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THE DISEASES − CHAPTER 4
101
Investment case
Yaws is a disabling and disfiguring disease that “begins where the road ends” – among
the poorest and most isolated communities. It is targeted by WHO for eradication by
2020 but the global campaign is not yet financed.
It has been estimated that a global yaws eradication campaign could be established with new
investments of as little as US$ 100 million in the 12 known endemic countries, provided
that the necessary medicines are donated. 1 The full economic cost including medicines
(yet to be donated) and existing Ministry of Health staff and assets would be higher (as
depicted in Chapter 2, Fig. 2.4). Even with these economic costs, however, eradication
would cost only US$ 26 (4.2–78) for each additional year of life lived without disability or
disfigurement due to yaws.
The cost of the “end game” of any eradication effort is uncertain, with the emergence of
complexities requiring some local adaptation of global strategies. Much of the uncertainty
will be resolved as endemic countries implement the programme. In any case, under
most reasonable assumptions, a global eradication campaign will be highly cost–effective.
Importantly, from the perspective of universal health coverage, it will benefit some of the
world’s least well off citizens. Eradication of this neglected disease of poverty can be seen
as complementary to universal health coverage and shared prosperity on the post-2015
development agenda.
There is less evidence to estimate investments for the control of bejel or pinta. Investment
targets for these diseases may be added in future updates to the analyses of this report.
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1
Fitzpatrick C, Asiedu K, Jannin J. Where the road ends, yaws begins? The cost effectiveness of eradication versus more
roads. PLoS Negl Trop Dis. 2014;8:e3165. doi:10.1371/journal.pntd.0003165.
Burden and distribution
The global burden of endemic treponematoses is not known accurately. Fig. 4.6.1 and
Fig. 4.6.2 show the most recent (2013) data, based on routine surveillance and surveys from
some countries. Since reporting of yaws is not mandatory, these figures are only indicative of
the distribution of the disease. However, with the eradication of yaws by 2020 in mind, it will
be essential to make its reporting mandatory.