Now let me tell you about something I don’t write about often. It is a situation in which unpredictable and seemingly irrational politics have saved millions of the poorest and most vulnerable people on the planet.
recently blog postJustin Sandefer, a senior fellow at the Center for Global Development, a Washington, D.C.-based think tank, examined the records of the president’s Emergency Plan for AIDS Relief (PEPFAR). The program, initiated by President George W. Bush to pay for antiretroviral drugs for millions of people living with HIV in sub-Saharan Africa and the Caribbean, is now the first in American history. is regarded as one of the most important foreign aid activities in For its generosity and effectiveness.
At the time, it was impossible to ignore the advice of many experts and set it up.
“The conventional wisdom in health economics was that sending AIDS drugs to Africa was a waste of money,” Sandefer wrote. It’s not that the medicine didn’t work. Antiretroviral therapy has been a revolutionary achievement in controlling HIV-AIDS, potentially saving lives and preventing new infections. But the drugs were so expensive that experts thought it would be more efficient to spend the money on prevention. Data suggests that every dollar spent on condom distribution, awareness campaigns, and antibiotics to treat bacterial infections that increase the likelihood of HIV infection saves more lives than treatment. ing.
now infamous 2005 Forbes Op-Ed Brown University economist Emily Oster is now best known for her book, “Treatment for HIV Is Not Affordable.” A parent’s guide to decision making“It may sound callous and callous, but comparing the years saved by antiretroviral drugs with the years saved by other interventions, such as education, suggests that treatment is not an effective way to combat the epidemic.” I found out no,” he wrote.
Like many other economists, she assumed that policymakers were working with two constraints. A massive global health disaster and a limited budget to deal with it. And since it costs far more to treat existing HIV-AIDS patients than to prevent new infections, the hard conclusion is that a focus on prevention is the best way to save as many lives as possible. reached. Even if it actually makes sense. let the infected die.
As it turns out, that argument was based on a false assumption. In fact, the Bush administration was willing to spend money on treatment that otherwise would never have been spent on prevention.
The Bush administration has been the target of persistent political lobbying from interest groups and activists like U2 frontman Bono and Franklin Graham, son of the Reverend Billy Graham. Their arguments were primarily moral rather than financial and emphasized the plight of those in need of treatment. If antiretroviral drugs existed, they argued, it would be wrong for the richest country in the world to let the poor die.
So it turns out the question is no It’s not just whether a dollar was spent most efficiently on cure or prevention, but which is the most politically compelling case for cure or prevention? allocate more dollars. And as for the latter question, therapy has triumphed by far.
President Bush created PEPFAR, a new multi-billion dollar program to fund AIDS treatment in poor countries. And in the end, not only did it save lives, it did so cheaper than the original cost-benefit analysis suggested. HIV treatment costs declined rapidly during the program. This change is likely due in part to PEPFAR creating new demand for the drug, especially cheaper generics that appeared a few years later.
Most efficient but may not be most effective
When I asked Sandefer about the broader lesson, he said that effective and easy-to-implement solutions are sometimes the best choices, even if they run counter to cost-benefit analyses.
“For me, who is passionate about education, school lunches are close to home and I think they are pretty proven,” he said. “They help kids learn. They help get more kids into school. And they obviously help improve nutrition.”
However, programs like India’s Luncheon Scheme, which feeds more than 100 million schoolchildren every day, are seen as a more efficient way of improving educational outcomes than other programs, making them cost-effective. Analyzing effects is often inadequate.
salience to science
The PEPFAR incident also provides another lesson. Politics is sometimes more important than economics.
Advocates for AIDS treatment included evangelical groups with significant political influence within the Republican Party. Franklin Graham’s phone call alongside Bono’s probably made it easier for the Bush administration to take notice, but it also reduced the political cost of spending US government money on a huge new foreign aid program.
In political science terms, saving the lives of HIV-AIDS patients had better ‘prominence’. Activists were emotionally connected to the cause and made it a priority for them.
My anecdotal experience bears it out. I was a student at that time. I remember many heated discussions among my classmates about how best to treat people in poor countries. Sure, if asked, they would all have supported precautionary measures, but their energies weren’t focused there. Much of the excitement and urgency of the people centered around the problem of getting medicine to people who would otherwise die. It felt like an emergency.
So perhaps the bigger lesson here is that policy is not, after all, separate from politics. And that means that the political costs and benefits often outweigh the economic costs, even if it seems absurd.
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