Concealing Disease: Trade and Travel Barriers and the Timeliness of Outbreak Reporting

Abstract

Slow outbreak reporting by states is a key challenge to effectively responding to global health emergencies like Zika, Ebola, and H1N1. Current policy focuses on improving domestic outbreak surveillance capacity globally in order to reduce reporting lags. However, governments also face economic and political incentives to conceal outbreaks, and these incentives largely are ignored in policy discussions. In spite of the policy implications for outbreak response, the "capacity" and "will" explanations have not been systematically examined. Analysis of a dataset coding the timeliness of outbreak reporting from 1996-2014 finds evidence that states' unwillingness to report-rather than just their inability-leads to delayed reporting. The findings suggest that though building surveillance capacity is critical, doing so may not be sufficient to reduce reporting lags. Policy aimed at encouraging rapid reporting must also mitigate the associated economic and political costs.

Keywords: World Health Organization; compliance; disease outbreaks; global health; international organizations.

Figure 1.

Ratios of simulated hazard rates of reporting for states with high trade exposure to those with low exposure, states facing domestic political opposition to those not facing opposition, states with high internet coverage to those with low coverage, and states with high health spending to those with low spending. In the case of domestic political opposition, “low” and “high” refer to 0 and 1. For all of the other variables, “low” and “high” refer to the first and third quartiles.

Figure 2.

Ratios of simulated hazard rates of reporting for states with large tourism sectors (third quartile) to those with small tourism sectors (first quartile) at increasing levels of internet coverage.