Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T04:49:18.809Z Has data issue: false hasContentIssue false
  • English
  • Français

Interdependent Factors of Demand-Side Rationale for Chemical, Biological, Radiological, and Nuclear Medical Countermeasures

Published online by Cambridge University Press:  18 November 2019

Mark Lawrence Johnson Open the ORCID record for Mark Lawrence Johnson [Opens in a new window] ,
Jean Belin ,
Frederic Dorandeu  and
Marianne Guille
Mark Lawrence Johnson*
Affiliation:
MJ Lawrence Consulting, Munich, Germany Université Panthéon-Assas, LEMMA & Labex MME-DII, Paris, France
Jean Belin
Affiliation:
University of Bordeaux(Gretha ‐ UMR CNRS 5113), Pessac cedex, France Armament and defence economy chair (cercle des partenaires de l’IHEDN), Paris, France
Frederic Dorandeu
Affiliation:
Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France Ecole du Val-de-Grace, Paris, France
Marianne Guille
Affiliation:
Université Panthéon-Assas, LEMMA & Labex MME-DII, Paris, France
*
Correspondence and reprint requests to Mark Lawrence Johnson, MJ Lawrence Consulting, Riedener Str. 8, 81475 Munich, Germany (email: johnson@mjlconsulting.eu)
Get access Rights & Permissions [Opens in a new window]

Abstract

The deliberate use of chemical, biological, radiological, and nuclear (CBRN) materials in war or terrorist attacks is perceived as a great threat globally. In the event of a release of CBRN agents, protection by means of medical countermeasures (MedCMs) could reduce health vulnerability. Nonetheless, for some diseases caused by these agents, innovative MedCMs do not exist and many of those that do might not be readily available. Inappropriate research and development funding and government procurement efforts can result in adverse economic consequences (eg, lost income, cost per loss of life, medical expenses) far exceeding the costs of strong and comprehensive preparedness initiatives. By illustrating factors of demand-side rationale for CBRN MedCMs, this article aims to strengthen integrity of policy-making associated with current demand requirements. Namely, an approach to inspire broader assessment is outlined by compiling and adapting existing economic models and concepts to characterize both soft and hard factors that influence demand-side rationale. First, the soft factor context is set by describing the impact of behavioral and political economics. Then, lessons learned from past public health funding models and associated collaborative access infrastructure are depicted to represent hard factors that can enhance the viability of MedCM preparedness evaluations.

Keywords

chemicalbiologicalradiologicaland nuclear agentsmedical countermeasurespublic health policyfundingmarket demand
Type
Systematic Review
Information
Disaster Medicine and Public Health Preparedness , Volume 14 , Issue 6 , December 2020 , pp. 739 - 755
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Sabol, J, Šesták, B, Polívka, L, et al. Current activities of the European Union in fighting CBRN terrorism worldwide. In: Apikyan, S, Diamond, D, eds. Nuclear Threats and Security Challenges. Dordrecht: Springer Netherlands; 2015:157‐167. https://doi.org/10.1007/978-94-017-9894-5_15 CrossRefGoogle Scholar
Global Health Security Initiative. 16th Ministerial Meeting. Washington, DC: GHSI; 2016.Google Scholar
Pellérdi, R, Berek, T. Redefining the CBRN risk assessment. AARMS. 2009;8:159‐172.Google Scholar
