UNDERSTANDING THE ECONOMICS
OF MICROBIAL THREATS
PROCEEDINGS OF A WORKSHOP
V. Ayano Ogawa, T. Anh Tran, and Cecilia Mundaca Shah, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the U.S. Agency for International Development; U.S. Army Medical Research and Materiel Command (10003469); U.S. Centers for Disease Control and Prevention (10003518); U.S. Department of Homeland Security (10003591); U.S. Department of Justice: Federal Bureau of Investigation (10003863): National Institute of Allergy and Infectious Diseases/National Institutes of Health (10003776), Uniformed Services University of the Health Sciences (10004290), and U.S. Food and Drug Administration (10002125); and U.S. Department of Veterans Affairs (10003856), and by the American Society for Microbiology, EcoHealth Alliance, Infectious Diseases Society of America, Johnson & Johnson (10003710), Merck & Co., Inc., Sanofi Pasteur, and The University of Hong Kong. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48302-5
International Standard Book Number-10: 0-309-48302-6
Digital Object Identifier: https://doi.org/10.17226/25224
Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2018 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Understanding the economics of microbial threats: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25224.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
PLANNING COMMITTEE ON UNDERSTANDING THE ECONOMICS OF MICROBIAL THREATS1
PETER A. SANDS (Chair), Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
ELIZABETH CAMERON, Vice President, Global Biological Policy and Programs, Nuclear Threat Initiative
PETER DASZAK, President, EcoHealth Alliance
MARCOS A. ESPINAL, Director, Department of Communicable Diseases and Health Analysis, Pan American Health Organization
TIMOTHY G. EVANS, Senior Director, Health, Nutrition, and Population, World Bank
JENNIFER L. GARDY, Senior Scientist, BC Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada
THOMAS V. INGLESBY, Director, Center for Health Security, Johns Hopkins Bloomberg School of Public Health
DEAN T. JAMISON, Professor Emeritus, Global Health, University of California, San Francisco; University of Washington
JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis
JOSHUA MICHAUD, Associate Director, Global Health Policy, Kaiser Family Foundation
JAMI TAYLOR, Board Advisor, Stanton Park Advisors
Health and Medicine Division Staff
CECILIA MUNDACA SHAH, Director, Forum on Microbial Threats, Board on Global Health
V. AYANO OGAWA, Program Officer, Board on Global Health
T. ANH TRAN, Senior Program Assistant, Board on Global Health
ALEXANDRA PRIOR, Intern (June–July 2018), Board on Global Health
JULIE PAVLIN, Director, Board on Global Health
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
This page intentionally left blank.
FORUM ON MICROBIAL THREATS1
PETER DASZAK (Chair), President, EcoHealth Alliance
KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
MARY E. WILSON (Vice Chair), Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development
JEFFREY S. DUCHIN, Health Officer and Chief, Communicable Disease Epidemiology and Immunization Section for Public Health, Seattle and King County, Washington
EMILY ERBELDING, Deputy Director, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health
MARCOS A. ESPINAL, Director, Department of Communicable Diseases and Health Analysis, Pan American Health Organization
KEIJI FUKUDA, School Director and Clinical Professor, The University of Hong Kong School of Public Health
JENNIFER L. GARDY, Senior Scientist, BC Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada
JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases; Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University
KAREN GROSSER, Vice President, Development, Infectious Disease, and Vaccine Therapeutic Area, Johnson & Johnson
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, University of California, Berkeley
CAROLINE S. HARWOOD, Gerald and Lyn Grinstein Professor of Microbiology, University of Washington
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
RIMA F. KHABBAZ, Director, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention
MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration
JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis
SALLY A. MILLER, Professor of Plant Pathology and State Extension Specialist for Vegetable Pathology, Ohio Agricultural Research and Development Center, The Ohio State University
SUERIE MOON, Director of Research, Global Health Centre, The Graduate Institute of International and Development Studies, Geneva
DAVID NABARRO, Advisor, Health and Sustainability, 4SD–Skills, Systems, and Synergies for Sustainable Development
KUMANAN RASANATHAN, Coordinator, Health Systems, Office of the World Health Organization Representative in Cambodia, World Health Organization
GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration
PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis
JAY P. SIEGEL, Retired Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson
PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research
EDWARD H. YOU, Supervisory Special Agent, Weapons of Mass Destruction Directorate, Federal Bureau of Investigation
National Academies of Sciences, Engineering, and Medicine Staff
CECILIA MUNDACA SHAH, Director, Forum on Microbial Threats, Board on Global Health
V. AYANO OGAWA, Program Officer, Board on Global Health
T. ANH TRAN, Senior Program Assistant, Board on Global Health
ALEXANDRA PRIOR, Intern (June–July 2018)
JULIE PAVLIN, Director, Board on Global Health
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
THOMAS CUENI, International Federation of Pharmaceutical Manufacturers & Associations
HELLEN GELBAND, Independent Consultant
EDUARDO GONZALEZ-PIER, Center for Global Development
PETER A. SANDS, The Global Fund to Fight AIDS, Tuberculosis and Malaria
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
This page intentionally left blank.
