Moving the needle on infectious disease control investment

In mid-June, the National Academies of Science, Engineering, and Medicine held a workshop called “Understanding the Economics of Microbial Threats”, bringing together economic and public health subject matter experts to discuss the economics of infectious disease emergencies. Discussion topics were diverse, ranging from preparing for the next pandemic to tackling antimicrobial resistance.

An inability to control a deadly outbreak substantially affects regional and global stability. The 2014 Ebola outbreak cost resource-constrained Sierra Leone, Guinea, and Liberia almost $3 billion, and contributed to longer term reductions in GDP.  Outbreaks burden communities both through associated direct costs of preventing and treating illness, and the resulting longer term reduced labor productivity and health consequences.

Dr. Tom Inglesby, our Center’s director, was a workshop panelist and described challenges and important considerations for optimizing responses to global catastrophic biological risks (GCBRs). An ideal response to these large-scale pandemics is multifaceted, requiring substantial planning, stockpile maintenance, non-pharmaceutical interventions (e.g., closing schools), and flexibility to account for unique pathogen attack or mortality rates. Strengthening resources to address GCBRs is critical. Though scientists and governments have historically focused on other catastrophic risks like nuclear threats, the consequences of inadequately preparing for the next pandemic could be immense, as we demonstrated in the Center’s recent Clade X exercise.

Despite consensus in the health economics community that infection control is important, these messages often do not resonate with other key stakeholders. As Workshop Chair Dr. Peter Sands articulated, economic policymakers rarely fully consider the financial burden of microbial threats. A contributing factor to this, Dr. Martin Meltzer explained, is that future pandemics are inevitable but unpredictable, appearing anywhere between once every 10 to 60 years. This time range makes the necessary investment in infection control often unpalatable to policymakers who prefer shorter-term solutions with clear outputs that can be achieved within terms or election cycles. Furthermore, the way in which modeling results are sometimes communicated can sometimes backfire. Some speakers cited that “trillion-itis”, or the tendency for modelling results to express potential findings in terms of billions and trillions, can make these issues appear too challenging to address. Communicating economic findings in compelling, transparent, and easily digestible ways is critical.

One of the most discussed topics was antimicrobial resistance (AMR). A clear threat to global health security, AMR has received increasing attention from governments, industry, and academia-- but finding solutions remains daunting.  A key issue is that pharmaceutical investment in antibiotics is generally not as profitable as other drugs because antimicrobial prescriptions are usually for acute issues and are restricted to reduce future drug resistance. Executives from major pharmaceutical stakeholders including Merck, Pfizer, and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) discussed potential strategies they believe could address this issue.  While many government-led incentives are designed to “push” industry to increase investment through initial R&D benefits, speakers cited the need for “pull incentives” that enable companies to view antibiotic development as a truly profitable long-term venture. Similar suggestions were stated in a recent World Economic Forum report. Ensuring market exclusivity, fostering public-private partnerships such as CARB-X, or structuring reimbursement mechanisms so that profits aren’t based on total use were also proposed as important future directions. Conversely, some participants acknowledged that solutions to incentivize industry can be politically challenging because they often result in resource-limited governments paying for-profit companies more for their products. Ensuring transparency, trust, and empathy for the complexities of these issues were cited as important considerations to tackle AMR. 

The valuable discussions and research presented in this two-day workshop served as an instrumental stepping stone for future progress in understanding and addressing the economic issues of infectious disease.