ECONOMIC CONSIDERATIONS FOR THE ERADICATION ENDGAME

Monday, 29th of September 2014

[source]Philosophical Transactions of the Royal Society B: Biological Sciences[|source]

Eradication of a global scourge is an audacious undertaking. Its achievement depends on the cooperation of nearly every community in every country. It requires pushing a complex biological–social–political system into unchartered territory. It requires trust in the people and organizations leading the effort. It requires patience. It requires luck. Unlike any other public health goal, it is intolerant of error. BUT above all, it requires resources.

In this report, the author develops and presents a framework for economic analysis of eradication, grounded in simple epidemiology. The framework exposes the tensions between private and public interests—tensions that can make elimination difficult to achieve. The report documents that the incremental cost calculations for control/elimination scenarios and eradication are nearly identical, implying that the marginal cost of reducing cases cannot be much greater than the average cost. . Detailed description of the framework and its implications on measles, polio and smallpox are accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720047/#!po=2.08333

 

ABSTRACT

An infectious disease will be eradicated only if it is eliminated everywhere, including in the hardest-to-reach, most vaccine-wary communities. If eradication is successful, it promises a dividend in the form of avoided infections and vaccinations. However, success is never certain unless and until eradication is achieved, and claiming the dividend means bearing the possibly great risk of re-emergence. Economic analysis of eradication evaluates these risks and rewards relative to the alternative of ‘optimal control’, and also exposes the incentives for achieving and capitalizing on eradication. Eradication is a ‘game’, because some countries may be willing to eliminate the disease within their borders only if assured that all others will eliminate the disease within their borders. International financing is also a game, because each country would rather free ride than contribute. Finally, for diseases such as polio, capitalizing on eradication is a game, for should any country continue to vaccinate in the post-eradication era using the live-attenuated polio vaccine, the countries that stop vaccinating will be exposed to the risk of vaccine-derived polioviruses. In the framework developed in this paper, eradication is a seductive goal, its attainment fraught with peril.