Pay Now or Pay More Later

Prevention may not consistently cost less than cure, but investing today in many global health challenges can avert much greater costs tomorrow. In some cases, the findings of disease may be latent for years, as with tobacco use. In other cases, from HIV/AIDS to Ebola virus, the disease scales with epidemic potential. If growing drug resistance is not checked, the yearly toll may rise to 10 million deaths in 2050, more than the number of lives claimed by cancer today. Cumulative economic losses could reach up to $100 trillion dollars by that year. Yet policymakers are less moved by statistical than identifiable victims. With only a handful of Ebola cases returning to the United States, the U.S. government appropriated $5.4 billion in response. With at least 23,000 Americans dying from drug-resistant infections each year, a near doubling of the funding to address antimicrobial resistance in the FY2016 U.S. President’s Budget brought it only to $1.2 billion.

As part of Politico’s public health round up in 2018, Dr. So’s “One Smart Upstream Investment” called for the launch of a Foresight Fund. He wrote: “With the Foresight Fund, we could move beyond making small, near-term bets—company by company and drug by drug—to investments that transform the innovation ecosystem. We could design innovative financing mechanisms that require upfront capital to implement antimicrobial stewardship in our health care delivery and food production systems. Prevention gains and intergenerational costs are seldom as compelling as today’s crisis, but we can correct this. The Foresight Fund could be seeded with a solidarity contribution, like UNITAID receives from participating countries on airline tickets, but this could be levied on international financial transactions. Over time, a coalition of the willing — both of countries and foundations — might make contributions to such a multilateral fund. Independent of these funding sources, however, the Foresight Fund could establish a framework for investing in these future public health risks, and in so doing, the process of prioritizing these issues will itself return dividends by informing policymakers of the challenges ahead.” For such issues, the choice is starkly clear: pay now or pay more later.