Epidemics and Public Goods

In a recent article about Ebola in the Wall Street Journal, Peter Piot, the Director of the London School of Tropical Medicine & Hygiene, referred to epidemics like Ebola as what economists refer to as a public good.  For most readers of the Wall Street Journal, I’d imagine that the economic definition of public good might be familiar.  It might not be for most of those interested in public health but without economics and business training. 

Public goods have two key characteristics: being non-excludable and non-rival.  Non-excludable means that it is impossible to keep someone from experiencing it.  Non-rival means that one person’s experiencing it doesn’t limit another person’s experience.  National defense has characteristics of a public good—everyone in a country experiences it and my enjoyment of the United States’ national defense does not limit anyone else’s experience.

So, an epidemic does have these characteristics—everyone gets to experience the risk and no one is excluded from the exposure to the risk.

While the epidemic has characteristics of a public good, some solutions do not have elements of public goods but instead have externalities.  For example, for a vaccine, if I get the dose no one else can have it.  But, when I get the dose, my protection also provides some amount of protection for those around me.

The funding of public goods comes at the public expense and there must be a way to determine how much of the public good the public desires.  Externalities imply that individuals will either overconsume (in the case of negative externalities) or underconsume (in the case of positive externalities like a vaccine) the good without some type of incentive or enforcement.   

Within national borders or provincial borders within a country, it is possible to have laws that encourage or require specific behaviors, to provide monetary incentives,  or to coordinate activity through a Department of Ministry of Health.  Economists would ask about the costs and benefits of such rules or coordinating efforts.  When the epidemic is within borders the power to regulate, incentivize, and enforce is clear. 

When the epidemic is actually an international pandemic the situation is more challenging.  There is no authority that has the same type of legislative role or public health coordinating role internationally as a government within a province or nation.  As a result, efforts at coordination are, of necessity, more voluntary. 

Given the risks of the emergence of new infectious diseases and the resurgence of old ones, this is a time to consider how best to develop international cooperation for to deal with future international epidemics.  Someone may find a way to provide incentives across countries that are enforceable and that lead to better coordination and appropriate amounts of action.  If not, this is an opportunity for those who want to conduct business (and run countries) with humanity in mind to think carefully about how to encourage stakeholders to act not just with local or national humanity in mind, but with all of humanity in mind. 

Mixed Messages About Public Health Surveillance

An opinion piece in the Wall Street Journal today left me wondering after I read it.  The piece focuses on how concerned we should be about Ebola.  The writer's opinion is that we should not worry too much.  While this outbreak has been bigger than any in the past and killed more than any in the past, the spread can be contained.  And while someone may emerge as being ill after reaching a more developed part of the world, it would be noticed, contained, and not spread widely.  

The writer mentions his own experience with respect to SARS (he was suspected of having it but did not, fortunately) and concludes the piece talking about international commitments to prevent the spread of disease throughout the world and the reason that the US should invest in science and public health surveillance at home and abroad.  

Many readers might be puzzled by that conclusion.

For control abroad (paritcularly for something like Ebola which is only spread through contact with bodily fluids) the steps to control can be fairly straightforward.   As the writer points out, cultural traditions of family caring for sick individuals at home and touching dead bodies in preparation for burial make avoiding all bodily fluids difficult.  (I do find it interesting that most accounts I have seen don't mention sweat as a bodily fluid by which the disease can be transmitted but it is clearly listed on a WHO website. That may be more of a cause for alarm in countries in which individuals are on public transportation in very close quarters.  Or perhaps for those of us who sweat like crazy at the gymnasium.)  However, the steps toward control are well known and may have as much to do with culture and the availability of personnel than anything else.

Would science help?  For preventing transmission and a cure, of course.  Would surveillance help?  For making sure that a minimal number of people are exposed, of course.  Would education and personnel help?  From what I have read, perhaps this would help more than anything else.  And while education often takes a long time, none of these will help very quickly.

For control at home in the US, it seems like we generally have things under control.  At least the writer does not suggest that there is a need to worry given current circumstances.  So, while a failure to act at all would be a disaster, our current infrastructure supports quite a bit of activity already.  Do we need that much beyond what we are already doing?  How much extra would it cost to go beyond what we are doing?  And if we are not likely to end up with a whole lot of morbidity or mortality with current activities in place, how much more would be prevented?  

I am in favor of wise icreases in investments in multiple aspects of public health and science.  But for an opinion piece to make the argument that there is not much to worry about while saying that investment is the right thing to do--unquestionably--is confusing.  Readers will wonder--appropriately, in my opinion--about how much investment will be needed to make a difference and how much of a difference will be made.  Clearly, in a world of limited resources, we cannot make every possibly investment in every mechanism to control all threats to public health.  This is one that appears to need more justification in light of what is already being done.  Using a potentially questionable line of logic to call for greater investment may not help when there is a clear need to make more sustainbed and larger investments later on.  

I, of course, am not saying that I have zero sympathy for the 1400+ infected so far.  I am saying that we have to live with some public health risks and this may just be one to live with or to leave to the market to solve.