Center for Disease Dynamics, Economics & Policy
Encyclopedia
The Center for Disease Dynamics, Economics & Policy (CDDEP) is a public health research organization with headquarters in Washington, D.C. and New Delhi. Its mission is "to produce independent, multidisciplinary research to advance the health and well-being of human populations in the United States and around the world." Founded in 2009 as a center of Resources for the Future
Resources for the Future
Resources for the Future is a nonprofit organization that conducts independent research into environmental, energy, and natural resource issues, primarily via economics and other social sciences. Headquartered in Washington, D.C., RFF performs research around the world...

, CDDEP is now an independent non-profit organization.

Overview

CDDEP’s team of economists, epidemiologists, disease modelers, policy and risk analysts carry out research on malaria, antibiotic resistance, disease control priorities, environmental health, alcohol and tobacco, and various other diseases. Research is divided across four areas: disease dynamics and behavior, disease dynamics and information structure, delivery of new technologies for disease control, and innovative financing.

Two key CDDEP initiatives focus on antibiotic resistance as a public health crisis. Within the United States, the Extending the Cure (ETC) project has received widespread media attention for work examining the costs of hospital acquired infections (HAIs) and designing novel incentive-based strategies to encourage antibiotic conservation. ETC researchers have contributed to Roll Call, the Wall Street Journal, and the Baltimore Sun, among others. In addition, The Global Antibiotic Resistance Partnership is developing actionable policy proposals on antibiotic resistance for five low- and middle-income countries: China, India, Kenya, South Africa, and Vietnam.

CDDEP staff are also well-known in the field of malaria research. Senior fellows were pioneers of the global subsidy idea that became Affordable Medicines Facility—malaria (AMFm), an innovative financing mechanism designed to expand access to the most effective treatment for malaria through the public, private and NGO sectors. CDDEP has contributed to malaria elimination planning in Zanzibar, and to efforts to promote the use of multiple first-line therapies (MFTs) to slow resistance to antimalarial drugs.

Extending the Cure

The Extending the Cure (ETC) project is a research and consultative effort that frames the growing problem of antibiotic resistance as a challenge in managing a shared societal resource. The ETC inaugural report and its subsequent papers examine the range of issues around resistance and look at innovative policy solutions to encourage the conservation of antibiotics without stifling new drug development.

Extending the Cure is funded in part by the Robert Wood Johnson Foundation
Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation is the United States' largest philanthropy devoted exclusively to health and health care; it is based in Princeton, New Jersey. The foundation's mission is to improve the health and health care of all Americans...

 through its Pioneer Portfolio, which supports innovative projects that may lead to breakthrough improvements in health and health care.

Global Antibiotic Resistance Partnership

The Global Antibiotic Resistance Partnership (GARP) will develop actionable policy proposals on antibiotic resistance for five low- and middle-income countries: China, India, Kenya, South Africa, and Vietnam. The expertise and capacity developed in these initial five countries will become the core of a wider partnership involving other low- and middle-income countries to create greater awareness among national policymakers about the need for policies to control antibiotic resistance as part of a worldwide effort. The GARP secretariat at CDDEP works collaboratively with partner organizations and national working groups in each of the five focus countries.

This project is funded in part by the Bill & Melinda Gates Foundation
Bill & Melinda Gates Foundation
The Bill & Melinda Gates Foundation is the largest transparently operated private foundation in the world, founded by Bill and Melinda Gates. It is "driven by the interests and passions of the Gates family"...

 through its Global Health Program.

Affordable Medicines Facility--Malaria

The Affordable Medicines Facility – malaria (AMFm) is an innovative financing mechanism designed to expand access to the most effective treatment for malaria, artemisinin-based combination therapies (ACTs) through the public, private and NGO sectors. It will reduce the use of drugs that no longer work because of drug resistance, and reduce the use of artemisinin by itself, as monotherapy, thereby delaying the onset of resistance to that drug and preserving its effectiveness. AMFm is being managed by the Global Fund with directed financing from UNITAID
Unitaid
UNITAID is an international facility for the purchase of drugs against HIV/AIDS, Malaria and Tuberculosis. It was founded in September 2006 on the initiative of Brazil and France, and is to a great part financed by so called innovative development financing mechanisms, namely a solidarity levy on...

