally, tourism and commerce have created a significant movement of people to and from Ukraine and Turkey. The current refugee pressure from the south adds a dangerous component to the mix.

And Ukraine, polio free since 1996, has serious problems of its own. The WHO this month issued a warning about the risks facing Ukraine as winter approaches. This includes hundreds of thousands of people displaced by the conflict, low immunization rates, shuttered hospitals, a drain of healthcare professionals and a critical shortage of vaccines.

Even before the civil unrest leading to the current crisis began last November, UNICEF warned that “dangerously low immunization coverage” put Ukraine at risk from a polio outbreak. The conflict and the polio outbreak in Syria, on Turkey’s doorstep, only heighten the risk.

The WHO and UNICEF are moving quickly to provide emergency medical assistance, including immunizing Ukraine’s children against polio, mumps, measles, pertussis and other vaccine-preventable diseases, to avert a full-blown public health emergency.

As this dangerous scenario plays out among this group of neighbouring nations – hopefully in the best interests of the entire region and its people – it is prudent for national and international leaders, planners, analysts and developers to pay close attention. A trove of public and private resources is at risk – resources that are vitally needed to spur sustainable economic development. But even more important are the health, safety and well-being of our most precious resource: our children.

Author: John Hewko is General-Secretary of the humanitarian organization Rotary International

Image: A girl receives polio vaccination during an anti-polio campaign on the outskirts of Jalalabad August 18, 2014. REUTERS/Parwiz