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For the past few years, the ‘Worms Wars’ have taken centre stage in a heated policy debate over the effectiveness of mass-treatment for parasitic worm infections, specifically soil-transmitted helminths and schistosomiasis. A key question is whether consistent mass deworming of school-age children, in areas of high infection prevalence, is truly cost-effective and has long-term economic impacts on a child’s future earnings.
The answer is yes. Evidence shows that supporting mass deworming programmes in low-income countries is one of the ‘best buys’ in human development. The sustainable benefits these programmes generate are much greater than the financial support they require.
A recent study by several teams of development economists, including Nobel prize winner Michael Kremer, found that deworming treatments improved school participation in children and that some effects persisted into adulthood. Moreover, they found that individuals who received two to three additional years of deworming in childhood benefit from “an increase of 14% in consumer spending, 13% in hourly earnings, 9% in non-agricultural work hours, and are 9% more likely to live in urban areas”. The researchers suggest that mass deworming has an overall societal benefit by producing an estimated 37% rate of return on investment.
Globally, roughly two billion people are infected with parasitic worms. School-age children play a vital role in transmission and are often found to have the highest burden of disease, which relates to the number of worms they are infected with. Without treatment, infection can result in internal organ damage, malnutrition and impaired physical development.
Drugs are not expensive; in fact treatment is cheaper than diagnostics. At Unlimit Health, we have calculated £0.33 as the average cost of treatment per child per year. Treatments are cost-effective because: 1) they are delivered in mass drug administration campaigns, removing the need to diagnose each suspected case of parasitic worms; 2) the World Health Organization Drug Donation Programme, to which drugs are donated by manufacturers, provides the medication for free; 3) local volunteers, including school teachers, distribute the drugs; and 4) drug distributors are trained by the programmes through the ministry of health and/or education.
Regular and consistent treatment is critical to maintaining the benefits of deworming; however, the Covid-19 pandemic has significantly challenged this requirement. For instance, school closures have meant mass deworming has not taken place in the usual manner and distribution methods have had to adapt. In addition, recent cuts by the UK government, a key contributor to deworming efforts, to overseas development assistance (ODA) allocations, are likely to further hamper the progress in reducing the burden of parasitic worm infections in marginalised communities and prolong the need for repeated campaigns in the future. The Hamory et al study is therefore a reminder of the detrimental impact that both Covid-19 and the ODA cuts will have on children, who without treatment, may still be disadvantaged in twenty years’ time.
Based on the UK average salary, a donation of a day’s wages could treat approximately 321 children in countries where parasitic worms are endemic. A donation of any amount helps ensure children can live life to the fullest; hence, it is a worthwhile investment in their future earnings, growth and wellbeing.
Unlimit Health currently supports ministries of health in thirteen sub-Saharan African countries to deliver treatment for schistosomiasis and soil-transmitted helminth infections. Supporting programmes that are country-owned and led promotes sustainability and supports efforts to strengthen health systems – as highlighted recently by the World Health Organization.
Unlimit Health’s focus on monitoring and evaluation ensures that the interventions we support continue to be cost-effective. We constantly assess the impact of programmes to inform future programming and work to increase access to treatment for those at risk, so that children in these communities can reap the economic benefits observed in the Hamory et al study.
For these reasons, GiveWell, a non-profit organisation that recommends high-impact giving opportunities, has recommended Unlimit Health as a top charity for the past decade.
The immediate, mid- and long-term benefits associated with mass deworming programmes offer evidence of the cost-effectiveness of these health interventions. But if the continuity of deworming is lost, so too are the positive outcomes. It is therefore critical that programmes continue to serve these at-risk populations without interruption.
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A child receives treatment during mass drug administration in Malawi. Credit: SCI Foundation/Demran Ali