Best-laid plans


By Kurt Kleiner in Washington DC THE WHO’s plans to eliminate seven major diseases may cost much more than the $7.5 billion the agency has budgeted. And the goal could even harm public health by soaking up money from other programmes, claim some US officials. The diseases targeted for eradication or “elimination”—reducing them to such a low incidence that they are no longer a problem—are lymphatic filariasis, guinea worm disease, polio, leprosy, measles, river blindness and Chagas’ disease. The polio eradication campaign should be completed by 2000 at a cost of $1.6 billion. Programmes on leprosy and guinea worm disease are also making good progress. But the General Accounting Office (GAO), the investigative arm of the US Congress, has doubts about other WHO plans, such as its goal of eliminating lymphatic filariasis, or elephantiasis, by 2030 at a cost of $228 million. “Data underlying the cost and the time-frame estimates are incomplete,” Ben Nelson, a GAO official, told the House of Representatives Committee on International Relations last week. The US Agency for International Development, meanwhile, in a letter to the GAO, warns that the programmes “may result in unfortunate reduction in efforts to prevent other diseases”. David Heymann, the WHO’s director of communicable diseases surveillance and control,
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