Acknowledgments
The Forum on Microbial Threats staff and planning committee deeply appreciate the many valuable contributions from individuals who assisted us with this project. The workshop and this proceedings would not be possible without the presenters and discussants at the workshop, who gave so generously of their time and expertise. A full list of the speakers and moderators and their biographical information may be found in Appendix C.
This page intentionally left blank.
Contents
Organization of the Proceedings of the Workshop
2 THE ECONOMICS OF GLOBAL HEALTH AND MICROBIAL THREATS
Perspectives on Priorities for Using Economics for Global Health
Reflections from the Keynote Presentation
3 THE ECONOMIC COST OF ENDEMIC INFECTIOUS DISEASES
Economic Case for Eradicating Polio
Costs and Value of Tuberculosis Control
4 THE ECONOMICS AND MODELING OF EMERGING INFECTIOUS DISEASES AND BIOLOGICAL RISKS
Assessing Economic Vulnerability to Emerging Infectious Disease Outbreaks
Epidemic Risk Modeling: Measuring the Effect of Aversion Behavior and Cascading Social Responses
Impact and Future of Global Catastrophic Biological Risks
5 THE COST DIMENSIONS OF ANTIMICROBIAL RESISTANCE
Considerations for Estimating the Cost of Antimicrobial Resistance: Direct Versus Indirect Costs
Reconceptualizing Antimicrobial Resistance to Build the Investment Case
6 INVESTING IN NATIONAL PREPAREDNESS INITIATIVES AGAINST MICROBIAL THREATS
Epidemic Preparedness: Lessons from Liberia
Potential Challenges and Opportunities for Investing in National-Level Preparedness
Using the Performance of Veterinary Services Pathway to Bolster Preparedness
Costs and Benefits of Implementing a One Health Approach Against Microbial Threats
7 ACCELERATING RESEARCH AND DEVELOPMENT OF ANTIMICROBIAL MEDICAL PRODUCTS
Commercial Perspectives on Opportunities and Barriers to Discovery and Development of Antimicrobials
8 REIMAGINING SUSTAINABLE INVESTMENTS TO COUNTER MICROBIAL THREATS
Economics of International Collective Action to Counter Microbial Threats
9 LOOKING TO THE FUTURE: POTENTIAL NEXT STEPS FOR USING ECONOMICS TO MANAGE MICROBIAL THREATS
Modeling the Economics of Emerging Infectious Diseases
Stimulating Research and Development for Antimicrobials
Incentivizing National Governments to Invest in Preparedness
Synthesis and General Discussion
This page intentionally left blank.
4-1 Constraints in the U.S. health care system for ventilation therapy by capacity level
4-2 A simplified framework of the economic impacts of an infectious disease
4-3 Epidemiologic models accounting for adaptive human behavior
4-4 Human behavior affects peak influenza prevalence
5-1 Impact of antimicrobial resistance (AMR) on additional health expenditures
5-2 Impact of antimicrobial resistance (AMR) on world gross domestic product (GDP)
6-1 Impact of Ebola on gross domestic product (GDP) growth in Liberia, 2012–2016
6-2 The Performance of Veterinary Services (PVS) gap analysis tool in four steps
8-1 The distribution of health aid across country-specific and global functions in 2013
8-2 Multiple overlapping supply chains for medical products in Nigeria
TABLES
4-1 Epidemiology of Public Health Emergencies of International Concern, Ebola Versus Zika
5-1 Cumulative Costs of Antimicrobial Resistance (AMR) in Trillions (in 2007 U.S. dollars)
Acronyms and Abbreviations
AMR |
antimicrobial resistance |
ART |
antiretroviral therapy |
ARV |
antiretroviral |
BARDA |
Biomedical Advanced Research and Development Authority |
BRICS |
Brazil, Russia, India, China, and South Africa |
CARB-X |
Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator |
CDC |
U.S. Centers for Disease Control and Prevention |
DRG |
diagnosis related group |
EID |
emerging infectious disease |
EPR |
emergency preparedness and response |
FDA |
U.S. Food and Drug Administration |
G20 |
Group of Twenty |
GCBR |
global catastrophic biological risk |
GDP |
gross domestic product |
GPEI |
Global Polio Eradication Initiative |
IFPMA |
International Federation of Pharmaceutical Manufacturers & Associations |
IHR |
International Health Regulations |
IMI |
Innovative Medicines Initiative |
IPV |
inactivated polio vaccine |
JEE |
Joint External Evaluation |
LPAD |
Limited Population Pathway for Antibacterial and Antifungal Drugs |
MDG |
Millennium Development Goal |
OECD |
Organisation for Economic Co-operation and Development |
OIE |
World Organisation for Animal Health |
OPV |
oral poliovirus vaccine |
PEF |
Pandemic Emergency Financing Facility |
PPR |
peste des petits ruminants |
PVS |
Performance of Veterinary Services |
R&D |
research and development |
SARS |
severe acute respiratory syndrome |
SDG |
Sustainable Development Goal |
SIR |
susceptible-infected-recovered |
TB |
tuberculosis |
TME |
transferable market exclusivity |
VAPP |
vaccine-associated paralytic polio |
VDPV |
vaccine-derived poliovirus |
WHO |
World Health Organization |
WPV |
wild poliovirus |