The 1% Treaty: Harnessing Greed to Eradicate Disease

Abstract: 6.65k diseases (95% CI: 5.70k diseases-8.24k diseases) diseases have 0 FDA-approved treatments. At current trial capacity (15 diseases/year (95% CI: 8 diseases/year-30 diseases/year) new first treatments/year), exploring the therapeutic search space takes ~443 years (95% CI: 324 years-712 years). Redirect 1% of military spending ($27.2B/year) to pragmatic clinical trials. Trial capacity jumps 12.3x (95% CI: 4.19x-61.3x). Search space explored in ~36 years (95% CI: 11.6 years-77.2 years) instead of centuries. Average treatment reaches patients 212 years (95% CI: 135 years-355 years) sooner. Timeline shift saves 10.7B deaths (95% CI: 7.39B deaths-16.2B deaths), valued at $84.8 quadrillion (95% CI: $62.4 quadrillion-$97.3 quadrillion). Cost-effectiveness: $0.0018 (95% CI: $0.0007-$0.0041)/DALY, 50.3kx (95% CI: 23.7kx-111.7kx) better than bed nets. Even at 1% (95% CI: 0.1%-10%) probability of treaty adoption, risk-adjusted cost-effectiveness remains superior to the best existing global health interventions. Incentive Alignment Bonds address political feasibility by tying legislators' career incentives to a public voting scorecard.