title: Incentives for reporting disease outbreaks.
abstract: BACKGROUND
  Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines.
  
  
  METHODS
  We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO) from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO.
  
  
  RESULTS
  We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased.
  
  
  CONCLUSIONS
  These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, D. C., United States of America; Princeton University, Princeton, New Jersey, United States of America; Public Health Foundation of India, ISID Campus, Institutional Area, Vasant Kunj, New Delhi, India.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
authors.affiliation: Department of Finance and Institute of Government and Public Affairs, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America.
authors.forename: Julian
authors.initials: J
authors.lastname: Reif
authors.affiliation: Law School and Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America; Center for Disease Dynamics, Economics & Policy, Washington, D. C., United States of America.
authors.forename: Anup
authors.initials: A
authors.lastname: Malani
mesh_terms: D000349:Africa / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D014943:Global Health / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D033181:Information Dissemination; D007391:International Cooperation; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D011159:Population Surveillance; D014611:Vaccination; D014944:World Health Organization
chemical_list: D022401:Meningococcal Vaccines