Title

Pathogens without passports: The provision and underprovision of global health goods

Date of Completion

January 2009

Keywords

Health Sciences, Public Health|Political Science, General|Sociology, General

Degree

Ph.D.

Abstract

Pathogens without Passports begins from the assumption that disease eradication is a public good. Put simply, eradication produces benefits that are nonexcludable and nonrival. Presently, it is technically feasible to eradicate a number of diseases, and yet, only two global eradication programs exist. One is for polio and the other for guinea worm. These findings beg the question: why are there varying levels of communicable disease control globally for diseases where eradication is possible? In order to understand this question better, this project uses a public goods framework and examines three cases: Polio, Measles, and Hepatitis B. The main mode of data collection that is utilized is interviewing. In total, more than forty interviews were conducted with individuals residing in international health organizations, regional health associations, private foundations, research and development firms, and nongovernmental groups. Further, the methodology employed is process tracing. Pathogens without Passports underscores four main findings. First, the value of public-private partnerships for health is explored as is the structure and configuration of these partnerships. Second, this project pushes forward the public goods agenda by highlighting a connection between levels of public goods provision (national, regional, and global) and introducing the concept of public goods contingency. Third, the concepts of eradication, elimination, and control are problematized in an effort to better understand the pros and cons of horizontally and vertically structured programs for health. Finally, the social construction of health and wellness and perception of disease transmission and disease pathology are explored. This project concludes that the current state of the world's health is not the result of scientific gaps in knowledge. Rather, the poor state of the world's health is the result of selective decision-making and human choice. In order to positively alter this situation, an increase in public-private partnerships for health is warranted, as are changes in how health and disease transmission are framed in the policy environment. Further, it is necessary that policymakers attempt to compensate, where possible, for the downfalls inherent in vertical and horizontal campaigns for health. Doing so will allow the global health community to function more efficiently and effectively. ^