Bugs and Bucks: Infectious Disease Persistence is a Matter of Economics

Dalla Lana School of Public Health, Department of Health Policy, Management and Evaluation, and School of Medicine, University of Toronto, Canada


We live at a moment in history unprecedented with respect to both the breadth and quantity of resources available for the prevention and control of infectious diseases. Many communicable diseases of public health importance have exclusively human reservoirs, and can be made nontransmissible using readily available tools (e.g., vaccines, antimicrobials, and improved water and sewage treatment). In other words, we live in a time when it is (theoretically) within our power to actually eliminate or eradicate several infectious diseases of public health importance, and yet these diseases persist. It is proposed that the reasons for disease persistence in such situations relate primarily to phenomena that fall easily into frameworks already well studied and understood by economists. In this paper, “economics” is defined in its broad sense, as a discipline that seeks to understand the behaviors and choices of individuals and societies as they attempt to maximize their well-being through the production and distribution of “goods.” The “good” in question is the absence of morbidity and mortality from persistent infectious diseases. The failure to incorporate economic considerations into diseasecontrol policy will result in suboptimal policy. Policy-relevant concepts include: (i) the concept of public goods (e.g., clean water, widespread vaccination) that produce environments and herd effects that benefit all members of a community and cannot be denied to anyone; (ii) the related concept of transmissibility of infection, and prevention of disease transmission, as key economic “externalities” that cannot be ignored when disease-policy decisions are made; and (iii) the fact that individuals with infectious disease, or at risk of infectious disease, are rational actors, and will behave and engage with one another in ways that can be described as economic “games.” Dissemination of knowledge related to these concepts, and tools and data that permit their incorporation into disease-control policy, represent a valuable opportunity to reduce the burden of persistent infectious diseases at local, national, and global levels.