Science
17 April 2015 vol 348, issue 6232, pages 257-368
http://www.sciencemag.org/current.dtl

Sanitation
For toilets, money matters
Jocelyn Kaiser
About 1 billion people in the developing world still walk out to a field, the bushes, or an open waterway to defecate instead of using a latrine. That has contributed to high rates of diarrheal disease. The problem is particularly acute in India, where Prime Minister Narendra Modi has vowed to build 111 million toilets as part of a plan to end open defecation by October 2019. But exactly how to get there is surprisingly controversial. Now, a large, controlled experiment, conducted in India’s neighbor Bangladesh and published online this week in Science, finds that the key to getting people to build hygienic latrines is to subsidize the cost. Although other experts say these results are important, some caution that building toilets doesn’t always mean people will use them or be healthier.

SANITATION SUBSIDIES
Encouraging sanitation investment in the developing world: A cluster-randomized trial
Raymond Guiteras1, James Levinsohn2, Ahmed Mushfiq Mobarak2,*
Author Affiliations
1Deptartment of Economics, University of Maryland, College Park, MD 20742, USA.
2School of Management, Yale University, New Haven, CT 06520, USA.
Abstract
Poor sanitation contributes to morbidity and mortality in the developing world, but there is disagreement on what policies can increase sanitation coverage. To measure the effects of alternative policies on investment in hygienic latrines, we assigned 380 communities in rural Bangladesh to different marketing treatments—community motivation and information; subsidies; a supply-side market access intervention; and a control—in a cluster-randomized trial. Community motivation alone did not increase hygienic latrine ownership (+1.6 percentage points, p=0.43), nor did the supply-side intervention (+0.3 percentage points, p=.90). Subsidies to the majority of the landless poor increased ownership among subsidized households (+22.0 percentage points, p<.001) and their unsubsidized neighbors (+8.5 percentage points, p=.001), which suggests investment decisions are interlinked across neighbors. Subsidies also reduced open defecation by 14 percentage points (p<.001).

Infectious Disease
Combating emerging viral threats
Elena Bekerman, Shirit Einav
Author Affiliations
Department of Medicine, Division of Infectious Diseases and Geographic Medicine, and Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA.
Although hundreds of viruses are known to cause human disease, antiviral therapies are approved for fewer than 10. Most approved antiviral drugs target viral enzymes, most commonly proteases and polymerases. Such direct acting antivirals (DAAs) have shown considerable success in the treatment of HIV and hepatitis C virus (HCV) infections. However, this approach does not scale easily and is limited particularly with respect to emerging and reemerging viruses against which no vaccines or antiviral therapies are approved.