4 ms·

Yea, I sort of wonder how important it is to actually eradicate it. Like, how much would it cost to achieve eradication (given the new knowledge of dog transmi

Yea, I sort of wonder how important it is to actually eradicate it. Like, how much would it cost to achieve eradication (given the new knowledge of dog transmission) vs. maintaining the current extraordinarily low infection rate indefinitely? Is the latter (on-going) cost cheaper than the interest on the former (one-time) cost? I'm sure this econ analysis has been done, but articles like these rarely mention it.

tialaramex 7y ago
Eradication of Guinea Worm means no more Guinea Worm. Zero ongoing cost for all subsequent time. This is actually more substantive than for Smallpox because Smallpox is deliberately stored in a lab in case it is interesting (supposedly for defensive research, in practice for weaponisation) and so invariably every decade or four it'll leak. Guinea Worm isn't suitable for that, when they eradicate it that's the end of the parasite forever. This is an infinite benefit. So to model that without getting nonsense out you have to use a discounting model where you arbitrarily consider infinite future value to not be worth more than, say, 10 billion dollars, and there's your answer. But that's a paper exercise, why bother? You could choose values that say a trillion dollars or $9.99.
- vidarh 7y ago
  > This is an infinite benefit. So to model that without getting nonsense out you have to use a discounting model where you arbitrarily consider infinite future value to not be worth more than, say, 10 billion dollars, and there's your answer. But that's a paper exercise, why bother? You could choose values that say a trillion dollars or $9.99. It's really not that arbitrary. There are many ways of valuing this, sure. Here's a fairly straightforward one: Say it costs you A per year to maintain current levels, and the yearly cost of capital to eradicate is X amount of capital * y% yearly cost per year (e.g. if you borrow X at y% interest, or if you have X but sacrifice y% returns by spending the money instead of investing it), and the lowest viable cost to save at least as many lives as the infection currently claims is B, then it's a question of whether A+B or X*y% is lower. Whichever is lower will allow you to divert more funds to other targets, and so save more lives (or do something else). Of course there are risks here, in that any of the variables can change, so if they're close it may be worth it to eradicate simply to eliminate the risks that the alternatives get more expensive going forwards. But this is not a very hard thing to model. The reason we don't do that more often is that often there are many other factors involved, such as politics and emotions and who fights hardest to get funded.
  - deleted 7y ago
    [deleted]
  - gibba999 7y ago
    ... only it doesn't work. Those models work very well on a short-term timescale. We have major upheavals every few hundred years. At that point, the fiat money in the bank account disappears. Once eradicated, the worm doesn't come back.
    - sbierwagen 7y ago
      You seem distracted by the use of the word “dollars”. No need to be so literal, they’re just using them as an abstract unit of value. It can be replaced with milligrams of gold or Satoshis without loss of meaning.
      - gibba999 7y ago
        It can. And that gold sits around until the Germanic tribes invade Rome and take it all. Major upheavals affect all systems.
- not_a_cop75 7y ago
  Well, yeah. Don't eradicate it. How will the CIA find new and interesting ways of torture without buddies like this?
- estsauver 7y ago
  So, I get why you're saying this, but it's actually a very well studied problem in business. Basically, let's imagine you're the Carter Foundation and you have found a way to treat the 30 cases a year exhaustively and prevent any meaningful spread for 2M$/year, and it's expected to stay flat over the rest of the future. Let's say you have a one time cost to get rid of the remaining worms of 10M$. Well, it's almost certainly a good idea to get rid of the worm's then, it costs 20% as much to treat next years infections as it does to eradicate them eternally! Instead consider if it would cost 1B$ to eradicate them. Still a good thing to do... but the interest from 1B$/year is about 50M$ (order of magnitude). You could keep guinea worms completely eradicated and give away 48M$ to other things indefinitely. (This is effectively the same calculation and efficient business should make for most any decision. Is the internal rate of return on this decision good enough to earn the money to do it.)
  - carlmr 7y ago
    Exactly. Looking at other things to invest in the opportunity cost right now might already be higher. Say you could have a slightly higher number of Guinea worms but stable for 1M a year. The 1M you save might save many more lives if used for something else with a higher impact. At 28 infections per year it's almost guaranteed there's something else that's already much more efficient at preventing deaths.
- KingPrad 7y ago
  A podcast, think it was Stuff to Blow Your Mind, did a podcast on the Guinea Worm and talked about this at length. The worm is wildly infectious. Every incident requires immediate deployment of teams of people to control it or it explodes with re-infections. There are wild populations of the worm still, which are the main source of ongoing infections. The 28 cases doesn't indicate low importance, it indicates those are enough to re-seed the worm if huge areas if not vigorously acted on, every time they see a new case. I'm surely getting some details wrong, but it sounds like zero for several years has to be the goal, or it'll rebound swiftly.
PeterisP 7y ago
Thing is, there's a big difference between eradicated and almost eradicated / controlled - it's that when for whatever reasons the control measures break down (e.g. civil war or natural catastrophes) then whatever is almost eradicated will come back with a vengeance (especially if a generation has passed and e.g. people aren't vaccinated anymore if vaccines apply), but whatever has been actually eradicated won't. There's also an ongoing health cost - for example, if vaccines apply (not in this particular case but in others) then if it's controlled by herd immunity, then you have to keep vaccinating and suffer any risks and sideeffects while doing so - but if it's eradicated, then you can stop doing so and there's some health benefit in being able to skip unneeded vaccines.
- kjs3 7y ago
  There is also the not-insignificant cost of simply rebuilding the specialized health care infrastructure to manage the new outbreak. Particularly difficult if the area of concern is already challenged by remoteness, poverty, conflict, etc. See: resurgence of polio.

