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Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases

Kids Risk Project, Harvard School of Public Health, Boston, Massachusetts 02115; and Delft Institute of Applied Mathematics, Delft University of Technology, 2628 CD Delft, The Netherlands
Kid Risk, Inc., Newton, Massachusetts 02459; and Kids Risk Project, Harvard School of Public Health, Boston, Massachusetts 02115
r.j.duintjertebbens{at}tudelft.nl
kimt{at}kidrisk.org

Public health budget constraints force policy makers to prioritize resources toward those interventions that yield the highest perceived benefits. Intuitively, it appears optimal to focus resources on affordable interventions against prevalent diseases. However, due to the dynamics of infectious disease eradication, policies focusing on a static perception of priorities may lead to economically suboptimal outcomes. Using a hypothetical two-disease dynamic transmission model, we explore several different decision rules with respect to vaccination policy for eradicable diseases. The simulations show that cost-effectiveness decreases as the extent of priority shifting increases. This model suggests the need for a longer-term dynamic perspective to appropriately recognize costs and benefits of different policies for eradicable diseases.

Key Words: infectious diseases; disease eradication; health economics; stochastic model; system dynamics; perception delay; benefit-cost analysis
History: Received: November 5, 2007; accepted: September 23, 2008.