Incentives for Reporting Disease Outbreaks

Abstract

BackgroundCountries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines.MethodsWe compiled data on reports of meningococcal meningitis to the World Health Organization (WHO) from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO.FindingsWe find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased.InterpretationThese results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.

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“…Societies also need significant resources and dedicated funding to deal with emerging and re-emerging infectious diseases focusing on its future recurring possibilities, prevention and management [ 157 ]. There should be incentives given to people for early reporting [ 158 ] followed by developing strategies to prevent antimicrobial resistance [ 159 , 160 ].…”

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“…In the context of pandemics (e.g., the COVID-19 outbreak) or of cross-country dispersion of endemic diseases (e.g., malaria or HIV), coordinated responses are essential for containment and eradication (Laxminarayan, 2016). This applies in particular to the timely reporting of local outbreaks; Laxminarayan et al (2014) show empirically that reporting incentives depend on the circumstances: for example, the availability of common pools of treatments or vaccines would encourage reporting for the purpose of having early access, whereas their lack may discourage reporting for fear of trade sanctions (cf. Malani and Laxminarayan, 2011;Saak and Hennessy, 2018 for models of epidemiological reporting games).…”

Health issues in the Hajj pilgrimage: a literature review

“…Reporting outbreaks of infectious disease allows Saudi Arabia to take the necessary measures to prevent spread of such disease among pilgrims during the Hajj. Laxminarayan et al (53) have shown that incentives, if not restricted to financial assistance, can modify reporting decisions, particularly when the burden of disease is low. New policies have been implemented in response to emerging infectious diseases, such as administering polio vaccine to pilgrims on arrival in Saudi Arabia, reducing Hajj quotas for foreign and domestic pilgrims in 2013, and strengthening the surveillance system for infectious diseases with involvement of international agencies (3).…”