Global Surveillance and the Value of Information: The Case of the Global Polio Laboratory Network
by Esther de Gourville, Radboud J. Duintjer Tebbens, Nalinee Sangrujee, Mark A. Pallansch, and Kimberly M. Thompson, Risk Analysis 2006;26(6):1557-1569

Abstract

Effective control and eradication of diseases requires reliable information from surveillance activities, including laboratories, which typically incur real financial costs. This article presents data from a survey we conducted to estimate the costs of the Global Polio Laboratory Network (GPLN), which currently supports aggressive global surveillance for acute flaccid paralysis (AFP) to detect circulating polioviruses. The Global Polio Eradication Initiative (GPEI) of the World Health Organization (WHO) provides resources for some of the laboratory network costs, but the total cost of the network remains relatively poorly characterized given the limited documentation of national contributions. We surveyed network laboratories to quantify AFP surveillance support costs and provide data for cost estimates of potential posteradication surveillance policies related to the laboratories. We estimate that the GPLN currently requires millions (US dollars 2002) in total support annually, and that half of the support for national and regional reference laboratories comes from external donors through the WHO or bilateral agreements and half from within nations that host those laboratories. The article also presents the framework for considering the value of information from this global surveillance network and suggests that the expected value of surveillance information from the GPLN currently exceeds its costs. We also provided important insights about how the value of information may change after successful eradication of wild polioviruses.

Corrections to printed article: Page 1564, right column, lines 14-15 should say: "Thus, E(N)=pC4+(1-p)C1 and E(Y)=pC2+(1-p)C3,..." and page 1565, first equations on the page should be: "E(N)=pC4+(1-p)C1 (choose N if p<p*) E(Y)=pC2+(1-p)C3 (choose Y if p>p*)."

Answers to frequently asked questions

What are the study’s main findings?
What are the study’s main recommendations?
Background on polio

What are the study’s main findings?

• Based on a survey among the laboratories of the global polio laboratory network (GPLN), we estimate annual costs for running the network of over $20 million (US$2002).
• Half of the support for national and regional reference laboratories comes from external donors through the WHO or bilateral agreements and half from within nations that host those laboratories.
• Using a framework for considering the value of information from this global surveillance network, the expected value of surveillance information from the GPLN currently exceeds its costs. Decisions about future changes to the surveillance network could benefit from taking a similar value of information perspective.
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• Applying a value of information approach for each laboratory within regions and/or individually might help to support decisions about transitions in the structure relative to the information that the GPLN provides.
• The GPLN should recognize opportunities to utilize personnel and laboratory infrastructure to support other public health activities and maximize the benefits of the investment made to date through the GPEI. At the same time, programs to support surveillance of other diseases may need to subsidize some ongoing and future efforts for polio surveillance.
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