Polio Eradication

I spoke with Norman Swan on the ABC Radio National Health Report program this morning about polio, and the strange economics of disease eradication. Here's a podcast. Transcript over the fold.
Norman Swan: Let's stay with costs for the moment because former economist and now Federal Member for Fraser in the ACT Dr Andrew Leigh has some thoughts on the government's recent announcement for money for polio eradication and what it might mean for how we prioritise health spending.

Andrew Leigh: Well the Australian government announced in CHOGM that we'd be committing $50 million towards eradicating polio. Polio's still in four countries: Pakistan, Afghanistan, Nigeria and India.

Norman Swan: But you've got a view as an economist?

Andrew Leigh: That's right, I think polio is worth eradicating but it does really strike me as an economist when you look at the cost of eradicating those final few cases of polio. In terms of lives saved this turns out to be a pretty bad deal. We're spending hundreds of millions of dollars on a disease in which there are only hundreds of cases. The thing is it's still a good deal in the long run because the effect of wiping out polio is that one day we won't have to vaccinate the next tranche of kids for polio that will mean we can focus global health efforts on other things, AIDS, tuberculosis, malaria, some of those huge killers in the world. So in some way you should think of polio eradication as freeing up global health resources much as smallpox eradication did for us in the 1970s.

Norman Swan: I'm not sure what you are saying are you saying that you economists are a waste of time in here, that the normal metrics that you use for deciding whether a health intervention is worth doing should just be thrown out the window or what? What are you actually saying Professor Leigh?

Andrew Leigh: I am saying that this is the curious case of disease eradication, that as you get towards the end each case becomes extremely expensive and so you are now eradicating a disease not because each life saved is worth it on the standard calculus but because the whole disease is worth wiping out. And once you've wiped out a disease and you've held it at bay for a number of years you can stop vaccinating and free up masses of world resources.

Norman Swan: How do you allow for those future benefits? I mean we have very inadequate ways of measuring benefits, we use the quality adjusted life year which puts a notional value on an extra year of life adjusted for the quality of that life and I think that we have a number somewhere between $30,000 and $70,000 per qualies, so heart transplantation just squeezes in but there's a whole debate about patient experience, patient preference and future discounting of those benefits. Do you feel they are adequately taken into account when we're talking about health?

Andrew Leigh: I think that's certainly the right way of thinking about these health decisions. What you want to do is to be able to bring all the public health measures onto the same metric and dollars are the standard metric on which you're able to make comparisons across things as diverse as treatments, vaccinations, public health information campaigns. But it turns out to be the wrong way of thinking about something like disease eradication.

Norman Swan: But you haven't answered my question Andrew which is you're putting a value on a life and then of course here's the thing that people don't want to talk about is that if you were in the Pakistani government, they're probably using $100 per qualy, if they use any metric at all for their health interventions. So they value a life because of their economic strife if you like at a very different level than we are. Isn't it a rather crude and tragic way of measuring whether you would invest in a different area?

Andrew Leigh: Norman I certainly understand where you're coming from, I remember as an economics professor teaching students and the topic that was perhaps the most controversial of the whole semester was when we suggested that you could put a value on a statistical life. We have to be absolutely clear what we are doing here. We're putting a value on an average life. We are not saying that the rich and unique human experience can be reduced to dollars. We are saying with a scarce government health budget when you have to decide whether you are going to allocate that to more spending on road safety, more spending on cancer labs or more spending on children's vaccines, you need some way of comparing it across those health interventions.

Norman Swan: So why is it different for airlines from health that if you actually do a quality adjusted life year assessment for what we spend on air safety, it's hugely more, my understanding is that it's like millions of dollars per year of life saved and yet we quibble over $70,000 per year of life, a quality adjusted year of life saved for health interventions yet every day of the week we are spending squillions of dollars on interventions which far exceed the value that we give to a life in the health care system?

Andrew Leigh: It's a good question. Economists do sometimes argue that we've over invested in air safety. I think the answer is that if air safety were as dangerous as road travel people would be much less likely to get on planes. The experience of an air disaster is one that seems to sear the collective consciousness, that is somehow more traumatic for people than the daily road toll and so I think that's why not only Australian society -

Norman Swan: So this is about mass psychology, this is the thing that we respond more to the rare high impact event rather than the fact that X hundred thousand Australians die unnecessarily from preventable health care injury.

Andrew Leigh: Yes, I think that's probably most of what's going on here and you don't hear a clamour from voters saying you're spending too much on air safety if only you could spend a little less. But I take your point, that the investment per quality adjusted life year ends up being more expensive in air safety.

Norman Swan: Is there something in it for us for polio eradication do you think? Is that $50 million well spent for Australia apart from just being altruistic which is fine in its own right?

Andrew Leigh: The notion that we as Australians can cease at some point in the future vaccinating kids for polio frees up a share of our health budget to invest on other things whether that be air safety or, as I think you would probably argue, public health initiatives.

Norman Swan: Andrew Leigh is Federal Member for Fraser and before that an economist at the Australian National University.

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