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A recent review suggests that forest cover needs to be restored or maintained on at least 40% of land area. In the absence of empirical evidence to support this threshold, we discuss how this suggestion is unhelpful and potentially dangerous. We advocate for regionally defined thresholds to inform conservation and restoration.
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Biodiversidade , Conservação dos Recursos Naturais , Ecossistema , FlorestasRESUMO
Global demands for agricultural and forestry products provide economic incentives for deforestation across the tropics. Much of this deforestation occurs with a lack of information on the spatial distribution of benefits and costs of deforestation. To inform global sustainable land-use policies, we combine geographic information systems (GIS) with a meta-analysis of ecosystem services (ES) studies to perform a spatially explicit analysis of the trade-offs between agricultural benefits, carbon emissions, and losses of multiple ecosystem services because of tropical deforestation from 2000 to 2012. Even though the value of ecosystem services presents large inherent uncertainties, we find a pattern supporting the argument that the externalities of destroying tropical forests are greater than the current direct economic benefits derived from agriculture in all cases bar one: when yield and rent potentials of high-value crops could be realized in the future. Our analysis identifies the Atlantic Forest, areas around the Gulf of Guinea, and Thailand as areas where agricultural conversion appears economically efficient, indicating a major impediment to the long-term financial sustainability of Reducing Emissions from Deforestation and forest Degradation (REDD+) schemes in those countries. By contrast, Latin America, insular Southeast Asia, and Madagascar present areas with low agricultural rents (ARs) and high values in carbon stocks and ES, suggesting that they are economically viable conservation targets. Our study helps identify optimal areas for conservation and agriculture together with their associated uncertainties, which could enhance the efficiency and sustainability of pantropical land-use policies and help direct future research efforts.
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Agricultura/economia , Conservação dos Recursos Naturais/economia , Agricultura Florestal/métodos , Florestas , Internacionalidade , Modelos Econômicos , Meio Selvagem , Agricultura/tendências , Poluição do Ar/efeitos adversos , Poluição do Ar/economia , Poluição do Ar/prevenção & controle , Animais , Ciclo do Carbono , Dióxido de Carbono/análise , Dióxido de Carbono/toxicidade , Conservação dos Recursos Naturais/tendências , Produtos Agrícolas/economia , Produtos Agrícolas/crescimento & desenvolvimento , Ecossistema , Agricultura Florestal/economia , Agricultura Florestal/tendências , Humanos , Clima TropicalRESUMO
Roman Carrasco and colleagues propose a "cap and trade" system for global health involving a cost-effectiveness criterion and a DALY global credit market, mirroring global carbon emission permits trading markets to mitigate climate change.
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Comportamento Cooperativo , Países Desenvolvidos/economia , Países em Desenvolvimento/economia , Saúde Global/economia , Custos de Cuidados de Saúde , Cooperação Internacional , Saúde Pública/economia , Mudança Climática , Comércio/economia , Análise Custo-Benefício , Saúde Global/legislação & jurisprudência , Custos de Cuidados de Saúde/legislação & jurisprudência , Política de Saúde , Humanos , Cooperação Internacional/legislação & jurisprudência , Investimentos em Saúde , Modelos Econômicos , Formulação de Políticas , Saúde Pública/legislação & jurisprudênciaRESUMO
BACKGROUND: The volume of influenza pandemic modelling studies has increased dramatically in the last decade. Many models incorporate now sophisticated parameterization and validation techniques, economic analyses and the behaviour of individuals. METHODS: We reviewed trends in these aspects in models for influenza pandemic preparedness that aimed to generate policy insights for epidemic management and were published from 2000 to September 2011, i.e. before and after the 2009 pandemic. RESULTS: We find that many influenza pandemics models rely on parameters from previous modelling studies, models are rarely validated using observed data and are seldom applied to low-income countries. Mechanisms for international data sharing would be necessary to facilitate a wider adoption of model validation. The variety of modelling decisions makes it difficult to compare and evaluate models systematically. CONCLUSIONS: We propose a model Characteristics, Construction, Parameterization and Validation aspects protocol (CCPV protocol) to contribute to the systematisation of the reporting of models with an emphasis on the incorporation of economic aspects and host behaviour. Model reporting, as already exists in many other fields of modelling, would increase confidence in model results, and transparency in their assessment and comparison.