Unal, B, Aghlani, S. Use of Chemical, Biological, Radiological and Nuclear Weapons by Non-State Actors: Emerging trends and risk factors. London, UK: Chatham House; 2016.Google Scholar
Gronvall, G. Biodefense countermeasures: the impact of Title IV of the US pandemic and all-hazards preparedness act. Emerg Health Threats J. 2008;1:1‐5. https://doi.org/10.3134/ehtj.08.003 Google ScholarPubMed
Vičar, R, Vičar, D. CBRN terrorism: a contribution to the analysis of risks. JoDRM. 2011;(2):21‐28.Google Scholar
United Nations Security Council. Fifth report of the Organization for the Prohibition of Chemical Weapons-United Nations Joint Investigative Mechanism. New York, NY: United Nations Security Council; 2017.Google Scholar
Haeussler, M, Concordet, JP. Genome editing with CRISPR-Cas9: can it get any better? J Genet Genom. 2016;43:239‐250. https://doi.org/10.1016/j.jgg.2016.04.008 CrossRefGoogle ScholarPubMed
Ramseger, A, Kalinowski, MB, Wei, L. CBRN Threats and the Economic Analysis of Terrorism. Economics of Security Working Paper Series. Berlin: German Institute for Economic Research; 2009.Google Scholar
Robinson, RA. BARDA Today & Tomorrow: Goals, Priorities, Successes & Challenges. Washington, DC: U.S. Department of Health & Human Services; 2015.Google Scholar
Chapman, RE, Leng, CJ. Cost-Effective Responses to Terrorist Risks in Constructed Facilities Cost-Effective Responses to Terrorist Risks in Constructed Facilities. Gaithersburg, MD: U.S. Department of Commerce Technology Administration National Institute of Standards and Technology; 2004.CrossRefGoogle Scholar
Stewart, MG. Risk-informed decision support for assessing the costs and benefits of counter-terrorism protective measures for infrastructure. Int J Crit Infrastruct Protect. 2010;3:29‐40. https://doi.org/10.1016/j.ijcip.2009.09.001 CrossRefGoogle Scholar
Klein, A. The Costs of Terror: The Economic Consequences of Global Terrorism. Berlin, Germany: Konrad-Adenauer-Stiftung; 2007.Google Scholar
Prager, F, Wei, D, Rose, A. Total economic consequences of an influenza outbreak in the United States. Risk Anal. 2017;37:4‐19. https://doi.org/10.1111/risa.12625 CrossRefGoogle ScholarPubMed
Rose, AZ, Oladosu, G, Lee, B, et al. The economic impacts of the 2001 terrorist attacks on the World Trade Center: a computable general equilibrium analysis. Peace Econom Peace Sci Public Policy. 2009;15(2):1‐31.Google Scholar
Rose, A, Liao, SY. Modeling regional economic resilience to disasters: a computable general equilibrium analysis of water service disruptions. J Reg Sci. 2005;45:75‐112. https://doi.org/10.1111/j.0022-4146.2005.00365.x CrossRefGoogle Scholar
Dixon, PB, Lee, B, Muehlenbeck, T, et al. Effects on the US of an H1N1 Epidemic: Analysis with a Quarterly CGE Model. Clayton, Australien: Monash University; 2010.Google Scholar
Giesecke, JA, Burns, WJ, Barrett, A, et al. Assessment of the regional economic impacts of catastrophic events: CGE analysis of resource loss and behavioral effects of an RDD attack scenario. Risk Anal. 2012;32:583‐600. https://doi.org/10.1111/j.1539-6924.2010.01567.x CrossRefGoogle ScholarPubMed
Johnson, ML, Belin, J, Dorandeu, F, et al. Strengthening cost-effectiveness of medical countermeasure development against rare biological threats ‐ the Ebola outbreak. Pharm Med. 2017;31:423‐436. https://doi.org/10.1007/s40290-017-0211-9 CrossRefGoogle Scholar
Baumstark, L, Dervaux, B, Treich, N. Éléments pour une révision de la valeur de la vie humaine. Rapports et Documents, Commissariat Général à la Stratégie et à la Prospective (for the Rapport Quinet), April (2013).Google Scholar
