A Common Good: Whither the Global Eradication of the Measles Virus?

Abstract

Measles, a disease caused by the highly infectious Rubeola virus, is responsible for 10% of global mortality for children under 5 years old. Measles infection can be prevented by an easy to administer and cheap vaccine given to young children. Following a successful international campaign to eradicate the smallpox virus, the WHO has proposed that eradication programmes be undertaken for a number of other diseases, including measles. Eradicating a disease has a twofold dividend: the public health benefits of mortality and morbidity avoided, and the financial savings associated with no longer having to maintain national vaccination programmes against the disease. This paper looks at the desirability of such a programme, and uses game theoretical analysis to evaluate whether it is a realistic aim. Any attempt at global eradication would face a number of serious challenges. At the national level, this paper looks at individual incentives to vaccinate, and shows that the existence of external benefits to vaccination imply that compulsory vaccination programmes would be necessary in order to achieve the Pareto optimal vaccination level. On an international level, global eradication will entail significant redistribution of funds between developed and developing countries. This paper shows that the nature of eradication, as a global and a threshold public good means that strong international cooperation will be required to overcome conflicting national incentives and achieve the globally optimal result. The smallpox eradication programme succeeded despite being subject to these same constraints and coordination problems. However, the economics and epidemiology of eradication are much less favourable for measles, and this paper concludes that whilst a measles eradication programme is highly desirable on both economic and public health grounds, a successful programme would require a level of international cooperation and coordination probably not achievable through existing institutions such as the WHO.