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Using behavioural economics insights for vector-borne diseases

Aiming for better health outcomes without addressing the behavioural roots of health problems is bound to be unsuccessful.



A recent public health issue that has made global headlines and has caught the imagination of public health practitioners the world over has been the spread of Zika– a virus that spreads through mosquitoes. While it hasn’t yet been conclusively established, there’s increasing evidence of the connection between the virus and microcephaly – a birth defect that causes brain damage in foetuses. This possible link between the virus and microcephaly has sent alarm bells ringing. The virus has infected people in more than 20 countries in Central and South America and the Caribbean and has the potential for further international spread. With the World Health Organisation (WHO) declaring the spread of Zika virus as an international public health emergency, countries around the world are announcing a slew of policy measures to tackle the outbreak and spread of the virus.

The WHO estimates that more than half the world’s population is at risk from vector-borne diseases (spread through mosquitoes) and that more than one million people die every year from such diseases. Low- and middle-income countries with high incidence of poverty, tropical weather – in which mosquitoes thrive and fragile public health systems are normally at a higher risk for spread of vector-borne illnesses. Clearly, vector control is the most important tool in preventing the outbreak and controlling the spread of such diseases. Indeed, as has been in the case of Zika, fumigation, distribution of mosquito repellant and vaccine development are the immediate measures that various countries adopt. Other solutions promulgated range from the benign travel advisories to the more controversial ones advising women to not get pregnant until the crisis has passed.

However, it is important that any policies for vector control do not just rely on traditional methods but also include insights from the recent advances in behavioural economics. This branch of economics, which has made inroads into public policies (at least in the US and the UK), counters neo-classical economics in that it does not assume (and rightly so) human beings to be fully rational agents when it comes to making decisions and choices. Various research studies in this area have shown how humans tend to consistently make sub-optimal choices. One of the insights is that of present bias, wherein the human mind disproportionately weighs present costs over future benefits and hence makes people deviate from their own desired behaviour. For instance, the cost (time and money) of getting a vaccination today outweighs the unseen future benefits and hence many people (especially the poor) delay getting the vaccinations. The researchers have also studied and proposed how policies – often termed as “nudges” can be designed that match people’s actual psychology. Typical health ailments that have been targeted through nudge approaches are obesity and smoking. However, the concept has not yet found currency to fight the diseases of the global South.

As human beings are at the centre of all policies that are aimed at improving public health, achieving improved health outcomes is nearly impossible without addressing the behavioural roots of health problems. It is therefore critical that developing countries’ large-scale public health policies to contain the spread of vector-borne diseases must utilize the insights from behavioural economics.

Nidhi Gupta is a Programme Manager at the Takshashila Institution and tweets at @nidhi1902


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Clear and present danger of Zika virus

Indian government should not bypass safety norms in clinical drug trials and testing to give expedient advantage to pharmaceutical companies and risk innocent lives

A global public health emergency has been declared by the World Health Organisation (WHO) on the outbreak of mosquito borne virus Zika.  The Indian government too has sounded the alarm on February 2. The virus gets its name from Zika forest in Uganda where it was first found in rhesus monkeys. It is transmitted by the Aedes mosquito which is also responsible for Chikungunya and dengue. The outbreak commenced in Brazil in May 2015  and nearly 1.5 million people are reported to have been affected. The virus is responsible for some serious congenital malformation.

Though a causal link has not yet been established, as of January 23, 4180 newborns had been reported in Brazil with microcephaly — where newborn babies have abnormally small heads. Cases of Guillain-Barre syndrome — a condition in which the immune system attacks the nervous system have also been reported. WHO estimates that there could be up to 4 million cases of Zika in Americas in the next year.  The fears of rapid spread of virus through Americas has forced governments to issue travel advisories. This outbreak is reminiscent of Ebola virus in West Africa which killed about 11,000 people in 2014. What makes diagnosis more difficult is that the symptoms of Zika are very similar to dengue and there is no known cure available in the market at present.

An Indian firm, Bharat Biotech announced a breakthrough in developing the first Zika vaccine on February 3. The vaccine is at an advanced stage of development. Krishna Ella, the Chairman and Managing Director of the company hopes that the Indian government will move quickly to give approval for trials because of the pandemic situation. The Aedes mosquito is widely found in India and there is every reason to be apprehensive. In addition to rigorous mosquito control measures, there is an urgency attached to introduce the drug into the market. The export potential can be very encouraging, both from building goodwill as well as profit for the company.

As a norm, drug development policies are quite stringent about testing and safety. The clinical trials takes three phases of development before being approved.  Regulatory approval is granted only after completion of pre-clinical studies which normally takes five months.  Earlier, the company had bypassed phase 2 for Ebola vaccine trials, which is its justification to speed up the process. This phase is testing of drug on patients to assess efficacy and safety. To side step this again will be setting a dangerous precedent. Just because a previous risk taking was a success is no convincing reason to bypass safety norms. The  company needs to be questioned whether it is a mere coincidence of the outbreak and development of vaccine.  As the outbreak is not yet reported in India, the ministry of health should issue instructions for necessary preventive measures. The government should ask Bharat Biotech to produce the drug after due testing process. We cannot afford to put innocent lives at risk.

Guru Aiyar is a Research Scholar at Takshashila Institution and tweets @guruaiyar

Featured Image: Antibiotics by Michael Mortensen, licensed from creativecommons.org

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