Tag Archives: infectious diseases

Modelling a social-ecological poverty trap due to infectious disease

In an interesting article Poverty trap formed by the ecology of infectious diseases (Proc Royal Soc B 2009) Mathew Bonds and others, describes how they couple a simple infectious disease model with an simple economic development model to produce model of a infectious disease induced poverty trap.  They write:

The combined causal effects of health on poverty and poverty on health implies a positive feedback system. Despite the importance of understanding such critical and systematic ecological interactions between humans and their most important natural enemies, and the anecdotal evidence that such poverty traps may indeed exist, we lack mechanistic frameworks of poverty traps that are rooted in the dynamics of disease. Here, we propose such a model. We find that a prototypical host–pathogen system, coupled with simple economic models, induces a poverty trap. More broadly, this model serves to illustrate how feedbacks between people and their environment can potentially give rise to major differences in human survival and economic welfare (Diamond 1997).

… we illustrate our underlying concept using a general one-disease SIS (susceptible–infected–susceptible) model, where individuals can be serially reinfected over the course of their lifetime. This model is meant to serve as the simplest general way of representing the kind of repeated threats of infection faced by poor tropical communities. More specifically, the general model also resembles a typical malaria system (Gandon et al. 2001), which has high prevalence rates among the poor and has been especially implicated in hindering economic growth (Gallup & Sachs 2001).

Their model produces two alternative regimes, a high productivity/low disease regime and a low productivity/high disease regime.

Feedback between economics and the ecology of infectious diseases forms a poverty trap. The prevalence of infectious diseases, I*(M) (black line), falls as per capita income rises, while per capita income, M*(I) (grey line), falls as disease prevalence, I, rises. The disease and income functions are in equilibrium where these two curves intersect at (I*(M*), M*(I*)). Two of these equilibria (I*(M*1), M*(I*1) and I*(M*3), M*(I*3)) are stable, and one (I*(M*2), M*(I*2)) is unstable. The poverty trap is the basin of attraction around (I*(M*3), M*(I*3)). α = 0.06; β̄ = 40; μ̄ = 0.01; ν = 0.02; h̄ = 90; δ = 5; ϱ = 0.003; τ = 0.15; ϕ = 15; κ = 30.

Feedback between economics and the ecology of infectious diseases forms a poverty trap. The prevalence of infectious diseases, I*(M) (black line), falls as per capita income rises, while per capita income, M*(I) (grey line), falls as disease prevalence, I, rises. The disease and income functions are in equilibrium where these two curves intersect at (I*(M*), M*(I*)). Two of these equilibria (I*(M*1), M*(I*1) and I*(M*3), M*(I*3)) are stable, and one (I*(M*2), M*(I*2)) is unstable. The poverty trap is the basin of attraction around (I*(M*3), M*(I*3)). α = 0.06; β̄ = 40; μ̄ = 0.01; ν = 0.02; h̄ = 90; δ = 5; ϱ = 0.003; τ = 0.15; ϕ = 15; κ = 30.

In this model, a social-ecological system can be pushed into or out of the poverty trap by changes that effect labour productivity, such as changes in the level of education or infrastructure, or changes in disease prevalence due to the expansion or contraction of public health.

In the paper the authors show that empirical patterns of disease burden and income suggest the existence of disease poverty traps.

They conclude:

While we hope that our model framework can serve as a useful point of departure for exploring more complex relationships, the theoretical analysis we present here has significant implications: simply coupling economics with a well-established model of the ecology of infectious diseases can imply radically different levels of health and economic welfare (i.e. poverty traps) depending on initial conditions. The practical implications are also significant. Because the world’s leading killers of the poor—malaria, HIV/AIDS, tuberculosis, diarrhoea and respiratory infections—are highly preventable and treatable, current global efforts to improve public health in areas of extreme poverty could theoretically pay long-term economic dividends. Furthermore, this analysis underscores that there are dramatic implications if economic activity is coupled with ecological processes that are well-known to behave in nonlinear ways.

Are Epidemic Early Warnings, Really “Early” Warnings?

kapan-et-al-2006

Information technological innovations seem to have played quite an important role in detecting early warnings of the current “new flu”, “swine flu” or H1N1.  This topic is elaborated in today’s issue of New York Times. Apparently, WHO received the first warning already on April 10th through its web-crawler based monitoring system. This again proves the usefulness of mining unofficial data for monitoring.

One point missing in the debate however, is the fact that other emerging and re-emerging infectious diseases (EIDs) – such as avian influenza (H5N1), Ebola hemorrhagic fever, and West Nile viral encephalitis – emerge not only as the result of changes in host dynamics or in the pathogen. On the contrary, a range of underlying social- ecological changes such as land use change, deforestation and biodiversity loss seem to contribute to the rise of EIDs globally. Durell Kapan and colleagues article on the social-ecological dimensions of avian influenza is a nice synthesis of how land-use change contributes to increases in H5N1.

So, even if ICT innovations such as Google Flu or GPHIN provide the first signals of pending epidemic outbreaks, they are really not designed to capture changes in underlying social-ecological interactions that induce EIDs. For example, if you want to predict novel outbreaks of Hantavirus pulmonary syndrome (HPS) in Brazil, you might want to keep an eye on deforestation patterns and increases in sugarcane production. Or if you want to stay ahead of increasing risks of Ebola hemorrhagic fever outbreaks in Central West Africa, you might want to track coastal fish stock decrease in the region. These are known to increase “bush-meat” hunting and hence the risk of Ebola outbreaks.

The question is what to call such a system. If field epidemiologist Nathan Wolfe is doing early warning, maybe this approach should be called ecological “early-early warning”?