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Surveillance of pathogen richness in wildlife is needed to identify host species with a high risk of zoonotic disease spillover. While several predictors of pathogen richness in wildlife hosts have been proposed, their relative importance has not been formally examined. This hampers our ability to identify potential disease reservoirs, particularly in remote areas with limited surveillance efforts. Here we analyzed 14 proposed predictors of pathogen richness using ensemble modeling and a dataset of 1040 host species to identify the most important predictors of pathogen richness in wild mammal species. After controlling for research effort, larger species geographic range area was identified to be associated with higher pathogen richness. We found evidence of duality in the relationship between the fast-slow continuum of life-history traits and pathogen richness, where pathogen richness increases near the extremities. Taxonomic orders Carnivora, Proboscidea, Artiodactyla, and Perissodactyla were predicted to host high pathogen richness. The top three species with the highest pathogen richness predicted by our ensemble model were Canis lupus, Sus scrofa, and Alces alces. Our results can help support evidence-informed pathogen surveillance and disease reservoir management to prevent the emergence of future zoonotic diseases.
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Carnívoros , Cervos , Características de História de Vida , Animais , Mamíferos , Zoonoses/epidemiologia , Animais Selvagens , Reservatórios de DoençasRESUMO
Southeast (SE) Asia is a highly biodiverse region, yet it is also estimated to cumulatively contribute a third of the total global marine plastic pollution. This threat is known to have adverse impacts on marine megafauna, however, understanding of its impacts has recently been highlighted as a priority for research in the region. To address this knowledge gap, a structured literature review was conducted for species of cartilaginous fishes, marine mammals, marine reptiles, and seabirds present in SE Asia, collating cases on a global scale to allow for comparison, coupled with a regional expert elicitation to gather additional published and grey literature cases which would have been omitted during the structured literature review. Of the 380 marine megafauna species present in SE Asia, but also studied elsewhere, we found that 9.1 % and 4.5 % of all publications documenting plastic entanglement (n = 55) and ingestion (n = 291) were conducted in SE Asian countries. At the species level, published cases of entanglement from SE Asian countries were available for 10 % or less of species within each taxonomic group. Additionally, published ingestion cases were available primarily for marine mammals and were lacking entirely for seabirds in the region. The regional expert elicitation led to entanglement and ingestion cases from SE Asian countries being documented in 10 and 15 additional species respectively, highlighting the utility of a broader approach to data synthesis. While the scale of the plastic pollution in SE Asia is of particular concern for marine ecosystems, knowledge of its interactions and impacts on marine megafauna lags behind other areas of the world, even after the inclusion of a regional expert elicitation. Additional funding to help collate baseline data are critically needed to inform policy and solutions towards limiting the interactions of marine megafauna and plastic pollution in SE Asia.
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Caniformia , Poluentes Químicos da Água , Animais , Ecossistema , Poluentes Químicos da Água/análise , Plásticos , Cetáceos , Poluição da Água , Monitoramento Ambiental , Resíduos/análise , Sudeste AsiáticoRESUMO
Southeast Asia is considered to have some of the highest levels of marine plastic pollution in the world. It is therefore vitally important to increase our understanding of the impacts and risks of plastic pollution to marine ecosystems and the essential services they provide to support the development of mitigation measures in the region. An interdisciplinary, international network of experts (Australia, Indonesia, Ireland, Malaysia, the Philippines, Singapore, Thailand, the United Kingdom, and Vietnam) set a research agenda for marine plastic pollution in the region, synthesizing current knowledge and highlighting areas for further research in Southeast Asia. Using an inductive method, 21 research questions emerged under five non-predefined key themes, grouping them according to which: (1) characterise marine plastic pollution in Southeast Asia; (2) explore its movement and fate across the region; (3) describe the biological and chemical modifications marine plastic pollution undergoes; (4) detail its environmental, social, and economic impacts; and, finally, (5) target regional policies and possible solutions. Questions relating to these research priority areas highlight the importance of better understanding the fate of marine plastic pollution, its degradation, and the impacts and risks it can generate across communities and different ecosystem services. Knowledge of these aspects will help support actions which currently suffer from transboundary problems, lack of responsibility, and inaction to tackle the issue from its point source in the region. Being profoundly affected by marine plastic pollution, Southeast Asian countries provide an opportunity to test the effectiveness of innovative and socially inclusive changes in marine plastic governance, as well as both high and low-tech solutions, which can offer insights and actionable models to the rest of the world.
