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Recommendation: While human mortality and the magnitude and duration of morbidity should remain the primary focus of DHS bioterrorism risk analysis, DHS should incorporate other measures of societal loss, including the magnitude and duration of first- and second-order economic loss and environmental and agricultural effects.


Some direct impacts of bioterrorist attacks are relatively easy to quantify because they are easy to measure in dollars: insured losses to homes, businesses, and industry; bridge and highway repairs; equipment replacement or repairs; crop loss; and so on. The costs of other direct impacts and many indirect impacts are less easy to determine and quantify—for example, psychological distress and family instability.

Cost-benefit analysis (CBA) has been proposed as a way of combining direct and indirect effects of alternative programs. If one undertakes CBA, it is necessary to monetize each of the direct and indirect impacts to provide a common metric for ranking the risks of different bioagents. Monetization means assigning values in dollars. Mortality and morbidity (including psychological distress) could be monetized by setting 1 DALY or 1 QALY equal to the “value of a statistical life-year” or to 1 year of income (typically on the order of $50,000). The value of environmental impacts is measured in terms of willingness to pay by using contingent valuation techniques and has been a source of debate by economists over the years.

The total social cost of a bioterrorist attack can be estimated by combining direct and indirect economic costs with the monetization of mortality, morbidity, and environmental costs. Some critics of CBA are unwilling to attach monetary values to life, environmental impacts, or other non-economic consequences from different events. One then has to use other methods of analysis such as cost-effectiveness analysis or multigoal analysis.10

REFERENCES

Armstrong, J.S. 2001. Principles of Forecasting. Newell, Mass.: Kluwer Academic Publishers.

Boardman, A., D. Greenberg, A. Vining, and D. Weimer. 2001. Cost-Benefit Analysis: Concepts and Practice. Upper Saddle River, N.J.: Prentice Hall.

Cooper, B. 2006. “Poxy Models and Rash Decisions.” Proceedings of the National Academy of Sciences 103(33):12221-12222.

DHS (Department of Homeland Security). 2006. Bioterrorism Risk Assessment. Biological Threat Characterization Center of the National Biodefense Analysis and Countermeasures Center. Fort Detrick, Md.

Ferguson, N. 2007. “Capturing Human Behavior.” Nature 446(7137):733.

Hammond, K.R. 2006. Beyond Rationality: The Search for Wisdom in a Troubled Time. New York: Oxford University Press.

Heinz Center for Science, Economics, and the Environment. 1999. The Hidden Costs of Coastal Hazards: Implications for Risk Assessment and Mitigation. Washington, D.C.: Island Press.

Janis, I.L. 1989. Groupthink: Psychological Studies of Policy Decisions and Fiascoes. Boston: Houghton Mifflin.

Kaplan, E.H., D.L. Craft, and L.M. Wein. 2003. “Analyzing Bioterror Response Logistics: The Case of Smallpox.” Mathematical Biosciences 185(1):33-72.

May, R.M. 2004. “Uses and Abuses of Mathematics in Biology.” Science 303(5659):790-793.

NRC (National Research Council). 1998. Summarizing Population Health: Directions for the Development and Application of Population Metrics. Washington D.C.: National Academy Press.

Silver R.C., E.A. Holman, D.N. McIntosh, M. Poulin, and V. Gil-Rivas. 2002. “Nationwide Longitudinal Study of Psychological Responses to September 11.” Journal of the American Medical Association 288(10):1235-1244.

Wessely S., K.C. Hyams, and R. Bartholomew. 2001. “Psychological Implications of Chemical and Biological Weapons.” BMJ 323(7318):878-879.

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For more details on the concepts and practice of cost-benefit analysis and alternative analyses, see Boardman et al. (2001).



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