10

Closing Remarks

The workshop discussions over the 1.5 days allowed participants to understand some of the challenges and opportunities of using economics to manage microbial threats, and to identify potential strategies to leverage economic tools to counter infectious diseases, ranging from endemic to emerging infectious diseases to antimicrobial resistance (AMR). At the end of the workshop, three participants summarized what they believed were the lessons learned from the discussion. First, Suerie Moon, director of research at the Global Health Centre of the Graduate Institute of International and Development Studies, Geneva, began with her reflections based on the breakout group discussion. Peter Sands, executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, followed with his thoughts on the key points from the workshop and the challenges that need to be overcome to push the field forward. Peter Daszak, president of EcoHealth Alliance, provided closing comments at the end the workshop.

RESEARCH, CONVENINGS, AND POLICY

Suerie Moon, director of research at the Global Health Centre of the Graduate Institute of International and Development Studies, Geneva, reflected on three overarching categories for action steps she observed from the final discussion: research, convenings, and policy. She said research needs to move from broad, global-level impact estimates to creating more specific data that are targeted and relevant to policy makers. She flagged the potential for this type of research and economic analyses to serve as an accountability tool for policy makers to measure actions taken by

responsible parties. To conduct these economic analyses, Moon raised participants’ questions on who should be involved and whether the group of stakeholders should be broadened. In all cases, she observed, communication among researchers themselves and with the broader policy community will remain crucial.

In terms of convenings, Moon observed repeated calls among some workshop participants for opportunities for research and policy communities to come together to better address issues, make decisions, and implement policies. To illustrate this point, she mentioned the crossroads for decision making with the available economic analyses and tools, particularly in light of the urgency with AMR, and the need for research and policy communities to convene to review the analyses, make a decision, and move on.

Finally, Moon stated the need to implement policy changes. She said that making policy changes would require expanding the usefulness of economic analyses for stakeholders who tend to exist in academic and policy silos, as well as crossing those silos, both within and outside the health sector. Doing so will contribute to improving the global capacity to manage microbial threats, asserted Moon.

FINAL THOUGHTS

Peter Sands, executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, provided his main points from the workshop’s 1.5 days of discussions, and he highlighted the continued challenges that the global community must grapple with. He observed that building an investment case for managing microbial threats is vital in a climate of increasing economic vulnerability as the world is more interconnected by social media and increased communication, transportation, and trade. The investment case, according to Sands, needs to be rooted in an analysis of the burdens and risks of microbial threats. Furthermore, he reflected that economic tools, whether they be models or behavioral economic frameworks, can be helpful in designing optimal interventions and making the inevitable trade-offs in resource-constrained environments. In his current role, he noted that this analysis will be necessary to build a compelling investment case to underpin the Global Fund’s next replenishment in 2019. Sands also mentioned that economics needs to be leveraged more in global health. To make this point, he shared two examples from the HIV field.

In his first example, he shared that in some countries, an HIV-diagnosed person must pay a small fee before getting on antiretroviral therapy (ART). He noted that the act of having to pay a fee typically leads to a high fall-off of HIV-diagnosed people receiving therapy. Even relatively small amounts

of money, he explained, can create an impediment to prompt treatment, a phenomenon that can be explained by behavioral economics. In his second example, Sands reported that while the largest proportion of new HIV infections is among adolescent girls and young women, qualitative data suggest that they have decreased fear of contracting HIV partly as a side effect of the availability of effective ART and treatments. Sands remarked that the development of effective ART is an enormous achievement that has been able to manage what was a fatal disease into a more chronic condition, but urged the global community to also think through the incentive structures to address the unintended consequences of the achievement.

Sands moved on to reviewing challenges that surfaced during workshop discussions. He noted the market failure of incentivizing research and development for new antimicrobials, which is reflected in industry debates over reimbursement reform, procurement, and what constitutes the suite of incentives. He also pointed out that investments in preparedness in low- and middle-income countries remain low. As an example, Sands cited the disparity between participation in the Joint External Evaluations (JEEs), which is high, and the few countries that have committed actual funding to implement plans addressing the gaps identified by those JEEs. He also expanded on the challenge of breaking through multiple silos, noting that they exist between economics and public health, scientific and clinical worlds, and also within the infectious disease realm among endemic diseases, emerging outbreaks, and AMR, in which different approaches are often used to calculate and communicate the economic impact. While this might reflect the intrinsic differences of the various diseases, he argued there could be more cross-fertilization among the diverse approaches. These communities are incrementally being bridged by convenings such as this workshop, but he said more progress is necessary to make approaches to economic analysis across domains more consistent, grounded in empirical evidence, and specific for policy makers on the national level.

As the breakout reports suggested, Sands said more work needs to be done to build the knowledge base for such rigorous analyses and to address data gaps. In particular, he highlighted the intellectual challenge of examining the economics of fear. In addition, Sands agreed with the need to build both local and global capacity and noted that there is a global shortage of the necessary economic expertise especially dedicated to tackling diseases with high mortality, such as tuberculosis. He hoped that the topic of economics of microbial threats becomes more attractive to young professionals and academics to boost this capacity. Finally, Sands urged better incorporations of rigorous and empirical economic considerations into health strategies, and for macroeconomic analyses to more effectively weave in health considerations. However, these economic analyses, he cautioned, cannot be too narrow and focus only on the technical aspects. He concluded:

Peter Daszak, president of EcoHealth Alliance, provided closing remarks for the workshop. He observed that the meeting had been an effort itself in breaking down silos and engaging communities across emerging and endemic infectious diseases, the biological and social sciences, the private and public sectors, and security with public health. Though bridging these disciplines will require compromises all around, Daszak said they will also provide opportunities to move the agenda forward to implement policy changes.