Governance structure affects transboundary disease management under alternative objectives

Julie C Blackwood,Suzanne Lenhart,Charles Sims,Ishan S Phadke,Mykhaylo M Malakhov,Katriona Shea,Jordan J Pellett,Junyan Duan

doi:10.1186/s12889-021-11797-3

Abstract

BackgroundThe development of public health policy is inextricably linked with governance structure. In our increasingly globalized world, human migration and infectious diseases often span multiple administrative jurisdictions that might have different systems of government and divergent management objectives. However, few studies have considered how the allocation of regulatory authority among jurisdictions can affect disease management outcomes.MethodsHere we evaluate the relative merits of decentralized and centralized management by developing and numerically analyzing a two-jurisdiction SIRS model that explicitly incorporates migration. In our model, managers choose between vaccination, isolation, medication, border closure, and a travel ban on infected individuals while aiming to minimize either the number of cases or the number of deaths.ResultsWe consider a variety of scenarios and show how optimal strategies differ for decentralized and centralized management levels. We demonstrate that policies formed in the best interest of individual jurisdictions may not achieve global objectives, and identify situations where locally applied interventions can lead to an overall increase in the numbers of cases and deaths.ConclusionsOur approach underscores the importance of tailoring disease management plans to existing regulatory structures as part of an evidence-based decision framework. Most importantly, we demonstrate that there needs to be a greater consideration of the degree to which governance structure impacts disease outcomes.

Highlights

The development of public health policy is inextricably linked with governance structure
Decentralized management Under the assumption that only jurisdiction A applies interventions, the best type of control at the decentralized level depends on both the initial conditions and control intensity
We developed and analyzed a mathematical model to assess the benefits and drawbacks of different governance structures in a two-jurisdiction setting

Summary

Introduction

The development of public health policy is inextricably linked with governance structure. In our increasingly globalized world, human migration and infectious diseases often span multiple administrative jurisdictions that might have different systems of government and divergent management objectives. In our increasingly globalized world, infectious diseases are rarely confined to a single country or administrative region. Decentralized management allows each local government to tailor management responses to the specifics of its population. Decentralized approaches risk coordination failures that result when the disease spreads across borders and might lead to selfish policies in which a governmental agency does not consider how its actions affect neighboring jurisdictions. Centralized management offers better coordination and can account for movement between regions, but may be unable to tailor responses to the heterogeneous populations impacted by the disease. At the beginning of the COVID-19 pandemic several countries applied unilateral travel restrictions despite World Health Organization recommendations to the contrary, and many rural counties in the United States argued that state-imposed mandates on business closures were unnecessary for their communities

Methods

Results

Conclusion