Abstract
Background
Pandemics can result in significant societal costs due to both the outbreak of disease and the mitigation measures imposed in response to it; for example, the health costs of deaths, the social costs of school closures and the economic costs of business closures. The magnitude of these societal costs can be alleviated through pandemic preparedness measures, such as investment in surveillance, health systems and vaccination infrastructure, but there is little quantitative evidence of the efficacy of such measures or their cost-effectiveness, and how this may vary between different country settings.
Methods
A multi-country tool that projects the societal costs of deaths (valued life-years lost), school closures (valued learning losses) and business closures (short-term GDP loss) for various outbreak scenarios is presented. The tool is based on the previously developed Daedalus model, an integrated economic-epidemiological model that accounts for heterogeneity of mixing and disease progression based on age and economic sector, modified to account for human behavioural responses. Outcomes for a number of different diseases are estimated, based on historic respiratory epidemics/pandemics, and under four different mitigation strategies observed during the COVID-19 pandemic (unmitigated, school-closures, reactive economic closures, elimination). The reduction in societal costs with improved pandemic preparedness is examined, including the effectiveness of contact tracing programmes, hospital capacity and vaccination rollout infrastructure, and the benefits of preparedness are directly compared to its costs, which are estimated using a number of previously developed costing tools.
Results
We find that the net benefits of pandemic preparedness for countries appear to scale with GDP per capita, owing to factors such as the underlying demography (younger populations in lower-income countries), and the valuation of life years and school years. Net benefits also increase with disease transmissibility and severity. The cost of pandemic preparedness can vary according to the costing tool employed, resulting in considerable uncertainty. The resulting return-on-investment values, which take the probability of pandemic emergence into account, also vary, ranging from <0% for mild pandemics in low-income countries (e.g., Swine flu in Ethiopia) to >1000% for severe pandemics in high-income countries (e.g., Spanish flu in the United States). The results of this study clearly show the benefits of pandemic preparedness for population health, education and economic prosperity, and its cost-effectiveness, further supporting the business case for investment in pandemic preparedness measures.