March 12, 2014
The Question
How do incentives affect countries’ decisions to report infectious disease outbreaks?
What we found
We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO) from 54 African countries between 1966 and 2002. This period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak.
We found that the Hajj vaccination requirements that were instituted in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased.
Why it matters
This shows that incentives, rather than just financial assistance to build surveillance networks, have the potential to alter reporting decisions for infectious disease outbreaks, especially when the burden of disease is low. In our study, policies that changed the benefits of reporting had little effect on reporting by countries with a large burden of meningococcal meningitis, but significantly altered reporting by countries with fewer cases.