, the UK Department for International Development
Department for International Development
The Department For International Development is a United Kingdom government department with a Cabinet Minister in charge. It was separated from the Foreign and Commonwealth Office in 1997. The goal of the department is "to promote sustainable development and eliminate world poverty". The current...

 (DFID), and other donors.

CDDEP researchers have been involved with the global subsidy idea behind AMFm since 2002, when the U.S. Institute of Medicine committee first deliberated on the questions of how to expand access to ACTs while maintaining the effectiveness of artemisinin compounds.

Disease Control Priorities Project

A joint effort of The World Bank, the Fogarty International Center of the National Institutes of Health, and the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, with substantial technical input from CDDEP researchers, DCPP was launched in 2001 as a four-year initiative to improve the health of people in developing countries by identifying disease control priorities based on scientific evidence and cost-effectiveness. Researchers at CDDEP were involved in carrying out the economic analysis for a number of chapters as well as in writing the cross-cutting chapter summarizing the main economic messages of the project, as well as the Lancet paper summarizing the main messages of the project. CDDEP researchers also co-led DCPP in India. That effort resulted in a book, “Choosing Health: An Entitlement for All Indians.” The overarching paradigm for DCPP is of quantitative evaluation of health system interventions and prioritizing interventions on the basis of cost-effectiveness.

Malaria Atlas Project--Elimination

A compliment to the Malaria Atlas Project
Malaria Atlas Project
The Malaria Atlas Project, abbreviated as MAP, is a non-profit project primarily funded by the Wellcome Trust, UK. MAP is a joint project between the Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine, Kenya and the Spatial Ecology & Epidemiology Group, University of...

, this research seeks to develop an improved bio-economic model for trans-boundary malaria control financing that considers imported malaria. Research couples economic models to the stochastic spatial models largely based on malaria transmission intensity data assembled by the Malaria Atlas Project. Research includes modeling vectors and malaria transmission to develop the further spatial components. The end product of this effort will be the development of a tool for making estimates of malaria transmission intensity and burden as a function of financing strategies.

Golden Mustard

CDDEP’s Golden Mustard project, funded by the International Center for Tropical Agriculture
International Center for Tropical Agriculture
The International Center for Tropical Agriculture is a not-for-profit research and development organization dedicated to reducing poverty and hunger while protecting natural resources in developing countries...

 (CIAT), Colombia, examines the potential impact of biofortification of mustard in India. The Indian context presents specific challenges: widely dispersed food production systems and sporadic health center access have hampered interventions to distribute vitamin A supplements, industrially fortified foods, or biofortified seed products in the past. CDDEP’s Golden Mustard project looks at how mustard biofortification could be an advantageous addition to a portfolio of strategies to alleviate Vitamin A deficiency in this context.

Multiple First-line Therapies

If two drugs (in combination) are good, are three or more being used concurrently by different patients better at keeping drug resistance at bay? The question has practical consequences, as nearly every malaria-endemic country adopts a single first-line treatment (now, a combination drug) as policy. National policies are difficult to change and to implement in these relatively poor countries, and good evidence would be needed to adopt a more complex approach. CDDEP researchers began investigating MFT in 2006 using an evolutionary-epidemiological modeling framework. They compared MFT with single combination drugs and with cycling strategies where therapies are rotated, either on a fixed cycling schedule or when resistance levels or treatment failure become too high. Compared with these alternatives, the analysis predicts that MFT strategies will delay the emergence and slow the fixation of resistant strains.

Notable Work

The Center for Global Development
Center for Global Development
The Center for Global Development is a non-profit think tank based in Washington, D.C. that focuses on international development. It was founded in November 2001 by former senior U.S. official Edward W. Scott, director of the Peterson Institute for International Economics, C. Fred Bergsten, and...

 describes CDDEP as a complement to "the CDC
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

, WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...

, and other agencies who fulfill basic surveillance and public health roles, but can’t give us much (if any) insight into the economic consequences of pandemic flu and other health disasters, nor can they use this insight to promote needed policy reform in the U.S. and globally."

Extending the Cure’s inaugural report Extending the Cure: Policy Responses to the Growing Threat of Antibiotic Resistance, has been widely debated at a series of consultations with representatives from the medical, insurance, pharmaceutical, government, and academic communities. It set the stage for continued research in the form of technical papers and policy briefs to prevent the impending health crisis of widespread antibiotic resistance.

