ANTANANARIVO, Madagascar — In April of 2012 the Government Accountability Office published a report that acknowledged that over $794 million in funding was still in expired grant accounts, that is “accounts that were more than 3 months past the grant end date and had no activity for 9 months or more”. Furthermore, over $100 million have lain untouched over 5 years after the end of a number of grants while almost another $10 million have been untouched for over ten years.
As shocking as this might seem, it is not a new problem. It was reported in 2008 that approximately $1 billion was still left in expired grant accounts at the end of 2006. Though the recent calculations represent an overall decrease in the problem of undisbursed balances left in expired grant accounts, progress depends on the agency.
What could be done with this money? One of the countless options would be to address the resurgence of the Bubonic Plague (a disease caused by the Yersinia pestis bacteria) in Madagascar that has caught media attention.
Most people automatically think of the Middle Ages when the Bubonic Plague is mentioned, and may also believe it was eradicated. However, not only is the Plague still active, but in recent weeks it has resurfaced in Madagascar at such a rate to cause alarm among health officials.
The disease first made its way to Madagascar in 1898 and has since become endemic to the central highlands. Each year an average of 300 cases are confirmed with a mortality rate of approximately 9%, but the number of deaths in 2012 rose rapidly to almost 25% of all Plague infected cases. Though it is unclear what caused such a sudden incline, the focal point of the influx is Madagascar’s prisons. In the capital Antananarivo alone, there are reportedly 3,000 inmates overcrowding prisons. A campaign begun in 2012 to capture and kill rats has garnered positive results, yet experts point out that rats are merely the vehicles for the infected fleas typically carrying the Plague bacteria. Officials also note that prison walls are ineffective at containing the Plague.
Outside of Madagascar’s prisons, there are a number of factors that contribute to the Plague’s resurgence. Risk factors include poor sanitation, contact with wildlife, traditional death rituals, and the semi-nomadic lifestyle of workers necessary for economic survival. The single greatest obstacle facing successful treatment of the Bubonic Plague is delay in treatment. Such delays stem from a lack of access to both medication and laboratory tests.
Diagnostic tests are crucial for detecting, controlling, and tracking outbreaks of the Plague. The three main tests cited by the National Institutes for Health are a blood culture, a fine-needle aspirate (or a culture of lymph node aspirate), and a sputum culture. In the U.S. the blood culture typically costs between $15-$50 while the fine-needle aspirate costs about $450 and the sputum culture costs about $75. The two main treatments used in Madagascar, Streptomycin and Gentamicin, cost $383 for a full 20 doses and $4 for a full 14 doses, respectively, though this varies depending on dosage.
What, then, are the total costs of treatment and tests for the average 300 individuals in Madagascar with the Plague?
- Streptomycin (at the given estimate): $114,900
- Gentamicin: $1,200
- Blood cultures (at highest rate of $50): $15,000
- Fine-needle aspirates: $135,000
- Sputum cultures: $22,500
All in all, the cost for 300 patients to receive essential diagnostic tests and medication to treat the Bubonic Plague equals $288,600.
Despite the fact that this may seem like a great deal of money, the U.S. government could easily afford to foot the bill, even without dipping into existing budgets. The $288,600 that it would take for the tests and treatment of 300 Plague patients is a mere 0.036% of the money sitting idly in the expired grant accounts. Even though the medical estimate does not include cost of labor or equipment, it is easy to imagine the remaining $793,711,400 would more than cover those extra expenses for 300 individuals. With the untouched funds at its feet the United States could effectively treat and control the entire Bubonic Plague issue in Madagascar. What other issues could $794 million solve?
– Katey Baker-Smith
Sources: Emblem Health, Fair Health Consumer, World Health Organization Plague Manual, Government Accountability Office, Coburn Wastebook 2012, National Center for Biotechnology Information, The Guardian, World Health Organization