Who should pay for global health, and how much?

Our article was published in PLOS Medicine (Carrasco, Coker, Cook). We devise a new way to identify the expected contributions to global health from each country in the world. We propose a global health cost-effectiveness threshold coupled to a DALY (disability-adjusted life year) credit market.

The idea is simple, high or middle-income countries or health projects in these countries that allocate resources to not very cost-effective projects need to buy DALY credits from highly cost-effective projects in low income countries to carry on with their projects.

For instance, if we want to adopt a very costly vaccine in Singapore, we would need to contribute a little bit to very cost-effective children immunization vaccines in Sub-Saharan Africa. Given how cheap is to avert DALYs in low-income countries compared to high income countries, we would only need to contribute an equivalent to ~0.1–0.5% of the costs of the project. We believe that this system could help to prevent the tragedy of the commons in global health by promoting a massive scale-up of global health donations to low-income countries.

The paper pdf and supporting information is open can be found here.

220px-Merlin_Maternal

Maternal health in Afghanistan.

Source: Merlin, Wikipedia.

 

Carrasco LR, Coker R, Cook AR (2013) Who Should Pay for
Global Health, and How Much? Plos Medicine 10: e1001392. doi:10.1371/journal.pmed.1001392

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Abstract

  • Mechanisms to establish the expected financial contribution from each country to achieve the health Millennium Development Goals (MDGs) could encourage scaling-up of contributions.
  • Mirroring global carbon permit markets to mitigate climate change, we propose a cap-and-trade system consisting of a global cost-effectiveness criterion and a disability-adjusted life year (DALY) global credit market.
  • Under this system, high-income and middle-income countries should contribute, respectively, 74% and 26% of the additional US$36–US$45 billion annually needed to attain the health MDGs. The change relative to current contributions would vary, with some countries needing to scale-up substantially their expected annual contributions under the proposed market (e.g., US, US$7–US$10 billion; China, US$2–US$3 billion; Japan, US$2 billion; Germany, US$1.5–US$2 billion), while a few already meet or exceed their required contributions (i.e., Norway, the United Arab Emirates, Luxembourg, and the UK).
  • A DALY tradable credit market offers the potential to increase the efficiency of global health investments while promoting international obligations to the pursuit of an agreed global common good.

Keywords

carbon credits, DALYs, global health, health aid, vaccination.

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Towards the Integration of Spread and Economic Impacts of Biological Invasions in a Landscape of Learning and Imitating Agents

Carrasco, L.R., Cook, D.C., Mumford, J.D., MacLeod, A., Knight, J.D., Baker, R.H.A. (2012) Towards the integration of spread and economic impacts of biological invasions in a landscape of learning and imitating agents. Ecological Economics. 76, 95-103. doi:10.1016/j.ecolecon.2012.02.009.

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Abstract

Invasions of harmful non-indigenous species (NIS) and their control by land managers are complex and opposing processes that generate economic costs in a dynamic and spatial fashion. Here we develop an agent-based model integrated with a spatial stochastic simulation NIS spread model where the agents (farmers) are endowed with learning and imitation capabilities. The model is applied to the case of the western corn rootworm invasion in England. We dynamically link the welfare loss of the producers to the spatial distribution of the invasion; allowing us to study the effects of control policies and farmers’ behaviour on welfare losses and the invasion process. The results show a trade-off between compliance costs and yield losses costs for different levels of control intensity, however, a laissez faire policy against the invasion would be preferred for England. When the farmers can learn from experiences and imitate each other, we find that control measures might fail completely if there is global knowledge of the burdens of compliance (e.g. through the media) and the farmers can foresee the future consequences of new actions. The effectiveness of the control program is respectively not affected or only partially affected if the farmers need to experience compliance to learn its consequences or communicate only locally. Attempts to take the pulse of negative opinions of land managers over NIS control programs and their media coverage might be a powerful predictor of the odds of failure of the programs.

Keywords

biosecurity, dispersal, diabrotica virgifera virgifera, metapopulation, invasive alien species, pest risk analysis

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Strategies for Antiviral Stockpiling for Future Influenza Pandemics: A Global Epidemic-Economic Perspective

Carrasco, L.R., Lee, V.J., Chen, M.I., Matchar, D.B., Thompson, J.P., Cook, A.R. (2011) Strategies for antiviral stockpiling for future influenza pandemics: a global epidemic-economic perspective. Journal of the Royal Society Interface. 8, 1307–1313. doi:10.1098/rsif.2010.0715.

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Abstract

Influenza pandemics present a global threat due to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the long-term optimal size of the stockpile under uncertainty and the characteristics of different countries.

