EA - Fungal diseases: Health burden, neglectedness, and potential interventions by Rethink Priorities

The Nonlinear Library

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Fungal diseases: Health burden, neglectedness, and potential interventions, published by Rethink Priorities on September 4, 2024 on The Effective Altruism Forum.
Editorial note
This report is a "shallow" investigation, as described
here, and was commissioned by Open Philanthropy and produced by Rethink Priorities from January to February 2023. We revised the report for publication. Open Philanthropy does not necessarily endorse our conclusions, nor do the organizations represented by those who were interviewed.
Our report focuses on exploring fungal diseases as a potential new cause area for Open Philanthropy. We assessed the current and future health burden of fungal diseases, provided an overview of current interventions and the main gaps and barriers to address the burden, and discussed some plausible options for philanthropic spending. We reviewed the scientific and gray literature and spoke with five experts.
While revising the report for publication, we learned of a new global burden study (
Denning et al., 2024) whose results show an annual incidence of 6.5 million invasive fungal infections, and 3.8 million total deaths from fungal diseases (2.5 million of which are "directly attributable" to fungal diseases). The study's results align with this report's estimate of annual 1.5 million to 4.6 million deaths (80% confidence) but were not considered in this report.
We don't intend this report to be Rethink Priorities' final word on fungal diseases. We have tried to flag major sources of uncertainty in the report and are open to revising our views based on new information or further research.
Executive summary
While fungal diseases are very common and mostly mild, some forms are life-threatening and predominantly affect low- and middle-income countries (LMICs). The evidence base on the global fungal disease burden is poor, and estimates are mostly based on extrapolations from the few available studies. Yet, all experts we talked to agree that current burden estimates (usually stated as >1.7M deaths/year) likely underestimate the true burden.
Overall, we think the annual death burden could be 1.5M - 4.6M (80% CI), which would exceed malaria and HIV/AIDS deaths combined.[1] Moreover, our best guess is that fungal diseases cause 8M - 49M DALYs (80% CI) per year, but this is based on our own back-of-the-envelope calculation of high-uncertainty inputs.
Every expert we spoke with expects the burden to increase substantially in the future, though no formal estimates exist. We project that deaths and DALYs could grow to approximately 2-3 times the current burden until 2040, though this is highly uncertain. This will likely be partly due to a rise in antifungal resistance, which is especially problematic as few treatment classes exist and many fungal diseases are highly lethal without treatment.
We estimate that only two diseases (chronic pulmonary aspergillosis [CPA] and candidemia/invasive candidiasis [IC/C]) account for ~39%-45% of the total death and DALY burden. Moreover, a single fungal pathogen (Aspergillus fumigatus) accounts for ~50% of the burden. Thus, much of the burden can be reduced by focusing on only a few of the fungal diseases or on a few pathogens.
Available estimates suggest the top fungal diseases have highest burdens in Asia and LMICs, and that they most affect immunocompromised individuals.
Fungal diseases seem very neglected in all areas we considered (research/R&D, advocacy/lobbying, philanthropic spending, and policy interventions) and receive little attention even in comparison to other diseases which predominantly affect LMICs. For example, we estimate the research funding/death ratio for malaria to be roughly 20 times higher than for fungal diseases.
Moreover, fewer than 10 countries have national surveillance systems for fungal infections, an...