The best investment we can make

Plus: Biden's new border politics, Covid origin debates, and more. June 4, 2024 [View in browser]( Good morning! Caroline was out yesterday, so I'm filling in on your Today Explained newsletter. From Vox's Future Perfect, senior correspondent Dylan Matthews brings us new data on how investing in public health can save money as well as lives. —Bryan Walsh, editorial director   [A mother and infant child together on a cot] Dan Kitwood/Getty Images Global health is the world's best investment The world spent about $97.9 billion in the years since 1994 trying to develop new tools to fight infectious diseases in poor countries. That includes things like vaccines, treatments, diagnosis tools, and preventative tools like bed nets for diseases like malaria. That sounds like a lot of money, and it is. But [Policy Cures Research](, the organization that came up with that number, also tried to estimate the benefit that this research generated. They got a dollar figure there, too: $49.7 trillion. The full investment will avert, the report finds, about 40.7 million total deaths between the years 2000 and 2040. These are big claims that deserve scrutiny. But they hold up. The finding is particularly important at a moment when key institutions like the World Health Organization, the vaccine fund Gavi, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are [all conducting fundraising drives](, ones that world leaders have yet to respond to with adequate investment. The resistance is understandable (these are big sums) but short-sighted. There are massive gains to be won by investing more to develop cures, treatments, and vaccines for the world’s deadliest infectious diseases. We just have to do it. [A boy gets a vaccine via mouthdrop ] Arvind Yadav/Hindustan Times via Getty Images How did they determine how many lives have been saved? The study focused on what Policy Cures calls “neglected diseases.” That means infectious diseases that primarily affect the developing world. Their burden is enormous. Respiratory infections and tuberculosis were responsible for [153 million years of healthy life lost]( in the year 2019. That’s about double the injury toll of car accidents worldwide. The report found 183 new technologies targeting these diseases approved between 1999 and 2023. It hired an outside firm, [Avenir Health](, which used data from the [Global Burden of Disease study]( to model how much they have cut death and disease to date. In some cases, the authors also had to extrapolate. Some technologies, like the [RTS,S]( and [R21]( malaria vaccines, only won backing from the World Health Organization in the past couple years, so the authors estimated the benefit these will have if/when they’re rolled out. In total, they estimate that these technologies will wind up saving 2.47 billion years of life (after [adjusting for lives saved in the future](). That’s about 40.7 million total lives saved. It’s a gargantuan, gargantuan total. [a child on a cot] Jason South/Fairfax Media via Getty Images Putting a price tag on a human life Calculating ROI for global health investments is tricky. First you need to know what the investments cost. The total cost spent on these technologies to date is $97.9 billion. Pushing through promising tools currently “in the pipeline” that could be rolled out before 2040 will cost another $24.8 billion, for a total cost of $122.7 billion. Then, putting a dollar value on the benefits accrued requires making some judgment calls. The bulk of the benefits come from saving lives and preventing illness. To calculate an ROI number, you have to put a monetary value on those saved lives and prevented illnesses, a value you can then compare to the upfront investment cost. The report values each year of healthy life saved at $19,985. Multiply that by 2.47 billion life years saved by these technologies, and you get about $49.4 trillion. Add in their estimates of the general economic benefits communities accrue because workers and dependents are less burdened by disease ($269.8 billion), and you get the $49.7 trillion in total benefits the report finds, or $405 for every dollar invested. Even that ROI is arguably an undercount. The $19,985 per life year figure that drives 99 percent of these benefits is a variant on what’s known as the [“value of a statistical life,](” and calculating it is among the most complex and controversial tasks in economics. Typically, the value is estimated by measuring what individuals are willing to pay to reduce their risk of dying. The idea is that people’s actual spending gives a truer sense of their feelings than, say, polling them would. But people in poor countries are willing to pay less than people in rich countries, for the obvious reason that they have less money. This approach tends to conclude that lives in poor countries are literally worth less. Indeed, the Policy Cures report uses smaller values of a statistical life for poor countries. In a subsection, they generate estimates where every life counts equally. Using a value for the US ($12.3 million) and applying it to every human being equally, they get an ROI of over $9,000 per dollar invested — which the report rejects as “potentially unrealistic and harmful to the project’s credibility.” I think that $9,000 figure is more realistic. Setting a lower value makes some sense for, say, the government of Nigeria; the statistic gives policymakers a sense of how much their citizens are willing to pay to save their lives, in situations where they will be the ones paying. But poor country governments are not the main funders of malaria vaccine research. The funders are governments and foundations in rich countries — groups in the global north, in other words. Those groups should be valuing every life equally, and highly. We need to spend now to make these gains possible The bulk of these billions of life years have already been saved, but some are yet to come. The report estimates malaria vaccines will save about 370 million life years from now until 2040. But malaria vaccines have only barely begun rolling out. The first vaccine, RTS,S, [took decades to be released](, and even now advocates are raising the alarm that [we don’t have enough money to fund a full rollout]( to every child who needs a vaccine. These vaccines might save 370 million life years, but they might not. We need to invest in getting them to people who need them. This is an immensely hopeful report. But it’s a report that also serves as a call to arms. Rich countries need to get their act together, fast, or this opportunity will slip through our fingers, with poor children in Africa and South Asia paying the price. —[Dylan Matthews, senior correspondent and lead writer](   [Listen]( The backlash to America's racial reckoning The murder of George Floyd and the protests that followed looked like a turning point in the fight against systematic racism. Except — it wasn't. [Listen now](   AROUND THE WORLD - Netanyahu is cool to a US-led ceasefire: The Israeli prime minister says not so fast to Biden — Israel isn't yet ready to sign onto a ceasefire. [[Washington Post](] - Biden goes a bit Trumpy on the border: The president is expected to sign an executive order Tuesday that would allow him to temporarily close the southern border when crossings surge. [[New York Times](//link.vox.com/click/35592296.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] - India's killer heat waves: At least 50 deaths have been blamed on a multi-day heat wave that marred voting in the world's biggest democracy. [[CBS News](] [Dr. Fauci at a hearing]( Valerie Plesch/Bloomberg via Getty Images ORIGINS - Dr. Fauci weathers hard questioning from Congress: Democrats painted the 83-year-old immunologist as a hero for leading the US through Covid, while Republicans blamed him for everything that went wrong during the pandemic. [[AP](] - The case for a Covid lab leak origin: A fascinating op-ed from a molecular biologist who lays out a five-point case for why Covid "probably started in a lab." [[New York Times](]   10 big things we think will happen in the next 10 years The staff of Vox's Future Perfect has predictions — with numbers. [Read more »](   Are you enjoying the Today, Explained newsletter? Forward it to a friend; they can [sign up for it right here](. And as always, we want to know what you think. Specifically: If there is a topic you want us to explain or a story you’re curious to learn more about, let us know [by filling out this form]( or just replying to this email. 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