The economics of malaria control: Opportunities, incentives, and risks on the road from control to elimination

What are the incentives for and against malaria control and elimination-related activities? This dissertation examines the question through both observation (of private actors engaged in malaria control at the levels of the firm, health programmes, and country) as well as direct inquiry (of malaria researchers and recipients of malaria control interventions). Results show that ample incentives exist to engage directly in malaria control: it can be profitable from a ledger perspective; uptake of and compliance with low-cost interventions appear high, which itself suggests that individuals are sufficiently incentivized to self-protect, thereby contributing to the positive externality of malaria control; and apart from the direct benefits to health, there are direct and indirect economic benefits for firms in regards to public relations. However, though incentives exist to engage in control, the evidence as a whole suggests that they are not sufficiently abundant or aligned to motivate scaled-up control efforts which could amount to country-level or regional elimination in endemic countries. Enthusiasm for ambitious investment in malaria control and elimination is tempered by scepticism over the expected value of those investments, not due to doubts over whether suppressing malaria would be widely beneficial, but rather due to doubts over the collective ability to suppress malaria. Those who design social corporate responsibility programs, as well as researchers whose work focuses on malaria, harbor a high degree of scepticism regarding the likelihood of near-term collective “success”, and therefore optimize programs to achieve returns at a rate prior to the point of diminishing returns. This dissertation shows that complexity may be an important element hindering increased engagement in malaria control activities not because it directly affects the incentives for control or elimination, but because it makes the perception of those incentives less clear. Complexity seeps into not only the costing of interventions, the optimizing of those interventions in complex human-animal dynamic situations, the quantification of the effectiveness of those interventions, but also the estimation of the expected value of those interventions. In turn, stakeholders engaged in malaria control and elimination-related activities (such as large foreign firms) may choose to “diversify” the corporate social responsibility portfolio,weighting more heavily towards those areas which are perceived to be less complex than malaria control and are also less binary in outcome than malaria elimination.