Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases
by Radboud J. Duintjer Tebbens and Kimberly M. Thompson, Management Science 2009;55(4):650-663. PDF
Technical appendix

Answers to frequently asked questions

What are the study’s main findings?
What are the study’s main recommendations?
Background on polio

What are the study’s main findings?

• All global human disease eradication efforts to date included initial great success followed by serious financing challenges. These financing challenges contributed to delays and/or failure to achieve eradication.
• Intuitively, prioritizing diseases with high incidence seems like a sound strategy. However, eradicating a disease at some point requires substantial resource allocation towards a low-incidence disease with little perceived urgency.
• From a hypothetical dynamic model of two eradicable diseases, we find that simple decision rules that respond aggressively to shifts in perceived priorities based on disease incidence may lead to alternating epidemics of increasing magnitude, corresponding to a situation of “fire-fighting.” This situation arises because of the non-linear nature of disease transmission coupled with the delay in perceiving and responding to priority shifts.
• In contrast, decision rules that pursue eradication regardless of perceived priorities based on disease incidence lead to overall lower cumulative cases and costs, depending on the extent of discounting of future costs and benefits, the specific cost function used, and assumptions about coverage level and initial population immunity level.
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• Disease eradication requires a sustained commitment, even as the perceived relative priorities change. Stakeholders must understand that diverting resources to other diseases or efforts may not lead to optimal outcomes in the long term.
• Managers of global public health funds must understand the dangers of using simple rules or thumb to allocate resources.
• Optimal allocation of resources for vaccine-preventable diseases, or by extension any competing non-linear processes, requires a long-term dynamic perspective.
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