ABSTRACT
Cost–benefit analysis is usually part of risk governance and, more specifically, of risk assessment activities. However, the level of uncertainty, the availability of data, the time pressure and power games may render this analysis challenging for global pandemic risks and even unethical when human lives are at stake. This chapter explores how costs and benefits are taken into account when selecting and implementing mitigation strategies against the A(H1N1) influenza pandemic. We applied a qualitative approach that combined studying official documentation, conducting semi-structured interviews with decision makers and experts, and collecting key financial data in Switzerland, Japan and the United States. We developed a grid of analysis to systematically compare the interview transcripts. We show that decision makers and experts are knowledgeable about the medical effectiveness of measures but lack cost information at the time decisions are made. Public authorities assume that current budget lines (and their allowable extensions in case of emergencies) will absorb overspending. Financial commitments are not an issue as long as front-line institutions have the cash available to purchase materials and hire the required personnel. We conclude that, in high-income countries, information on the cost of measures plays only a minor role in shaping the A(H1N1) response and public expenditures analysis is mostly performed ex post to justify and evaluate the use of public funds. Our findings therefore question the ability of decision makers to re-assess the true efficiency of all possible interventions during a longer and/or more severe pandemic and to allocate resources effectively among health issues.
