Swine influenza and vaccines: an alternative approach for decision making about pandemic prevention.

BACKGROUND: During the global pandemic of A/H1N1/California/07/2009 (A/H1N1/Cal) influenza, many governments signed contracts with vaccine producers for a universal influenza immunization program and bought hundreds of millions of vaccines doses. We argue that, as Health Ministers assumed the occurrence of the worst possible scenario (generalized pandemic influenza) and followed the strong version of the Precautionary Principle, they undervalued the possibility of mild or weak pandemic wave. METHODOLOGY: An alternative decision rule, based on the non-extensive entropy principle, is introduced, and a different Precautionary Principle characterization is applied. This approach values extreme negative results (catastrophic events) in a different way and predicts more plausible and mild events. It introduces less pessimistic forecasts in the case of uncertain influenza pandemic outbreaks. A simplified application is presented using seasonal data of morbidity and severity among Italian children influenza-like illness for the period 2003-10. PRINCIPAL FINDINGS: Established literature results predict an average attack rate of not less than 15% for the next pandemic influenza [Meltzer M, Cox N, Fukuda K. The economic impact of pandemic influenza in the United States: implications for setting priorities for interventions. Emerg Infect Dis 1999;5:659-71; Meltzer M, Cox N, Fukuda K. Modeling the Economic Impact of Pandemic Influenza in the United States: Implications for Setting Priorities for Intervention. Background paper. Atlanta, GA: CDC, 1999. Available at: http://www.cdc.gov/ncidod/eid/vol5no5/melt_back.htm (7 January 2011, date last accessed))]. The strong version of the Precautionary Principle would suggest using this prediction for vaccination campaigns. On the contrary, the non-extensive maximum entropy principle predicts a lower attack rate, which induces a 20% saving in public funding for vaccines doses. CONCLUSIONS: The need for an effective influenza pandemic prevention program, coupled with an efficient use of public funding, calls for a rethinking of the Precautionary Principle. The non-extensive maximum entropy principle, which incorporates vague and incomplete information available to decision makers, produces a more coherent forecast of possible influenza pandemic and a conservative spending in public funding.

Pharmaceutical interventions for mitigating an influenza pandemic: modeling the risks and health-economic impacts.

Model-based analyses built on burden-of-disease and cost-effectiveness theory predict that pharmaceutical interventions may efficiently mitigate both the epidemiologic and economic impact of an influenza pandemic. Pharmaceutical interventions typically encompass the application of (pre)pandemic influenza vaccines, other vaccines (notably pneumococcal), antiviral treatments and other drug treatment (e.g., antibiotics to target potential complications of influenza). However, these models may be too limited to capture the full macro-economic impact of pandemic influenza. The aim of this article is to summarize current health-economic modeling approaches to recognize the strengths and weaknesses of these approaches, and to compare these with more recently proposed alternative methods. We conclude that it is useful, particularly for policy and planning purposes, to extend modeling concepts through the application of alternative approaches, including insurers' risk theories, human capital approaches and sectoral and full macro-economic modeling. This article builds on a roundtable meeting of the Pandemic Influenza Economic Impact Group that was held in Boston, MA, USA, in December 2008.

Analysing demand for environmental quality: a willingness to pay/accept study in the province of Siena (Italy).

The province of Siena, Italy, enacted a new garbage plan (NGP) with the objective of increasing separate waste collection (SWC), shutting down six landfills and increasing incineration. The aim of the paper is to evaluate costs and benefits of the NGP. The hypothesis is that willingness to pay (WTP) should reflect the value to the community of having better environmental quality, according to the Contingent Valuation literature. The paper reports the results of a contingent valuation (CV). The sample was divided into two subsets: firms and households. Through the information gathered via a detailed questionnaire, parametric and non-parametric estimates were elaborated to analyse the WTP of the population for the benefits flowing from increased SWC, increased incineration and shutting down of landfills. These values were expressed as a share of the tax actually paid. Although a small subset of firms and households valued increasing incineration less positively, requesting compensation, on the whole interviewees (with large differences between firms and households) had a net positive WTP for the provisions included in NGP. Parametric estimation procedures enabled us to analyse the economic as well as social and demographic factors affecting these results. These elements are useful for computing a value for the waste charge that also reflects external effects. Finally, we estimated household income elasticity of WTP for the increase in SWC and found less than one: environmental quality is not a luxury good.