The potential impact of immunization campaign budget re-allocation on global eradication of paediatric infectious diseases

Abstract

BackgroundThe potential benefits of coordinating infectious disease eradication programs that use campaigns such as supplementary immunization activities (SIAs) should not be over-looked. One example of a coordinated approach is an adaptive "sequential strategy": first, all annual SIA budget is dedicated to the eradication of a single infectious disease; once that disease is eradicated, the annual SIA budget is re-focussed on eradicating a second disease, etc. Herd immunity suggests that a sequential strategy may eradicate several infectious diseases faster than a non-adaptive "simultaneous strategy" of dividing annual budget equally among eradication programs for those diseases. However, mathematical modeling is required to understand the potential extent of this effect.MethodsOur objective was to illustrate how budget allocation strategies can interact with the nonlinear nature of disease transmission to determine time to eradication of several infectious diseases under different budget allocation strategies. Using a mathematical transmission model, we analyzed three hypothetical vaccine-preventable infectious diseases in three different countries. A central decision-maker can distribute funding among SIA programs for these three diseases according to either a sequential strategy or a simultaneous strategy. We explored the time to eradication under these two strategies under a range of scenarios.ResultsFor a certain range of annual budgets, all three diseases can be eradicated relatively quickly under the sequential strategy, whereas eradication never occurs under the simultaneous strategy. However, moderate changes to total SIA budget, SIA frequency, order of eradication, or funding disruptions can create disproportionately large differences in the time and budget required for eradication under the sequential strategy. We find that the predicted time to eradication can be very sensitive to small differences in the rate of case importation between the countries. We also find that the time to eradication of all three diseases is not necessarily lowest when the least transmissible disease is targeted first.ConclusionsRelatively modest differences in budget allocation strategies in the near-term can result in surprisingly large long-term differences in time required to eradicate, as a result of the amplifying effects of herd immunity and the nonlinearities of disease transmission. More sophisticated versions of such models may be useful to large international donors or other organizations as a planning or portfolio optimization tool, where choices must be made regarding how much funding to dedicate to different infectious disease eradication efforts.

Strategi Realokasi Anggaran sebagai Referensi Struktur Anggaran Daerah yang Efisien

“…Pandemi menyebabkan struktur anggaran di awal tahun menjadi kurang tepat dan efisien dalam rangka menghadapi pandemi sehingga dibutuhkan realokasi dan refocusing anggaran. Hal ini sejalan dengan penelitian dari Fitzpatrick & Bauch (2011) yang menyatakan bahwa pada saat kondisi darurat seperti pandemi, strategi realokasi anggaran dapat mempercepat penanganan dan pemberantasan penyakit.…”

Evidence of the Cost-Efficiency of Scale as seen in Polio Vaccination and Surveillance Costs

“…In this paper, we examine whether programmatic costs for supplementary 31 immunization activities (SIAs) demonstrate efficiencies of scale. If so, budgeting based on unit cost 32 would drive inappropriate decision making, as shown by Claxton et al (2016) and suboptimal budget 33 allocation, as previously demonstrated by Fitzpatrick and Bauch (2011).…”