Managing the Endogenous Risk of Disease Outbreaks with Non-Constant Background Risk

Challenges of integrating economics into epidemiological analysis of and policy responses to emerging infectious diseases

COVID-19 has shown that the consequences of a pandemic are wider-reaching than cases and deaths. Morbidity and mortality are important direct costs, but infectious diseases generate other direct and indirect benefits and costs as the economy responds to these shocks: some people lose, others gain and people modify their behaviours in ways that redistribute these benefits and costs. These additional effects feedback on health outcomes to create a complicated interdependent system of health and non-health outcomes. As a result, interventions primarily intended to reduce the burden of disease can have wider societal and economic effects and more complicated and unintended, but possibly not anticipable, system-level influences on the epidemiological dynamics themselves. Capturing these effects requires a systems approach that encompasses more direct health outcomes. Towards this end, in this article we discuss the importance of integrating epidemiology and economic models, setting out the key challenges which such a merging of epidemiology and economics presents. We conclude that understanding people's behaviour in the context of interventions is key to developing a more complete and integrated economic-epidemiological approach; and a wider perspective on the benefits and costs of interventions (and who these fall upon) will help society better understand how to respond to future pandemics.

Investing to Both Prevent and Prepare for COVID-XX

One cause of the high rate of COVID-19 cases in the USA is thought to be insufficient prior capital investment in national health programs to preemptively reduce the likelihood of an outbreak and in national capacity to reduce the severity of any outbreak that does occur. We analyze the choice of capital investments (e.g. testing capacity, stockpiles of PPE, and information sharing capacity) and find the economically efficient capital stock associated with mitigating pandemic risk should be dramatically expanded. Policymakers who fail to invest in public health forgo significant expected cost savings from being prepared.

Economic Incentives for Managing Filterable Biological Pollution Risks from Trade

Infectious livestock disease problems are "biological pollution" problems. Prior work on biological pollution problems generally examines the efficient allocation of prevention and control efforts, but does not identify the specific externalities underpinning the design of efficiency-enhancing policy instruments. Prior analyses also focus on problems where those being damaged do not contribute to externalities. We examine a problem where the initial biological introduction harms the importer and then others are harmed by spread from this importer. Here, the externality is the spread of infection beyond the initial importer. This externality is influenced by the importer's private risk management choices, which provide impure public goods that reduce disease spillovers to others-making disease spread a "filterable externality." We derive efficient policy incentives to internalize filterable disease externalities given uncertainties about introduction and spread. We find efficiency requires incentivizing an importer's trade choices along with self-protection and abatement efforts, in contrast to prior work that targets trade alone. Perhaps surprisingly, we find these incentives increase with importers' private risk management incentives and with their ability to directly protect others. In cases where importers can spread infection to each other, we find filterable externalities may lead to multiple Nash equilibria.

The Economic Case for a Pandemic Fund

The rapid urban spread of Ebola virus in West Africa in 2014 and consequent breakdown of control measures led to a significant economic impact as well as the burden on public health and wellbeing. The US government appropriated $5.4 Billion for FY2015 and WHO proposed a $100 Million emergency fund largely to curtail the threat of future outbreaks. Using epidemiological analyses and economic modeling, we propose that the best use of these and similar funds would be to serve as global insurance against the continued threat of emerging infectious diseases. An effective strategy would involve the initial investment in strengthening mobile and adaptable capacity to deal with the threat and reality of disease emergence, coupled with repeated investment to maintain what is effectively a 'national guard' for pandemic prevention and response. This investment would create a capital stock that could also provide access to safe treatment during and between crises in developing countries, lowering risk to developed countries.

Managing Wildlife Faced with Pathogen Risks Involving Multi-Stable Outcomes

Most models designed to understand how to manage infected wildlife systems with bioeconomic multi-stability take the initial conditions as given, thereby treating pathogen invasion as unanticipated. We examine how ex ante management is an opportunity to influence the ex post conditions, which in turn affect the ex post optimal outcome. To capture these ex ante management choices, we extend the Poisson "collapse" model of Reed and Heras (Bull Math Biol 54:185-207, 1992) to allow for endogenous initial conditions and ex post multi-stability. We account for two uncertain processes: the introduction and establishment of the pathogen. Introduction is conditional on anthropogenic investments in prevention, and both random processes are conditional on how we manage the native population to provide natural prevention of invasion and natural insurance against establishment placing the system in an undesirable basin of attraction. We find that both multi-stability of the invaded system and these uncertainty processes can create economic non-convexities that yield multiple candidate solutions to the ex ante optimization problem. Additionally, we illustrate how the nature of natural protection against introduction and establishment risks can play an important role in the allocation of anthropogenic investments.