In this review, we examine how to strengthen the cost-effectiveness of developing medical countermeasures (MedCMs) for rare but high-impact biological threats, using the 2014–2016 Ebola outbreak as a case study. The article explains why free-market incentives underdeliver for CBRN MedCMs: long, risky, and expensive R&D; uncertain regulatory paths (e.g., reliance on animal efficacy); scarce patients; and a quasi-monopsony buyer landscape—all of which depress expected returns and delay availability. Public funding and targeted incentives are therefore essential. The authors trace how Ebola’s unprecedented scale, cross-border risks, and macroeconomic disruptions reframed the investment case, spurring BARDA and international partners to fund vaccines, therapeutics, diagnostics, and manufacturing—while initiatives like CEPI and the World Bank’s PEF sought to close financing gaps and accelerate preparedness.
The paper argues that traditional cost-effectiveness metrics (e.g., DALYs tied to local GDP) can underweight rare, catastrophic threats and miss wider political, geostrategic, and economic spillovers. It recommends broader demand-side logic: treat priority MedCMs as global public goods; diversify funding (taxation, bonds/insurance, auctioned incentives like priority review vouchers); and design sustainability via dual-use products (peacetime + CBRN), shelf-life extensions, platform technologies, and vendor-managed inventory. The core message: timely, internationally coordinated investment in MedCMs costs far less than crisis-driven response and recovery—and materially reduces human, economic, and security risks when the next outbreak hits.
Johnson, M. L. et al. (2017). Strengthening to Cost… Pharmaceutical Medicine, 31(6), 423–436.