Garrigues, B. Etude CRRéa: Evaluation médico-économique du Coût Réel d’une journée en RÉAnimation. Paris, France: IMS Health; 2010.Google Scholar
Kahneman, D, Tversky, A. Prospect theory: an analysis of decision under risk. Econometrica. 1979;47:263. https://doi.org/10.2307/1914185 CrossRefGoogle Scholar
Thaler, RH, Sunstein, CR. Nudge. Improving Decisions about Health; Wealth and Happiness. London, UK: Penguin Books; 2008.Google Scholar
Oullier, O, Cialdini, R, Thaler, RH, et al. Improving Public Health Prevention with a Nudge. Paris, France: Centre for Strategic Analysis; 2010:38‐46.Google Scholar
Catford, J. Creating political will: moving from the science to the art of health promotion. Health Promot Int. 2006;21:1‐4. https://doi.org/10.1093/heapro/dak004 CrossRefGoogle ScholarPubMed
International Atomic Energy Agency. Implementing Guide: Risk Informed Approach for Nuclear Security Measures for Nuclear and Other Radioactive Material out of Regulatory Control. Vienna, Austria: IAEA; 2015.Google Scholar
Li, S-CS. Fear appeals and college students’ attitudes and behavioral intentions toward global warming. J Environ Educ. 2014;45:243‐257. https://doi.org/10.1080/00958964.2014.930399.CrossRefGoogle Scholar
Smith, CB, Battin, MP, Jacobson, JA, et al. Are there characteristics of infectious diseases that raise special ethical issues? Dev World Bioeth. 2004;4:1‐16. https://doi.org/10.1111/j.1471-8731.2004.00064.x CrossRefGoogle ScholarPubMed
Richards, EP, O’Brien, T, Rathbun, KC. Bioterrorism and the use of fear in public health. Urban Lawyer. 2002;34:685‐726.Google Scholar
Posner, EA. Fear and the regulatory model of counterterrorism. Harvard Journal of Law and Public Policy. 2002;25:681‐697.Google Scholar
Risse, G. B., Driven by Fear: Epidemics and Isolation in San Francisco’s House of Pestilence. Champaign, IL: University of Illinois Press; 2016.Google Scholar
Witte, K. Putting the fear back into fear appeals: the extended parallel process model. Commun Monogr. 1992;59:329‐349. https://doi.org/10.1080/03637759209376276 CrossRefGoogle Scholar
Witte, K. Fear as motivator, fear as inhibitor: using the extended parallel process model to explain fear appeal successes and failures. In: Andersen, PA, Guerrero, LK, eds. Handbook of Communication and Emotion. San Diego: Academic Press; 1996:423‐450. https://doi.org/http://dx.doi.org/10.1016/B978-012057770-5/50018-7.Google Scholar
Araña, JE, León, CJ. Do emotions matter? Coherent preferences under anchoring and emotional effects. Ecol Econom. 2008;66:700‐711. https://doi.org/10.1016/j.ecolecon.2007.11.005 CrossRefGoogle Scholar
Zalmanovitch, Y, Cohen, N. The pursuit of political will: politicians’ motivation and health promotion. Int J Health Plann Manage. 2015;30:31‐44. https://doi.org/10.1002/hpm.2203 CrossRefGoogle ScholarPubMed
Valatin, G, Moseley, D, Dandy, N. Insights from behavioural economics for forest economics and environmental policy: potential nudges to encourage woodland creation for climate change mitigation and adaptation? For Policy Econ. 2016;72:27‐36. https://doi.org/10.1016/j.forpol.2016.06.012 CrossRefGoogle Scholar
Matjasko, JL, Cawley, JH, Baker-Goering, MM, et al. Applying behavioral economics to public health policy: illustrative examples and promising directions. Am J Prev Med. 2016;50:S13‐S19. https://doi.org/10.1016/j.amepre.2016.02.007 CrossRefGoogle ScholarPubMed
Michie, S, West, R. Behaviour change theory and evidence: a presentation to Government. Health Psychol Rev. 2013;7:1‐22. https://doi.org/10.1080/17437199.2011.649445 CrossRefGoogle Scholar