ETC received national media attention for its study on the costs of Hospital-Acquired Infections, including coverage by NPR, ABC, CNN, and Reuters. Published in Archives of Internal Medicine
Archives of Internal Medicine
The Archives of Internal Medicine is a peer-reviewed medical journal published twice a month by the American Medical Association. The Archives of Internal Medicine was established in 1908 and covers all aspects of internal medicine, including cardiovascular disease, geriatrics, infectious disease,...

, the study demonstrated that two conditions caused by HAIs killed 48,000 people and ramped up health care costs by $8.1 billion in 2006 alone.

The 2010 ETC-sponsored paper Fighting Antibiotic Resistance: Marrying New Financial Incentives to Meeting Public Health Goalswas cited by the Guardian
The Guardian
The Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...

 as “a radical plan to save antibiotics.” The study, published in Health Affairs
Health Affairs
Health Affairs is a peer-reviewed healthcare journal established in 1981 by John K. Iglehart. It was described by The Washington Post as "the bible of health policy". Health Affairs is indexed and/or abstracted in PubMed, MEDLINE, EBSCO databases, ProQuest, LexisNexis, Current Contents/Health...

, examined novel strategies for conserving antibiotics while also encouraging new drug development.

ETC research featured in the CDC's Emerging Infectious Diseases also received widespread national media coverage. The study found the community-associated strain of the deadly superbug MRSA—an infection-causing bacteria resistant to most common antibiotics—poses a far greater health threat than previously known and is making its way into hospitals. The new threat is easily picked up in fitness centers, schools, and other public places and has increased the overall burden of MRSA within hospitals. The study analyzed data from more than 300 microbiology labs serving hospitals all over the United States, found a seven-fold increase in the proportion of "community-associated" strains of methicillin-resistant Staphylococcus aureus, or MRSA, in outpatient hospital units between 1999 and 2006.

CDDEP Senior Fellow David L. Smith’s 2010 study in Nature
Nature
Nature, in the broadest sense, is equivalent to the natural world, physical world, or material world. "Nature" refers to the phenomena of the physical world, and also to life in general...

, Climate Change and the Global Malaria Recession, rebuked the widespread claim that climate change will be linked to increasing malaria incidence.

CDDEP researchers are contributing to the Lancet Series on Malaria Elimination as well as to the 5th report in Roll Back Malaria’s Progress & Impact Series.

CDDEP is known as a pioneer in researching Multiple First-line Therapies as a means of slowing the spread of drug resistance to antimalarials.

Key Researchers

Ramanan Laxminarayan is director and senior fellow at the Center for Disease Dynamics, Economics & Policy. He is also visiting scholar and lecturer at Princeton University. His research deals with the integration of epidemiological models of infectious diseases and drug resistance into the economic analysis of public health problems. He has worked to improve understanding drug resistance as a problem of managing a shared global resource. Laxminarayan has worked with the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (WHO) and the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...

 on evaluating malaria treatment policy, vaccination strategies, the economic burden of tuberculosis, and control of non-communicable diseases. He has served on a number of advisory committees at WHO, Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

, and the [Institute of Medicine]. In 2003-04, he served on the National Academy of Science/Institute of Medicine Committee on the Economics of Antimalarial Drugs and subsequently helped create the Affordable Medicines Facility- malaria (AMFm), a novel financing mechanism for antimalarials. Laxminarayan received his undergraduate degree in engineering from the Birla Institute of Technology and Science in Pilani, India, and his master’s degree in public health (Epidemiology) and doctorate in economics from the University of Washington in Seattle.

Hellen Gelband focuses on health policy issues in the United States and internationally. During her career, she has used the evaluation of medical evidence to inform a wide range of both American and global health policies. Her work at CDDEP explores the growing resistance to antibiotic and anti-malarial drugs, as well as access to and cost of such pharmaceuticals. She is coordinating the Global Antibiotic Resistance Partnership – a project that will establish centers in five developing countries to foster rational policies governing the use of antibiotics. Gelband spent 15 years at the Congressional Office of Technology Assessment and ten years at the Institute of Medicine of the National Academies. She also has worked for the World Health Organization, the University of Oxford, Doctors without Borders, and a number of foreign governments and U.S.-based consulting companies.

