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Anthropogenic evolution, ���externalities, and public health
Carl T. BergstromDepartment of Biology
University of Washington
Department of Ecology and Evolution, UCLA���January 6, 2016
Mark Tanaka Ben Althouse Ted Bergstrom Marc LipsitchUNSW IDM USCB Harvard
Participants in the 2011 Heron
Island Summit on Evolutionary Challenges in
Food, Health, and the Environment
Overview
Anthropogenic evolution and externalities.
Carroll et al (2014) Science 346:313
Public choice theory for public health
Althouse et al (2010) PNAS 107:1696
Timing of antiviral use during a pandemic
Tanaka et al (2014) Evolution, Medicine, and Public Health 2014:150
http://octavia.zoology.washington.edu
Anthropogenic evolution and externalities.Carroll al (2014) Science 346:313
Herbicide resistance
Heap (2012) OnlineGlyphosate (Roundup) resistant weeds
Antibiotic resistance
Bergstrom and Dugatkin (2016) Evolution 2nd ed.
Fisheries Induced Evolution
Borrell (2013) Nature
Harvesting Induced Evolution
Decreasing size in harvested, but not non-harvested, species of snow lotus in the Himalayas.
Law and Salick (2005) PNAS
Conservation & captive breeding
Gene drive
Harvard Wyss Institute Gene Drive FAQ
In general, the problem with managing anthropogenic evolution is that
The species we ���want to evolve fast,evolve slow,
And the species we ���want to evolve slow,���evolve fast.
Images: superbwallpapers.com, free-‐designer.net
Evolutionary changes in wild populations generate externalities
What are externalities? ���������
Economic side-effects that are���not captured by market prices.���
Negative ���externalities
Images: Wikimedia
Many other situations with negative externalities involve���common-pool resources: they are non-excludable, ���
but rivalrous. The result in tragedies of the commons.
cc by flickr:bekhiann
Positiveexternalities
cc by flickr:Brigit Murphy
Meanwhile, pure public goods are non-excludable ���and non-rivalrous. Creating these generates positive ���externalities.
Private markets tend to under-allocate to pure public ���goods. Governments need to intervene.
National Defense is the example acceptedmost broadly on bothsides of the political aisle.
cfr.org
Evolutionary changes in wild populations generate externalities
Harmful changes tend to be common pool issues. • Non-excludable but rivalrous• Hard to monitor, hard to attribute cause / blame
Beneficial changes tend to be pure public goods• Non-excludable, non-rivalrous
How can we deal with externalities?���������
Economists have a rich toolkit���(and extensive theory, of course!)
Command ���and control���
policies
wikimedia
Sir Alexander Fleming,
Nobel Prize Lecture, 1945
wikimedia
(We need) Antibiotic regulation
Bergstrom and Dugatkin (2016) Evolution 2nd ed.
Tort Law
wikimedia
Aventis Starlink Corn
Images: NCI, wikimedia.
Establish property rights (cap and trade)
cc flickr:Thomas Berg
Catch shares for fisheries
wikimedia
Pigovian taxes
In Sweden, spirits are taxed €50 euro / liter
Pigovian subsidiesPoster: Wikimedia
As evolutionary biologists we can explain how human actions lead
to anthropogenic evolution ���
We would do well to understand the the policy tools available for modulating these actions.
Public choice theory for public healthAlthouse et al (2010) PNAS 107:1696
When should the government���get involved in public health?
When it can improve the lives of the most needy members of society.
On efficiency grounds, when ���does government investment���in public health out-perform ���
private market solutions?
Public choice theory
SuscepEble� Infected � Removed
Epidemiological modeling
Paul Samuelson 1955
Tetanus
Measles
Otitis media
Pandemic Influenza
Tetanus
Tetanus occurs when the soil microbe ���Clostridium tetani infects a deep wound.
It is not transmitted from human to humanVaccine targets the toxin, not the microbe.
My tetanus vaccine doesn’t affect you, positively or negatively.
It is a pure private good. cc flickr : Penn State
Measles
Image: Helen Bergstrom, then age 6.
Images: kinderhelper.com
My problem�
Your problem �
Images: kinderhelper.com
Private good�
Positive externality�
SuscepEble� Infected � Removed
Vaccinate fraction p�
SuscepEble� Infected � Removed
Vaccinate fraction p�
Infections decrease linearly with ���fraction of the population vaccinated.
OptimalSubsidy
€
v(q) −C'(qN) − kX(q) = 0
Direct value of ���treating one individual
Cost of treating ���one individual
Effect of treating one ���person on all others.
First-order condition for social efficiency
€
v(q) −C'(qN) − k q∂htreated (q)∂q
+ (1− q)∂huntreated (q)∂q
$
% &
'
( ) = 0
Direct value of ���treating one individual
Cost of treating ���one individual
Cost of one infection
Effect on other treated individuals
Effect on untreated individuals
€
s = −k q∂htreated (q)∂q
+ (1− q)∂huntreated (q)∂q
$
% &
'
( )
In our measles example, vaccinationaffects untreated but not treated individuals
A Pigouvian subsidy of this magnitudealigns private and public interest
Otitis mediawikimedia
Otitis media is caused Streptococcus pneumonia and Haemophilus influenzae. ���Half of preschool aged children carry ���them asymptomatically.
Image: Dennis Kunkel
Otitis media occurs when these bacteria make their way up the eustachian tube into the tympanic cavity - and thus is rarely transmissible from the infection site.
www.patienteducationcenter.org
American Academy of Pediatrics (2004)
Minimize use of antibiotics for uncomplicated otitis media.
Use amoxicillin rather than a late generation drug if antibiotics are necessary.
Patients vary in their ���need for the drug
Otherwise healthy children ���can easily clear the infection ���without treatment.
Children suffering from other complications mayneed drug treatment
After Bonhoeffer et al. 1996
Steady-state resistanceincreases with fractiontreated.
Marginal private benefit
Marginal public benefit
Marginal cost
Optimaltax
€
s = −k q∂htreated (q)∂q
+ (1− q)∂huntreated (q)∂q
$
% &
'
( )
In our Otitis media example, ���treatment affects other treated ���individuals but not those who are untreated
A Pigouvian tax of this magnitude aligns private and public interest
Pandemic Influenza
Images: http://www.coo.kz/
• Social distancing
• Vaccination
• Antivirals
Antivirals
Reduce mortality & morbidity������Reduce transmission ������Select for resistance
Private good
Positive externality
Negative externality
How should we distribute antivirals?
Flu Kits:���Families purchase in advance as insurance against pandemic
���Pharmacy distribution: Doses are distributed to individuals once infected
After Lipsitch et al 2007
Flu kit scenario
Pharmacy distribution scenario
Timing of antiviral use during a pandemicTanaka et al (2014) Evolution, Medicine, and Public Health 2014:150
Staphylococcus aureus
Pseudomonas aeruginosa
Enterococcus sp.
Klebsiella pneumoniae
Surgical ICU central line catheter infecEon rates Denver Health Quality Report 2009
When should we deploy a limited stockpile of antimicrobials to maximize benefits over the course of an epidemic?
Direct benefits (private goods): reduction of mortality and morbidity in treated individuals.
Indirect benefits (externalities): changes in the epidemic trajectory due to antimicrobial use.
See Handel, Longini, and AnEa (2007) Proc R. Soc. B 274:833-‐837
See Handel, Longini, and AnEa (2007) Proc R. Soc. B 274:833-‐837
See Handel, Longini, and AnEa (2007) Proc R. Soc. B 274:833-‐837
See Handel, Longini, and AnEa (2007) Proc R. Soc. B 274:833-‐837
X
YSU YST
YR
Z θ ν/(1-‐ε)
ν
ν
1-‐fξ
fξ
Treatment start Eme (days)
FracEo
n of stockpile used successfully
Model results (≠policy suggestions)
Limited stockpile? Don’t use it right away.
Even with an unlimited stockpile, the total social welfare is greatest when one delays antimicrobial use some time into the epidemic.
Why ?
Indirect benefits come from reducing overshoot by reducing transmission at and beyond the epidemic threshold, i.e., late in the epidemic, to minimize overshoot.
Direct benefits depend on the number ���of treatment failures due to resistance.Here timing is everything.
Direct benefits depend on the number ���of treatment failures due to resistance.Here timing is everything.
To summarize:
Early use generates negative externalities by promoting the evolution of antiviral resistance.
Late use creates positive externalities, by reducing the overshoot of the epidemic.
You might take this as an argument in favor of delaying antiviral treatment until well into an epidemic.
Generally not a good idea to delay antiviral use.
Delaying use • may not be ethical • prevents any chance of early eradication• risks wasting doses if use begins too late
Correctly ordering the use of multiple drugs may be feasible.
Compare Wu et al. 2009 PLoS Medicine
SummaryAnthropogenic evolution in wild populations has profound costs—and benefits—for society. ������But its consequences are diffuse and rarely captured by economic markets.
We can manage anthropogenic evolution—but we need the tools and theory from public choice economics to implement effective policy.
This is our chance as evolutionary biologists to be societally relevant. Let’s do this!
Mark Tanaka Ben Althouse Ted Bergstrom Marc LipsitchUNSW IDM USCB Harvard
Participants in the 2011 Heron
Island Summit on Evolutionary Challenges in
Food, Health, and the Environment