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Ecossistema , Plásticos , Sudeste Asiático , Monitoramento Ambiental , Poluição Ambiental , Filipinas , Resíduos/análiseRESUMO
Tropical deforestation is one of the most pressing threats to biodiversity, and substantially reduces ecosystem services at the global scale. Little is known however about the global spatial distribution of the actors behind tropical deforestation. Newly available maps of global cropland field size offer an opportunity to gain understanding towards the spatial distribution of tropical deforestation actors. Here we use a map of global cropland field size and combine it with maps of forest loss to study the spatial association between field size and deforestation while accounting for other anthropogenic and geographical drivers of deforestation. We then use linear mixed-effects models and bootstrapping to determine what factors affect field sizes within deforested areas across all countries in the global tropics and subtropics. We find that field size within deforested areas is largely determined by country-level effects indicating the importance of socio-economic, cultural and institutional factors on the distribution of field sizes. Typically, small field sizes appear more commonly in deforested areas in Africa and Asia while the association was with larger field sizes in Australia and the Americas. In general, we find that smaller field sizes are associated with deforestation in protected areas and large field sizes with areas with lower agricultural value, although these results have low explanatory power. Our results suggest that the spatial patterns of actors behind deforestation are aggregated geographically which could help target conservation and sustainable land-use strategies.
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Biodiversidade , Conservação dos Recursos Naturais , Produção Agrícola , Florestas , Clima Tropical , Fatores SocioeconômicosRESUMO
Many species depend on multiple habitats at different points in space and time. Their effective conservation requires an understanding of how and when each habitat is used, coupled with adequate protection. Migratory shorebirds use intertidal and supratidal wetlands, both of which are affected by coastal landscape change. Yet the extent to which shorebirds use artificial supratidal habitats, particularly at highly developed stopover sites, remains poorly understood leading to potential deficiencies in habitat management. We surveyed shorebirds on their southward migration in southern Jiangsu, a critical stopover region in the East Asian Australasian Flyway (EAAF), to measure their use of artificial supratidal habitats and assess linkages between intertidal and supratidal habitat use. To inform management, we examined how biophysical features influenced occupancy of supratidal habitats, and whether these habitats were used for roosting or foraging. We found that shorebirds at four of five sites were limited to artificial supratidal habitats at high tide for ~11-25 days per month because natural intertidal flats were completely covered by seawater. Within the supratidal landscape, at least 37 shorebird species aggregated on artificial wetlands, and shorebirds were more abundant on larger ponds with less water cover, less vegetation, at least one unvegetated bund, and fewer built structures nearby. Artificial supratidal habitats were rarely used for foraging and rarely occupied when intertidal flats were available, underscoring the complementarity between supratidal roosting habitat and intertidal foraging habitat. Joined-up artificial supratidal management and natural intertidal habitat conservation are clearly required at our study site given the simultaneous dependence by over 35,000 migrating shorebirds on both habitats. Guided by observed patterns of habitat use, there is a clear opportunity to improve habitat condition by working with local land custodians to consider shorebird habitat requirements when managing supratidal ponds. This approach is likely applicable to shorebird sites throughout the EAAF.
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RIDL (release of insects with dominant lethality) and Wolbachia are 2 potentially powerful tools in the fight against Zika, but their technological advancement is being hampered by policy barriers. In this study, we discuss what could be done to overcome these regulatory deadlocks.
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With the continuous growth of internet usage, Google Trends has emerged as a source of information to investigate how social trends evolve over time. Knowing how the level of interest in conservation topics--approximated using Google search volume--varies over time can help support targeted conservation science communication. However, the evolution of search volume over time and the mechanisms that drive peaks in searches are poorly understood. We conducted time series analyses on Google search data from 2004 to 2013 to investigate: (i) whether interests in selected conservation topics have declined and (ii) the effect of news reporting and academic publishing on search volume. Although trends were sensitive to the term used as benchmark, we did not find that public interest towards conservation topics such as climate change, ecosystem services, deforestation, orangutan, invasive species and habitat loss was declining. We found, however, a robust downward trend for endangered species and an upward trend for ecosystem services. The quantity of news articles was related to patterns in Google search volume, whereas the number of research articles was not a good predictor but lagged behind Google search volume, indicating the role of news in the transfer of conservation science to the public.
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Mudança Climática , Ecossistema , Disseminação de Informação , Mídias Sociais , Navegador , Animais , Bases de Dados Factuais , HumanosRESUMO
Previous studies have shown that contact with urban green spaces can produce positive effects on people's stress, health and well-being levels. However, much of this research has been conducted in the temperate regions of Europe or North America. Additionally, most studies have only compared the effects of urban and natural areas on health and well-being, but not made a finer distinction between different types of urban green spaces. We tested the relationship between well-being and the access or use of different types of green spaces among young adults in Singapore, a tropical city-state. The results showed that extraversion and emotional stability increased subjective well-being, positive affect and life satisfaction and decreased stress and negative affect. In addition, we found that level of physical activity increased positive affect and health problems increased negative affect. Neither access to green spaces nor the use of green spaces in Singapore significantly affected the well-being metrics considered, contradicting findings in the temperate regions of the world. We hypothesize that the differences in temperature and humidity and the higher greenery and biodiversity levels outside parks in Singapore could explain this phenomenon. Our results thus question the universality of the relationship between well-being and park usage and highlight the need for more research into the multifaceted effects of green spaces on well-being in the tropics.
