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16Mo Putera
Humanity has only ever eradicated two diseases (and one of those, rinderpest, is only in cattle not humans). The next disease on the list is probably Guinea worm (though polio is also tantalizingly close).
At its peak Guinea worm infected ~900k people a year. In 2024 we so far only know of 7 cases. The disease isn't deadly, but it causes significant pain for 1-3 weeks (as a worm burrows out of your skin!) and in ~30% of cases that pain persists afterwards for about a year. In .5% of cases the worm burrows through important ligaments and leaves you permanently disabled. Eradication efforts have already saved about 2 million DALYs.[1]
I don't think this outcome was overdetermined; there's no recent medical breakthrough behind this progress. It just took a herculean act of international coordination and logistics. It took distributing millions of water filters, establishing village-based surveillance systems in thousands of villages across multiple countries, and meticulously tracking every single case of Guinea worm in humans or livestock around the world. It took brokering a six-month ceasefire in Sudan (the longest humanitarian ceasefire in history!) to allow healthcare workers to access the region. I've only skimmed the history, and I'm generally skeptical of historical heroes getting all the credit, but I tentatively think it took Jimmy Carter for all of this to happen.
Rest in peace, Jimmy Carter.
- ^
I'm compelled to caveat that top GiveWell charities are probably in the ballpark of $50/DALY, and the Carter Center has an annual budget of ~$150 million a year, so they "should" be able to buy 2 million DALYs every single year by donating to more cost-effective charities. But c'mon this worm is super squicky and nearly eradicating it is an amazing act of agency.
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2I don't think you need that footnoted caveat, simply because there isn't $150M/year worth of room for more funding in all of AMF, Malaria Consortium's SMC program, HKI's vitamin A supplementation program, and New Incentives' cash incentives for routine vaccination program all combined; these comprise the full list of GiveWell's top charities.
Another point is that the benefits of eradication keep adding up long after you've stopped paying for the costs, because the counterfactual that people keep suffering and dying of the disease is no longer happening. That's how smallpox eradication's cost-effectiveness can plausibly be less than a dollar per DALY averted so far and dropping (Guesstimate model, analysis). Quoting that analysis:
3.10.) For how many years should you consider benefits?
It is not clear for how long we should continue to consider benefits, since the benefits of vaccines would potentially continue indefinitely for hundreds of years. Perhaps these benefits would eventually be offset by some other future technology, and we could try to model that. Or perhaps we should consider a discount rate into the future, though we don’t find that idea appealing.
Instead, we decided to cap at an arbitrary fixed amount of years set to 20 by default, though adjustable as a variable in our spreadsheet model (or by copying and modifying our Guesstimate models). We picked 20 because it felt like a significant enough amount of time for technology and other dynamics to shift.
It’s important to think through what cap makes the most sense, though, as it can have a large effect on the final model, as seen in this table where we explore the ramifications of smallpox eradication with different benefit thresholds:
Smallpox Eradication Cost-effectiveness
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