Using an epidemic-economic model we studied the effect on total mortality and costs of antiviral stockpile sizes for Brazil, China, Guatemala, India, Indonesia, New Zealand, Singapore, the UK, the USA, and Zimbabwe.

In the model, antivirals stockpiling considerably reduced mortality. There was greater potential avoidance of expected costs in the higher resourced countries (e.g. from $55bn to $27bn over a 30-year time horizon for the USA) and large avoidance of fatalities in those less resourced (e.g. from 11.4 to 2.3 million in Indonesia). Under perfect allocation, higher resourced countries should aim to store antiviral stockpiles able to cover at least 15% of their population, rising to 25% with 30% misallocation, to minimise fatalities and economic costs.

Stockpiling is estimated not to be cost-effective for two thirds of the world’s population under current antivirals pricing. Lower prices and international cooperation are necessary to make the life-saving potential of antivirals cost-effective in resource-limited countries.

Keywords

antiviral drugs, epidemic modelling, health economics, influenza pandemic, uncertainty

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Optimal and Robust Control of Invasive Alien Species Spreading in Homogeneous Landscapes

Carrasco, L.R., Baker, R., MacLeod, A., Knight, J.D., Mumford, J.D. (2010) Optimal and robust control of invasive alien species spreading in homogeneous landscapes. Journal of the Royal Society Interface. 7, 529-540. doi:10.1098/​rsif.2009.0266.

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Abstract

Government agencies lack robust modelling tools to manage the spread of invasive alien species (IAS). In this paper we combine optimal control and simulation methods with biological invasion spread theory to estimate the type of optimal policy and switching point of control efforts against a spreading IAS. We employ information-gap theory to assess how the optimal solutions differ from a policy that is most robustly immune to unacceptable outcomes. The model is applied to the potential invasion of the Colorado potato beetle in the UK. Under no uncertainty, we demonstrate that for many of the parameter combinations the optimal control policy corresponds to slowing down the invasion. The information-gap analysis showed that eradication policies identified as optimal under no uncertainty are robustly the best policies even under severe uncertainty, i.e. even if they are likely to turn into slowing down policies. We also show that the control of satellite colonies, if identified as optimal under no uncertainty, will also be a robust slowing down policy for IAS that can spread by long distance dispersal even for relatively ineffective control measures. The results suggest that agencies adopt management strategies that are robustly optimal despite the severe uncertainties they face.

Keywords

control theory, pest risk analysis, reaction-diffusion, stratified diffusion

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Unveiling Human-Assisted Dispersal Mechanisms in Invasive Alien Insects: Integration of Spatial Stochastic Simulation and Phenology Models

Carrasco, L.R., Mumford, J.D., MacLeod, A., Harwood, T.D., Grabenweger, G., A.W. Leach, Knight, J.D., Baker, R.H.A. (2010) Unveiling human-assisted dispersal mechanisms in invasive alien insects: integration of spatial stochastic simulation and phenology models. Ecological Modelling. 221, 2068-2075. doi:10.1016/j.ecolmodel.2010.05.012.

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Abstract

Capturing the spread of biological invasions in heterogeneous landscapes is a complex modelling task where information on both dispersal and population dynamics needs to be integrated. Spatial stochastic simulation and phenology models have been rarely combined to facilitate such integration in order to assist on the study of human-assisted long-distance dispersal events.

Here we develop a process-based spatially explicit landscape extent simulation model that considers the spread and detection of invasive insects. Natural and human-assisted dispersal mechanisms are modelled with an individual-based approach using negative exponential and negative power law dispersal kernels and gravity models. The model incorporates a phenology submodel that uses daily temperature grids for the prediction and timing of the population dynamics in each habitat patch. The model was applied to the study of the invasion by the important maize pest Western corn rootworm (WCR) Diabrotica virgifera ssp. virgifera in Europe. We parameterised and validated the model using maximum likelihood and simulation methods from the historical invasion of WCR in Austria.

WCR was found to follow stratified dispersal where international transport networks in the Danube basin played a key role in the occurrence of long-distance dispersal events. Detection measures were found to be effective and altitude had a significant effect on limiting the spread of WCR. Spatial stochastic simulation combined with phenology models, maximum likelihood methods and predicted versus observed regression showed a high degree of flexibility that allowed capturing the salient features of WCR spread in Austria. This modelling approach is useful because allows to fully exploit the limited and heterogeneous information regarding the population dynamics and dispersal of harmful non-indigenous species.

Keywords

biological invasions, biosecurity, pest risk analysis, policy analysis, risk management

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