Pricing infectious disease

infectious diseases constitute a tenacious and major public-health problem all over the world. although some, such as smallpox and poliomyelitis, have been eradicated from nature or almost wiped out, many diseases persist with little or no hope of getting them under control. in addition, new infectious diseases are emerging and old ones that were thought to be under control are regaining lost ground. according to the uS national institutes of Health (niH; Bethesda, MD, uSa), 16 new infectious diseases have been identified in the past two decades (niH, 2008; Fauci et al, 2005); five others have been identified as re-emerging. the word ‘new’ refers to the recent discovery of the disease; many of these agents might have long existed as non-pathogenic organisms, but have only just mutated into a pathogenic form. in fact, we are witnessing a slow realization among public-health experts and the general public that infectious diseases are back with a vengeance. With the discovery of antibiotics in the early twentieth century and the successful eradication of smallpox in 1979, it seemed that humanity was about to finally rid itself of infectious diseases. During the past couple of decades, however, microbes have shown a tenacious ability to adapt, re-adapt, survive and challenge human ingenuity (table 1). the impact of these diseases is immense and is felt across the world. in addition to affecting the health of individuals directly, infectious diseases are also having an impact on whole societies, economies and political systems. in the developing world in particular, crucial sectors for sustained development such as health and education, have seen a marked loss of qualified personnel, most notably to human immunodeficiency virus (HiV)/acquired immune deficiency syndrome (aiDS), tuberculosis (tB) and malaria. these and other infectious agents not only take an enormous physical toll on humanity, but also cause significant economic losses both directly in the developing world and less directly in the developed world. it is therefore a matter not only of public health, but also of economic interest, to invest in and organize an internationally coordinated strategy to fight the major infectious diseases, or at least to bring them under control. of course, one could simply think the solution would be to try to eliminate the pathogens and/or their vectors from their natural reservoirs or hosts. after all, this was successfully done with smallpox, for example. cholera and malaria were similarly brought under control in the uSa and southern Europe. unfortunately, it is not easy to predict where and when most infectious agents will strike or which new diseases will emerge. the reasons for their persistence are manifold and include biological, social and political causes.