Time for the NHS to learn that prevention is better than cure

The NHS pioneered so many areas of inoculation, from polio onwards, that its reluctance to extend the principle to PrEP is hard to comprehend

Campaigners have won the battle to have the NHS fund HIV prevention drug PrEP (Getty)

“Prevention is better than cure” is an old, but mostly reliable, maxim for public health policy. It has been applied by judges in the High Court to the case brought by an AIDS charity. The charity argued that the NHS in England was wrong to say that it could not prescribe a preventative treatment, pre-exposure prophylaxis, or PrEP. It is difficult to understand quite why NHS England chose to take the charity on, given that prevention is often such a cost-effective approach. In any case, the charity won, and it is a landmark moment.

This ruling has wide implications, and not just for Aids sufferers, invaluable as this new development is for them. For 30 years and more Aids has represented one of the most dangerous, and costly, threats to public health the world has seen. In much of the developing world, especially sub-Saharan Africa, it has retained all of its old power to infect and destroy. In Britain we have had more success in limiting its effects for those infected, and life expectancies have been greatly improved via antiretroviral therapies. How much better, though, if the risks of infection could be reduced with the help of a drug? The cost benefits are all in its favour, and the total cost of the prescriptions, some £10m-£20m, are well within the margin of error in the overall NHS drugs bill. It will save valuable lives, as indeed, it is already doing in the US, where insurance firms, whose business it is to make advantageous actuarial calculations, are happy to make use of it for their customers. The NHS pioneered so many areas of inoculation, from polio onwards, that its reluctance to extend the principle, albeit quite a long way, is hard to comprehend.

Perhaps the NHS was worried about “moral risk”, in the sense that the prescription of such drugs would encourage promiscuity. And yet much the same could be said for male and female contraceptives, and with the same degree of truth probably, which is that it certainly might have such an effect in some cases, but the benefits from reduced sexually transmitted diseases vastly outweigh the damage to public morals (whatever that may be thought to be).

The ruling has a wider lesson and impact, however, as it pushes the NHS and government policy more generally towards an ever more preventative approach to health risks. Drugs and inoculations can no longer be so easily withheld on the grounds of some spurious distinction about what category they sit in. More than that, it will help alter the mind-set and encourage the authorities to move against excessive salt and fat levels in food, as they have already started to do with sugar in soft drinks, and, of course, with punitive taxation on tobacco and alcohol. In a world where the demands on the NHS are set to increase exponentially, where new and expensive treatments are constantly being developed, and where the economy is going to find it more difficult to fund the cost of curing and older population, now more than ever is prevention the best form of treatment - as any judge would tell you.