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.