tialaramex 7y ago

Eradication of Guinea Worm means no more Guinea Worm. Zero ongoing cost for all subsequent time. This is actually more substantive than for Smallpox because Smallpox is deliberately stored in a lab in case it is interesting (supposedly for defensive research, in practice for weaponisation) and so invariably every decade or four it'll leak. Guinea Worm isn't suitable for that, when they eradicate it that's the end of the parasite forever. This is an infinite benefit. So to model that without getting nonsense out you have to use a discounting model where you arbitrarily consider infinite future value to not be worth more than, say, 10 billion dollars, and there's your answer. But that's a paper exercise, why bother? You could choose values that say a trillion dollars or $9.99.

vidarh 7y ago
> This is an infinite benefit. So to model that without getting nonsense out you have to use a discounting model where you arbitrarily consider infinite future value to not be worth more than, say, 10 billion dollars, and there's your answer. But that's a paper exercise, why bother? You could choose values that say a trillion dollars or $9.99. It's really not that arbitrary. There are many ways of valuing this, sure. Here's a fairly straightforward one: Say it costs you A per year to maintain current levels, and the yearly cost of capital to eradicate is X amount of capital * y% yearly cost per year (e.g. if you borrow X at y% interest, or if you have X but sacrifice y% returns by spending the money instead of investing it), and the lowest viable cost to save at least as many lives as the infection currently claims is B, then it's a question of whether A+B or X*y% is lower. Whichever is lower will allow you to divert more funds to other targets, and so save more lives (or do something else). Of course there are risks here, in that any of the variables can change, so if they're close it may be worth it to eradicate simply to eliminate the risks that the alternatives get more expensive going forwards. But this is not a very hard thing to model. The reason we don't do that more often is that often there are many other factors involved, such as politics and emotions and who fights hardest to get funded.
- deleted 7y ago
  [deleted]
- gibba999 7y ago
  ... only it doesn't work. Those models work very well on a short-term timescale. We have major upheavals every few hundred years. At that point, the fiat money in the bank account disappears. Once eradicated, the worm doesn't come back.
  - sbierwagen 7y ago
    You seem distracted by the use of the word “dollars”. No need to be so literal, they’re just using them as an abstract unit of value. It can be replaced with milligrams of gold or Satoshis without loss of meaning.
    - gibba999 7y ago
      It can. And that gold sits around until the Germanic tribes invade Rome and take it all. Major upheavals affect all systems.
not_a_cop75 7y ago
Well, yeah. Don't eradicate it. How will the CIA find new and interesting ways of torture without buddies like this?
estsauver 7y ago
So, I get why you're saying this, but it's actually a very well studied problem in business. Basically, let's imagine you're the Carter Foundation and you have found a way to treat the 30 cases a year exhaustively and prevent any meaningful spread for 2M$/year, and it's expected to stay flat over the rest of the future. Let's say you have a one time cost to get rid of the remaining worms of 10M$. Well, it's almost certainly a good idea to get rid of the worm's then, it costs 20% as much to treat next years infections as it does to eradicate them eternally! Instead consider if it would cost 1B$ to eradicate them. Still a good thing to do... but the interest from 1B$/year is about 50M$ (order of magnitude). You could keep guinea worms completely eradicated and give away 48M$ to other things indefinitely. (This is effectively the same calculation and efficient business should make for most any decision. Is the internal rate of return on this decision good enough to earn the money to do it.)
- carlmr 7y ago
  Exactly. Looking at other things to invest in the opportunity cost right now might already be higher. Say you could have a slightly higher number of Guinea worms but stable for 1M a year. The 1M you save might save many more lives if used for something else with a higher impact. At 28 infections per year it's almost guaranteed there's something else that's already much more efficient at preventing deaths.
KingPrad 7y ago
A podcast, think it was Stuff to Blow Your Mind, did a podcast on the Guinea Worm and talked about this at length. The worm is wildly infectious. Every incident requires immediate deployment of teams of people to control it or it explodes with re-infections. There are wild populations of the worm still, which are the main source of ongoing infections. The 28 cases doesn't indicate low importance, it indicates those are enough to re-seed the worm if huge areas if not vigorously acted on, every time they see a new case. I'm surely getting some details wrong, but it sounds like zero for several years has to be the goal, or it'll rebound swiftly.

PeterisP 7y ago

Thing is, there's a big difference between eradicated and almost eradicated / controlled - it's that when for whatever reasons the control measures break down (e.g. civil war or natural catastrophes) then whatever is almost eradicated will come back with a vengeance (especially if a generation has passed and e.g. people aren't vaccinated anymore if vaccines apply), but whatever has been actually eradicated won't. There's also an ongoing health cost - for example, if vaccines apply (not in this particular case but in others) then if it's controlled by herd immunity, then you have to keep vaccinating and suffer any risks and sideeffects while doing so - but if it's eradicated, then you can stop doing so and there's some health benefit in being able to skip unneeded vaccines.

kjs3 7y ago
There is also the not-insignificant cost of simply rebuilding the specialized health care infrastructure to manage the new outbreak. Particularly difficult if the area of concern is already challenged by remoteness, poverty, conflict, etc. See: resurgence of polio.