Charatan, F. The demon in the freezer. BMJ. 2002;325:1367‐1369.CrossRefGoogle Scholar
Jacobsen, A. The Pentagon’s Brain: An Uncensored History of DARPA, America’s Top-Secret Military Research Agency. New York, NY: Little, Brown and Company; 2015.Google Scholar
De Paolo, C. Pandemic Influenza in Fiction: A Critical Study. Jefferson, NC: McFarland & Company; 2014.Google Scholar
Hutton, G, Baltussen, R. Valuation of Goods in Cost-Effectiveness Analysis: Notions of Opportunity Costs and Transferability. GPE Discussion Paper. 2002. https://www.who.int/choice/publications/d_2002_valuation.pdf?ua=1. Accessed May 3, 2018.Google Scholar
United Nations University, WorldRiskReport 2016 (Bonn, Germany, 2016).Google Scholar
Samuelson, PA. The pure theory of public expenditure. Rev Econ Stat. 1954;36:387‐389. https://doi.org/10.2307/1925895 CrossRefGoogle Scholar
Bentham, J. An Introduction to the Principles of Morals and Legislation. Kitchener, Canada: Batoche Books; 2000.Google Scholar
Salazar, DG. Rationalisation of the expenditure and the right to immigrants and the fairness of public health reform. J Appl Ethics. 2013;123‐142.Google Scholar
Smith, DN, Beaglehole, R, Woodward, R, eds. Global Public Goods for Health: Health Economics and Public Health Perspectives. Oxford, UK: Oxford University Press; 2003.Google Scholar
Kaul, I, Grunberg, I, Stern, M. Global Public Goods: International Cooperation in the 21st Century (1999). https://doi.org/10.1186/1744-8603-3-9 CrossRefGoogle Scholar
Pavia, AT. Germs on a plane: aircraft, international travel, and the global spread of disease. J Infect Dis. 2007;195:621‐622. https://doi.org/10.1086/511439 CrossRefGoogle ScholarPubMed
Gartner, D. Innovative financing and sustainable development: lessons from global health. Pacific Rim Law Policy J. 2015;24:495‐515.Google Scholar
The Global Fund. Market Shaping Strategy. Geneva, Switzerland: The Global Fund; 2015.Google Scholar
World Health Organization. About UNITAID. WHO, (2017). https://unitaid.eu/how-we-work/donors/#en. Accessed October 31, 2017.Google Scholar
International Finance Facility for Immunization. GAVI Recognised as International Institution. London: International Finance Facility for Immunization; 2009. http://www.iffim.org/library/news/press-releases/2009/gavi-recognised-as-international-institution/. Accessed December 2, 2017.Google Scholar
International Finance Facility for Immunization. Overview of IFFIm. IFFIm, (2017). http://www.iffim.org/about/overview/. Accessed October 31, 2017.Google Scholar
Kremer, M Williams, H. Incentivizing innovation: adding to the tool kit. Innov Policy Econ. 2010;10:1‐17. https://doi.org/10.1086/605851 CrossRefGoogle Scholar
Gavi. Advance Market Committment for Pneumococcal Vaccines: Annual Report 2016. Geneva, Switzerland: Gavi; 2016.Google Scholar
ITAD Limited, UNITAID 5 Year Evaluation. (2012).Google Scholar
Mossialos, E, Morel, C, Edwards, S, et al. Policies and Incentives for Promoting Innovation in Antibiotic Research. London, UK: The European Observatory on Health Systems and Policies; 2010.Google Scholar
Sciarretta, K, Røttingen, J-A, Opalska, A, et al. Economic incentives for antibacterial drug development: literature review and considerations from the Transatlantic Task Force on Antimicrobial Resistance. Clin Infect Dis. 2016;63:1470‐1474. https://doi.org/10.1093/cid/ciw593 CrossRefGoogle ScholarPubMed
PCAST. Report To the President on Combating Antibiotic Resistance. Washington, DC: PCAST; 2014.Google Scholar
