Governance structure affects transboundary disease management under alternative objectives

BMC Public Health

Junyan Duan¹  Katriona Shea²  Ishan S. Phadke³  Charles Sims⁴  Julie C. Blackwood⁵  Suzanne Lenhart⁶  Jordan J. Pellett⁶  Mykhaylo M. Malakhov⁷ 

[1] Center for Complex Biological Systems, University of California Irvine, 92697, Irvine, CA, USA;Department of Biology, The Pennsylvania State University, University Park, 16802, Pennsylvania, USA;Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, 16802, Pennsylvania, USA;Department of Economics, University of North Carolina at Chapel Hill, 27516, Chapel Hill, NC, USA;Department of Economics, University of Tennessee, 37996, Knoxville, TN, USA;Howard H. Baker Jr. Center for Public Policy, University of Tennessee, 37996, Knoxville, TN, USA;Department of Mathematics and Statistics, Williams College, 01267, Williamstown, MA, USA;Department of Mathematics, University of Tennessee, 37996, Knoxville, TN, USA;Division of Biostatistics, School of Public Health, University of Minnesota, 55455, Minneapolis, MN, USA;

关键词: Governance;    Infectious disease;    Management;    Mathematical model;    Migration;    Objectives;    Public health policy;   

DOI  :  10.1186/s12889-021-11797-3

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY