1. Strategic Analysis of Infectious Disease Eradication
How the World Health Organization Can Become an Effective Facilitator of International Public Health Cooperation
Simin Gharib Lee | April 28, 2009 | Economics 970 | Rajiv Shankar

2. Thesis and Roadmap
The WHO must partner with the private sector in order to successfully eradicate infectious diseases.
Game 1: Eradication as a Public Good
Game 2: Smallpox Eradication
Game 3: Polio Eradication

3. Biological Background
A disease can be eradicated if it …
Is a severe disease
Has no subclinical cases
Has a relatively low level of contagiousness
Has an effective and stable vaccine
Demonstrates seasonality
Has no animal reservoir

4. Game 1: Eradication as a Public Good
NE is mutual defection
Eradication is a weakest link public good
So, this is not the best representation.
But, conclude: need institutions to shift world to efficient outcome.

5. Game 2: Smallpox Eradication
1948: WHO created
1949: USSR leaves WHO
1955: US pushes malaria eradication campaign
1956: USSR returns
1959: USSR pushes smallpox eradication campaign (malaria campaign is failing)
1965: US supports campaign
1966: only 8 countries have donated for ~$27,000
1980: Smallpox eradication is certified

6. Game 2: Smallpox Eradication
Players: WHO and DONOR
Payoffs: functions of cost C, reputation R, and lives saved L
YDONOR = -2C2 + R + L (1)
YWHO = 3(R + L) (2)

7. Game 2: Smallpox Eradication
Backwards induction shows SPNE at (2, -3).

8. Game 2: Smallpox Eradication
SPNE is for DONOR to back away from supporting WHO-led smallpox eradication.
Consistent with events from
Things to consider:
Fairness (Sigmund, Fehr, and Nowak)
Biological properties of smallpox

9. Game 3: Polio Eradication
Transformation from international and intergovernmental to global health.
1988: WHO votes to eradicate polio by 2000
1999: Bill and Melinda Gates Foundation established
Today
Gates: $29.7b of assets
WHO: $6b annual budget
4 countries left with polio: India, Nigeria, Pakistan, and Afghanistan

10. Game 3: Polio Eradication
Players: GATES, WHO, and LAST
Payoffs: functions of reputation R, lives saved L, efficiency E, and domestic political instability P.
YWHO = 3(R + L) (2)
YGATES = 3L2 + E (3)
YLAST = -3P2 + 2L + R (4)

11. Game 3: Polio Eradication
Backwards induction shows SPNE at (14, 12, 1).

12. Game 3: Polio Eradication
SPNE is for last polio-endemic countries to pursue/renew eradication efforts and for WHO and the Gates Foundation to cooperate to provide these countries with enough resources.
Compare with reality:
$500m from Rotary International
$630m from Gates (1/2009)
But, polio may not be eradicable due to biological features (symptom expression, contagiousness, vaccine)
Nonetheless, conclude that getting the eradication this far and successful eradication both require public-private partnership.

13. Limitations Payoffs Argument only holds for ID that can be eradicated
Issues with private-public partnership:
WHO could become entangled in private interests of private partners
Dampen incentive to contribute for others?
Dampen research activity in certain areas?

14. Summary
Infectious disease eradication is a global public good that requires the intervention of an institution
Smallpox eradication shows that financial burden is the most serious concern to donor countries
Polio eradication shows that private foundations can fill the funding gap between WHO and donor countries to move eradication campaign forward.
By partnering with the private sector, WHO can successfully eradicate disease.