World Bank Group. Pandemic Emergency Financing Facility ‐ Global Response through a Financial Intermediary Fund. Washington, DC: World Bank Group; 2016.Google Scholar
World Bank Group. Pandemic Emergency Facility: Frequently Asked Questions. Washington, DC: The World Bank; 2016.Google Scholar
U.S. Centers for Disease Control and Prevention. Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response. Washington, DC: U.S. Department of Health and Human Services; 2000.Google Scholar
World Bank Group. From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level. Washington, DC: World Bank Group; 2017.Google Scholar
Lurie, N. ASPR in 2016: Poised to Reach the Next Horizon. Washington DC: United States Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response; 2016.Google Scholar
Outterson, K, McDonnell, A. Funding antibiotic innovation with vouchers: recommendations on how to strengthen a flawed incentive policy. Health Aff. 2016;35:784‐790. https://doi.org/10.1377/hlthaff.2015.1139 CrossRefGoogle ScholarPubMed
Sharma, P, Towse, A. New Drugs to Tackle Antimicrobial Resistance: Analysis of EU Policy Options. London, UK: The Office of Health Economics; 2011.Google Scholar
Renwick, MJ, Brogan, DM, Mossialos E A systematic review and critical assessment of incentive strategies for discovery and development of novel antibiotics. J Antibiot (Tokyo). 2016;69:73‐88. https://doi.org/10.1038/ja.2015.98 CrossRefGoogle Scholar
University of Pittsburgh Medical Center. FDA Priority Review Vouchers for Biosecurity Threats. Pittsburgh, PA: University of Pittsburgh Medical Center; 2007.Google Scholar
Ridley, DB. Priorities for the priority review voucher. Am J Trop Med Hyg. 2017;96:14‐15. https://doi.org/10.4269/ajtmh.16-0600 CrossRefGoogle ScholarPubMed
EvaluatePharma. World Preview 2016, Outlook to 2022. London, UK: EvaluatePharma; 2016.Google Scholar
Disbrow, GL. Chemical/Biological/Radiological/Nuclear. Washington, DC: U.S. Department of Health & Human Services; 2016.Google Scholar
Hatchett, RJ. Sustainable Preparedness for Established Threats: Challenges & Strategy Washington, DC: U.S. Department of Health & Human Services; 2016.Google Scholar
Merkeley, T. Sustainable Preparedness for Current Threats: Sustainability. Washington, DC: U.S. Department of Health & Human Services; 2016.Google Scholar
Laney, J. Improved Medical Countermeasures against Chemical Threats. Washington, DC: U.S. Department of Health & Human Services; 2016.Google Scholar
Zervos, V, Siegel, DS. Technology, security, and policy implications of future transatlantic partnerships in space: lessons from Galileo. Res Policy. 2008;37:1630‐1642. https://doi.org/10.1016/j.respol.2008.06.008 CrossRefGoogle Scholar
Marinissen, MJ, Barna, L, Meyers, M, et al. Strengthening Global Health Security by Developing Capacities to Deploy Medical Countermeasures Internationally. Biosecur Bioterror. 2014;12:284‐291. https://doi.org/10.1089/bsp.2014.0049 CrossRefGoogle ScholarPubMed
Elbe, S, Roemer-Mahler, A, Long, C. Medical countermeasures for national security: a new government role in the pharmaceuticalization of society. Soc Sci Med. 2015;131:263‐271. https://doi.org/10.1016/j.socscimed.2014.04.035 CrossRefGoogle Scholar
World Health Organization. Guideline on the International Packaging and Shipping of Vaccines. Geneva, Switzerland: WHO; 2005. https://doi.org/WHO/V&B/01.05 Google Scholar
Johnson, ML. International Availability of Medical Countermeasures Against Chemical, Biological, Radiological, and Nuclear Agents. Paris: Université Paris II-Panthéon-Assas; 2018.Google Scholar