David L. Smith’s work focuses on the ecology, epidemiology, and economics of infectious diseases. The majority of his research is on malaria and the policy-oriented science related to its outbreak, spread and management. He also works on other emerging diseases, including influenza, rabies, and methicillin-resistant Staphylococcus aureus (MRSA). He has worked on problems such as the development of resistance to anti-malarial drugs and bacterial resistance to antibiotics. With regard to malaria, his work focuses on fine-tuning policy strategies for deploying multiple drugs --- such as highly effective artemisinin-based combination therapies for malaria --- so as to increase their treatment effectiveness while also decreasing opportunities for the pathogen to develop resistance to an individual drug.

Anup Malani is a Professor of Law at the University of Chicago
University of Chicago
The University of Chicago is a private research university in Chicago, Illinois, USA. It was founded by the American Baptist Education Society with a donation from oil magnate and philanthropist John D. Rockefeller and incorporated in 1890...

. He is also a Research Affiliate for the Joint Center for Poverty Research at Northwestern University and the University of Chicago. Mr. Malani teaches, among other classes, Health Law, Corporations, and Bankruptcy. His research examines the control of infectious disease, placebo effects, antibiotic resistance, medical malpractice
Medical malpractice
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and...

 liability, and the conduct of and inferences from medical trials. Mr. Malani graduated from the University of Chicago Law School in 2000. He clerked for the Hon. Stephen F. Williams, U.S. Court of Appeals for the D.C. Circuit in 2000-2001 and for U.S. Supreme Court Justice Sandra Day O'Connor in 2001-2002. Mr. Malani received a Ph.D. from the University of Chicago's Department of Economics in 2003. Between 2002 and 2006, Mr. Malani was an Associate Professor at the University of Virginia Law School and the Health Evaluation Sciences Department of the University of Virginia Medical School.

Dean Jamison
Dean Jamison
Dean Jamison is an economist and global health researcher. He is a professor of global health at the University of Washington in Seattle and is on the faculty at the Institute for Health Metrics and Evaluation . He has also been on the faculty at UCLA, Harvard, University of California, San...

 is a Professor of Global Health at the University of Washington. Concurrently, he is Adjunct Professor at both the Peking University Guanghua School of Management and at the University of Queensland School of Population Health in Australia. Before joining CDDEP and the University of Washington, Dr. Jamison served as T & G Angelopoulos Visiting Professor of Public Health and International Development in the Harvard Kennedy School and the Harvard School of Public Health, while in tandem holding a position as Professor of Development Economics at the University of California, San Francisco. Prior to that, Dr. Jamison was at the World Bank for more than a decade, where he was a senior economist in the research department, division chief for education policy, and division chief for population, health and nutrition. In the 1990s, he temporarily rejoined the World Bank to serve as Director of the World Development Report Office and as lead author for the bank’s 1993 World Development Report, Investing in Health. In 1994, Dr. Jamison was elected to membership in the Institute of Medicine of the U.S. National Academy of Sciences. He has served frequently on advisory groups to national and international organizations. Jamison recently led the Disease Control Priorities Project, for which he was senior editor of Disease Control Priorities in Developing Countries, 2nd edition, and an editor of Global Burden of Disease and Risk Factors, both published by Oxford University Press in 2006.

See also

  • Resources for the Future
    Resources for the Future
    Resources for the Future is a nonprofit organization that conducts independent research into environmental, energy, and natural resource issues, primarily via economics and other social sciences. Headquartered in Washington, D.C., RFF performs research around the world...

  • Malaria Atlas Project
    Malaria Atlas Project
    The Malaria Atlas Project, abbreviated as MAP, is a non-profit project primarily funded by the Wellcome Trust, UK. MAP is a joint project between the Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine, Kenya and the Spatial Ecology & Epidemiology Group, University of...

  • Bill & Melinda Gates Foundation
    Bill & Melinda Gates Foundation
    The Bill & Melinda Gates Foundation is the largest transparently operated private foundation in the world, founded by Bill and Melinda Gates. It is "driven by the interests and passions of the Gates family"...

  • Robert Wood Johnson Foundation
    Robert Wood Johnson Foundation
    The Robert Wood Johnson Foundation is the United States' largest philanthropy devoted exclusively to health and health care; it is based in Princeton, New Jersey. The foundation's mission is to improve the health and health care of all Americans...


External links

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