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Felicidade , Parques Recreativos/estatística & dados numéricos , Clima Tropical , Adolescente , Adulto , Feminino , Humanos , Masculino , Singapura , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Dengue causes 50 million infections per year, posing a large disease and economic burden in tropical and subtropical regions. Only a proportion of dengue cases require hospitalization, and predictive tools to triage dengue patients at greater risk of complications may optimize usage of limited healthcare resources. For severe dengue (SD), proposed by the World Health Organization (WHO) 2009 dengue guidelines, predictive tools are lacking. METHODS: We undertook a retrospective study of adult dengue patients in Tan Tock Seng Hospital, Singapore, from 2006 to 2008. Demographic, clinical and laboratory variables at presentation from dengue polymerase chain reaction-positive and serology-positive patients were used to predict the development of SD after hospitalization using generalized linear models (GLMs). PRINCIPAL FINDINGS: Predictive tools compatible with well-resourced and resource-limited settings--not requiring laboratory measurements--performed acceptably with optimism-corrected specificities of 29% and 27% respectively for 90% sensitivity. Higher risk of severe dengue (SD) was associated with female gender, lower than normal hematocrit level, abdominal distension, vomiting and fever on admission. Lower risk of SD was associated with more years of age (in a cohort with an interquartile range of 27-47 years of age), leucopenia and fever duration on admission. Among the warning signs proposed by WHO 2009, we found support for abdominal pain or tenderness and vomiting as predictors of combined forms of SD. CONCLUSIONS: The application of these predictive tools in the clinical setting may reduce unnecessary admissions by 19% allowing the allocation of scarce public health resources to patients according to the severity of outcomes.
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Dengue Grave , Dor Abdominal , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dengue Grave/diagnóstico , Dengue Grave/epidemiologia , Dengue Grave/fisiopatologia , Singapura/epidemiologia , Vômito , Organização Mundial da SaúdeRESUMO
BACKGROUND: Previously, most dengue cases in Singapore were hospitalized despite low incidence of dengue hemorrhagic fever (DHF) or death. To minimize hospitalization, the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) in Singapore implemented new admission criteria which included clinical, laboratory, and DHF predictive parameters in 2007. METHOD: All laboratory-confirmed dengue patients seen at TTSH during 2006-2008 were retrospectively reviewed for clinical data. Disease outcome and clinical parameters were compared over the 3 years. RESULTS: There was a 33.0% mean decrease in inpatients after the new criteria were implemented compared with the period before (p < 0.001). The proportion of inpatients with DHF increased significantly from 31.7% in 2006 to 34.4% in 2008 (p = 0.008); 68 DHF cases were managed safely on an outpatient basis after compared with none before implementation. DHF inpatients had more serious signs such as clinical fluid accumulation (15.5% vs 2.9% of outpatients), while most DHF outpatients had hypoproteinemia (92.7% vs 81.3% of inpatients). The eight intensive care unit admissions and five deaths during this time period all occurred among inpatients. The new criteria resulted in a median cost saving of US$1.4 million to patients in 2008. CONCLUSION: The new dengue admission criteria were effective in sustainably reducing length of hospitalization, yielding considerable cost savings. A minority of DHF patients with mild symptoms recovered uneventfully through outpatient management.
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Dengue/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Adulto , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Singapura , Centros de Atenção Terciária/economia , Triagem/normasRESUMO
Harmful non-indigenous species (NIS) impose great economic and environmental impacts globally, but little is known about their impacts in Southeast Asia. Lack of knowledge of the magnitude of the problem hinders the allocation of appropriate resources for NIS prevention and management. We used benefit-cost analysis embedded in a Monte-Carlo simulation model and analysed economic and environmental impacts of NIS in the region to estimate the total burden of NIS in Southeast Asia. The total annual loss caused by NIS to agriculture, human health and the environment in Southeast Asia is estimated to be US$33.5 billion (5(th) and 95(th) percentile US$25.8-39.8 billion). Losses and costs to the agricultural sector are estimated to be nearly 90% of the total (US$23.4-33.9 billion), while the annual costs associated with human health and the environment are US$1.85 billion (US$1.4-2.5 billion) and US$2.1 billion (US$0.9-3.3 billion), respectively, although these estimates are based on conservative assumptions. We demonstrate that the economic and environmental impacts of NIS in low and middle-income regions can be considerable and that further measures, such as the adoption of regional risk assessment protocols to inform decisions on prevention and control of NIS in Southeast Asia, could be beneficial.
