AIDS: A GLOBAL ASSESSMENT : The Burgeoning Costs

By 1991, worldwide AIDS control will cost billions of dollars a year, according to estimates by World Health Organization officials. About 100 countries will require some external assistance to supplement their own expenditures, particularly many Third World countries in which annual per capita health care spending is only $5 to $20.

The World Health Organization’s special program on AIDS alone projects that it will need about $650 million--more than twice its current annual budget.

Some of this money would be for AIDS vaccine and treatment research, global surveillance and coordination of international control programs. But the majority of the funds would be used to defray the costs of World Health Organization-approved national AIDS control programs in developing countries.

Unless AIDS vaccines and treatments are developed, expenditures in these national programs are expected to grow rather than diminish. This is because the majority of the money would go toward providing educational programs and disposable supplies, including AIDS blood test kits, sterile needles and condoms, and the creation and maintenance of basic health services.

A primary health care infrastructure is lacking in vast expanses of many developing countries, particularly in rural areas. Yet the creation of an effective infrastructure is considered a prerequisite to caring for AIDS patients and preventing transmission of the AIDS virus, as well as treating the whole range of common illnesses.

For every dollar that developing countries receive from the World Health Organization, they will need at least an additional $4 for AIDS control from other sources, including the world’s major economic powers, U.N. agencies and the World Bank, according to Dr. Jonathan Mann, the director of the World Health Organization’s special program on AIDS. By 1991, this additional international aid might total $2 billion.

The magnitude of these expenditures depends on the perspective with which they are viewed.

One approach is to compare the projected AIDS expenditures to total international aid for development, including assistance to health programs.

International development aid totaled $37 billion worldwide in 1986, according to the Organization for Economic Cooperation and Development in Paris. Of that, about $1.3 billion, or 3.5%, was targeted for health programs.

Thus, expenditures of $2.65 billion on international AIDS control in 1991 would roughly triple the funding for health programs in developing countries. But health care expenditures would still remain a small percentage of the total international aid to Third World nations.

Another approach is to contrast the international AIDS expenditures with projected AIDS spending in developed countries. By 1991, the United States and some other Western nations are expected to be spending billions of dollars each on their own AIDS control programs and for the care of AIDS patients.

By comparison, $2.65 billion in international AIDS assistance for about 100 developing countries would amount to average expenditures of slightly more than $25 million per country.

“A couple billion dollars a year is not unreasonable,” said Dr. Donald A. Henderson, dean of the Johns Hopkins University School of Public Health. “It really is going to be a question of how it is perceived by donor countries.”

SPENDING ON AIDS CONTROL

Headquarters Regional and staff for AIDS country staff 1987 20 22-26 1988* 20-25 50 1989* 25 70 1990* 25-30 100 1991* 30-35 125