As countries begin stockpiling swine flu vaccines to deal with an anticipated "second wave" outbreak, research from the European School of Management & Technology (ESMT) in Berlin and Duke University in North Carolina warns that countries should be prepared to sacrifice their vaccines to more vulnerable countries in the face of a critical outbreak.
The research suggests that this may prove the best method of minimizing the total number of people infected globally and containing the spread of the disease across geographies.
The study uses a sophisticated mathematical model that represents the dynamics of an epidemic taking hold, factoring in the character of initial infections, the spread of the disease and drug efficacy. Using economic 'game theory', the research models how countries with drug supplies should respond to an epidemic in a neighboring country with little or no supplies of their own, when the objective is to protect their respective populations.
While accepting the political cost of sacrificing supplies to other nations, the research concludes that at the very least some countries will have to face up to the reality of giving up all their drug stockpiles to contain the pandemic globally. The ideal solution would be centralized decision-making and deployment of drugs, by an agency such as the World Health Organization (WHO). In this area, the study highlights the fundamental tension that world governments will face in effectively combating a global outbreak: the current lack of centralized control.
The research concludes that having a centralized planner take ownership and allocate drugs to the country first affected by outbreak would result in the best global containment of infection, and typically benefit all countries including those giving up drugs. Yet as richer nations begin to stockpile vaccines to deal with a national outbreak, the reality is that individual nations will be faced with the decentralized decision about whether or not to give away their supplies.
To be effective all countries will need to be prepared to give up their supplies, as only one or two nations' sacrifice would be futile. Moreover, the likelihood is that decentralized decision-making will leave countries locked in a 'prisoner's dilemma' - watching one another's actions, where no-one is prepared to make the first move. The research's modeling shows that only in half of these cases would individual countries reach the same decision as a central planner, resulting in around double the number of global infections than if centralized co-ordination were possible.
Francis de Véricourt, Professor at the European School of Management & Technology, explains: "Drug allocation will not be as effective when the decision-makers are individual governments, which in turn will dramatically increase the chance of infection from abroad. What is needed is for nations to come together and agree a shared drug allocation strategy. In reality, this is in their 'selfish' best interest as it will result in the best chance of arresting the spread of the disease including, potentially, to their own shores. Nonetheless, the political risk of sacrificing vaccines is clearly enormous. The inefficiency of decentralized action is not necessarily about free-riding off the generosity of another state - it is the very real and difficult decision facing political leaders about how best to act."
Recent events have shown that some progress is being made towards more centralized thinking, with nine countries (including the US and UK) pledging to give up 10 per cent of their supplies to help fight the spread of infection internationally. At present, the majority of drugs have been purchased by richer nations considered at less risk, with most vaccines being produced in Western Europe, North America and Japan. However, the UN has called for much greater donation, claiming that £900m needs to be raised to help poorer nations fight the onset of a global epidemic that could kill millions. According to flucount.org, the number of reported H1N1 infections now stands at 473,774 across the globe. At the start of this week, the site reported that 352 people had died from H1N1 deaths in the previous seven days - an increase of 9.3% on the previous week.Francis de Véricourt concludes:
Martha Ihlbrock | idw
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