Unforeseen Costs of Cutting Mosquito Surveillance Budgets

Abstract

A budget proposal to stop the U.S. Centers for Disease Control and Prevention (CDC) funding in surveillance and research for mosquito-borne diseases such as dengue and West Nile virus has the potential to leave the country ill-prepared to handle new emerging diseases and manage existing ones. In order to demonstrate the consequences of such a measure, if implemented, we evaluated the impact of delayed control responses to dengue epidemics (a likely scenario emerging from the proposed CDC budget cut) in an economically developed urban environment. We used a mathematical model to generate hypothetical scenarios of delayed response to a dengue introduction (a consequence of halted mosquito surveillance) in the City of Cairns, Queensland, Australia. We then coupled the results of such a model with mosquito surveillance and case management costs to estimate the cumulative costs of each response scenario. Our study shows that halting mosquito surveillance can increase the management costs of epidemics by up to an order of magnitude in comparison to a strategy with sustained surveillance and early case detection. Our analysis shows that the total costs of preparedness through surveillance are far lower than the ones needed to respond to the introduction of vector-borne pathogens, even without consideration of the cost in human lives and well-being. More specifically, our findings provide a science-based justification for the re-assessment of the current proposal to slash the budget of the CDC vector-borne diseases program, and emphasize the need for improved and sustainable systems for vector-borne disease surveillance.

An Explosive Epidemic of DENV-3 in Cairns, Australia

“…A delay in recognition of a dengue epidemic can exponentially increases the total number of cases and total cost to the community [5]. Despite a relatively low mortality rate, the large number of cases cumulatively creates relatively high disability-adjusted life year (DALYs) values for dengue.…”

Time Lags between Exanthematous Illness Attributed to Zika Virus, Guillain-Barré Syndrome, and Microcephaly, Salvador, Brazil

“…Additional individual and population level investigations, both clinical and epidemiologic (case–­control and cohort studies) are needed, as are increased resources for surveillance, vector control, and diagnostic capabilities to make definitive connections. With emerging infectious diseases increasing worldwide ( 28 ), investing in public health surveillance on the city, state, national, and global levels is one of the most cost effective way to help address these ongoing and increasing challenges ( 29 ). …”

Sources of Dengue Viruses Imported into Queensland, Australia, 2002–2010

“…Rapid identification of cases and disease tracking, incorporating targeted vector surveillance, and control measures adopted rigorously to limit epidemic potential have been major factors in preventing local transmission and in reducing the cost of managing mosquito-borne disease ( 7 ). …”