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Agricultura/economia , Análise Custo-Benefício/estatística & dados numéricos , Países em Desenvolvimento/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Espécies Introduzidas/economia , Animais , Sudeste Asiático , Columbidae/fisiologia , Humanos , Insetos/patogenicidade , Insetos/fisiologia , Espécies Introduzidas/estatística & dados numéricos , Método de Monte Carlo , Plantas Daninhas/fisiologia , Roedores/fisiologia , Vírus/crescimento & desenvolvimentoRESUMO
A growing body of evidence suggests that dengue infection in Singapore predominantly occurs away from the home, but when and where dengue transmission occurs is unclear, confounding control efforts. The authors estimate days of the week in which dengue inpatients in Singapore were infected during the period 2006-2008, based on the day they became febrile and historical data on the incubation period, using Bayesian statistical methods. Among male inpatients, the relative risk of infection is an estimated 57% higher at the weekend, suggesting infections associated with the home or leisure activities. There was no evidence of elevated risk of infection at the weekend for female inpatients. The study motivates further research identifying locales frequented in the week leading up to onset to improve the effective targeting of vector control efforts.
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Dengue/epidemiologia , Dengue/transmissão , Adulto , Teorema de Bayes , Etnicidade , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Método de Monte Carlo , Fatores de Risco , Singapura/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations. It is important to differentiate between them during first presentation as their management, especially for dengue hemorrhagic fever (DHF), is different. This study compares their clinical presentation in Singapore adults to derive predictors to assist doctors in diagnostic decision-making. METHODS: We compared 117 patients with chikungunya infection diagnosed with reverse transcription-polymerase chain reaction (RT-PCR) with 917 dengue RT-PCR-positive adult patients (including 55 with DHF). We compared dengue fever (DF), DHF, and chikungunya infections by evaluating clinical characteristics of dengue and chikungunya; developing classification tools via multivariate logistic regression models and classification trees of disease etiology using clinical and laboratory factors; and assessing the time course of several clinical variables. FINDINGS: At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough (for DF), nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients. From the decision trees, platelets <118 × 10(9)/L was the only distinguishing feature for DF versus chikungunya with an overall correct classification of 89%. For DHF versus chikungunya using platelets <100 × 10(9)/L and the presence of bleeding, the overall correct classification was 98%. The time course analysis supported platelet count as the key distinguishing variable. INTERPRETATION: There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management.
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Infecções por Alphavirus/diagnóstico , Técnicas de Laboratório Clínico/métodos , Medicina Clínica/métodos , Técnicas de Apoio para a Decisão , Dengue/diagnóstico , Adulto , Infecções por Alphavirus/patologia , Estudos de Casos e Controles , Febre de Chikungunya , Dengue/patologia , Humanos , Estudos Retrospectivos , SingapuraRESUMO
Influenza pandemics present a global threat owing to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the long-term optimal size of the stockpile under uncertainty and the characteristics of different countries. Using an epidemic-economic model we studied the effect on total mortality and costs of antiviral stockpile sizes for Brazil, China, Guatemala, India, Indonesia, New Zealand, Singapore, the UK, the USA and Zimbabwe. In the model, antivirals stockpiling considerably reduced mortality. There was greater potential avoidance of expected costs in the higher resourced countries (e.g. from $55 billion to $27 billion over a 30 year time horizon for the USA) and large avoidance of fatalities in those less resourced (e.g. from 11.4 to 2.3 million in Indonesia). Under perfect allocation, higher resourced countries should aim to store antiviral stockpiles able to cover at least 15 per cent of their population, rising to 25 per cent with 30 per cent misallocation, to minimize fatalities and economic costs. Stockpiling is estimated not to be cost-effective for two-thirds of the world's population under current antivirals pricing. Lower prices and international cooperation are necessary to make the life-saving potential of antivirals cost-effective in resource-limited countries.
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Antivirais/provisão & distribuição , Vacinas contra Influenza/provisão & distribuição , Influenza Humana/prevenção & controle , Modelos Econômicos , Pandemias/economia , Antivirais/economia , Antivirais/uso terapêutico , Número Básico de Reprodução , Simulação por Computador , Humanos , Vacinas contra Influenza/economia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/economia , Influenza Humana/epidemiologia , Pandemias/prevenção & controleRESUMO
BACKGROUND: Dengue illness causes 50-100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings. METHODS AND FINDINGS: We estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%-59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9-14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively. CONCLUSIONS: Dengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially.