Strategic Analysis of Infectious Disease Eradication

How the World Health Organization Can Become an Effective Facilitator of International

Public Health Cooperation

Simin Gharib Lee | April 28, 2009 | Economics 970 | Rajiv Shankar

Thesis and Roadmap

The WHO must partner with the private sector in order to successfully eradicate infectious diseases.

• Game 1: Eradication as a Public Good

• Game 2: Smallpox Eradication

• Game 3: Polio Eradication

Biological Background

A disease can be eradicated if it …

• Is a severe disease• Has no subclinical cases• Has a relatively low level of contagiousness• Has an effective and stable vaccine• Demonstrates seasonality • Has no animal reservoir

Game 1: Eradication as a Public Good

• NE is mutual defection

• Eradication is a weakest link public good

• So, this is not the best representation.

• But, conclude: need institutions to shift world to efficient outcome.

Game 2: Smallpox Eradication

• 1948: WHO created• 1949: USSR leaves WHO• 1955: US pushes malaria

eradication campaign• 1956: USSR returns • 1959: USSR pushes smallpox

eradication campaign (malaria campaign is failing)

• 1965: US supports campaign• 1966: only 8 countries have

donated for ~$27,000• 1980: Smallpox eradication is

certified

Game 2: Smallpox Eradication• Players: WHO and DONOR

• Payoffs: functions of cost C, reputation R, and lives saved L

YDONOR = -2C2 + R + L (1)

YWHO = 3(R + L) (2)

Game 2: Smallpox Eradication

Backwards induction shows SPNE at (2, -3).

Game 2: Smallpox Eradication

• SPNE is for DONOR to back away from supporting WHO-led smallpox eradication.

• Consistent with events from 1959 - 1974

• Things to consider:– Fairness (Sigmund, Fehr,

and Nowak)– Biological properties of

smallpox

Game 3: Polio Eradication• Transformation from international

and intergovernmental to global health.

• 1988: WHO votes to eradicate polio by 2000

• 1999: Bill and Melinda Gates Foundation established

• Today– Gates: $29.7b of assets– WHO: $6b annual budget– 4 countries left with polio: India,

Nigeria, Pakistan, and Afghanistan

Game 3: Polio Eradication

• Players: GATES, WHO, and LAST• Payoffs: functions of reputation R, lives saved

L, efficiency E, and domestic political instability P.

YWHO = 3(R + L) (2)

YGATES = 3L2 + E (3)

YLAST = -3P2 + 2L + R (4)

Game 3: Polio Eradication

Backwards induction shows SPNE at (14, 12, 1).

Game 3: Polio Eradication• SPNE is for last polio-endemic countries to

pursue/renew eradication efforts and for WHO and the Gates Foundation to cooperate to provide these countries with enough resources.

• Compare with reality: – $500m from Rotary International

– $630m from Gates (1/2009)

• But, polio may not be eradicable due to biological features (symptom expression, contagiousness, vaccine)

• Nonetheless, conclude that getting the eradication this far and successful eradication both require public-private partnership.

Limitations

• Payoffs• Argument only holds for ID that can be

eradicated • Issues with private-public partnership:

– WHO could become entangled in private interests of private partners

– Dampen incentive to contribute for others?– Dampen research activity in certain areas?

Summary• Infectious disease eradication is a global

public good that requires the intervention of an institution

• Smallpox eradication shows that financial burden is the most serious concern to donor countries

• Polio eradication shows that private foundations can fill the funding gap between WHO and donor countries to move eradication campaign forward.

• By partnering with the private sector, WHO can successfully eradicate disease.