Surveillance and reporting of disease outbreaks: private incentives and WHO policy levers

In spite of the obvious global public goods nature of warnings about infectious disease outbreaks, international legal requirements for reporting outbreaks remain weak and disclosure of outbreaks depends on the self-interest of nations. Using a simple game-theoretic model, we explore the incentives of countries to invest in disease surveillance and to report outbreaks to international health authorities. We evaluate existing and potential policy instruments available to the WHO to encourage countries to detect and report disease outbreaks, including medical assistance to control outbreaks, trade sanctions for nonreporting and assistance in disease surveillance. These ideas are relevant to policy design, not just in the context of singular events such as avian influenza, but also for more routine problems such as hospitalacquired infections.