| The SARS (severe acute respiratory pneumonia, SARS) haze in2003has not completely subsided, H1N1influenza in Mexico spread worldwide. About55million people die each year in the world according to the report of World Health Organization (WHO), a quarter of them die of infectious diseases. The new cases of malaria worldwide in2010is over23.57million and33million people died; approximately8.8million new TB cases and1.45million people died;2.7million additional people living with HIV, and thus bring the total number of HIV more than34million. As development of economic globalization, scale of people and things mobility is expanding, and frequency is speeding up, which makes infectious diseases globalization. Welfare losses caused by infectious diseases are increasing while it’s become more difficult to control and eliminate infectious diseases. It is estimated that the outbreak of mad cow disease in1995caused a loss of＄5.75billion of the UK economy. In2003, the outbreak of SARS resulted in huge economy loss of30billion U.S. dollars for the global trade, tourism and services industry. Especially, in China and Canada, the enormous economic losses caused by SARS accounted for1%of their GDP. The GDP of sub-Saharan Africa and Central regions had decreased by20%or more by the year of2010, which caused by the loss of manpower due to the HIV/AIDS and Malaria. The annual cost for the treatment is more than120billion U.S. dollars in America even if the number of suffers is small relatively.The whole world has never stopped the fight against infectious diseases because their serious consequences. Although personal health is not public goods, but an important external nature feature of health is public goods. Prevention of personal infectious diseases was apparently in favor of other people associated, and by reducing the risk of infection generates positive externalities on others. The same is true among nations. However, its effect on infectious disease control is non-competitive, it requires both exclusive supply inputs, such as vaccination and clean water, etc., and also need to put non-exclusive investment, such as prevention knowledge, the best treatment methods, etc. Both investment supplies are insufficient. The most direct cause of global infectious disease control supply shortage is the lack of funds; the establishment of effective financing mechanisms is the key to guarantee sufficient funds and stability. In recent years, despite the raising mechanism is innovative, from the initial bilateral donors to the public-private partnership established, financing a lot of money for global infectious disease control. But there is still a funding gap and presents increasing trend. To the Global Alliance for Vaccines and Immunization (The Global Alliance for Vaccines and Immunizations, GAVI), for example, in the10years between1999-2008, the Global Alliance for Vaccines and Immunization has received public and private sector＄3.8billion in cash and commitments of donors, and State funding has been made to meet the standards financed＄2.7billion. But from2009to2015, the Global Alliance for Vaccines and Immunization need total funding＄8.1billion, of which the existence of a funding gap of about＄3billion. Obviously, adequate funding is the first step in global infectious disease control. Only with sufficient fund, measures of infectious disease prevention and control can be in order, and then infectious diseases drugs can be produced and used in the treatment, the prevention and control of infectious diseases processes can to be continued. We must establish an effective disease control funding mechanism to ensure adequate stable and sustainable funding. Which several parts are the financing mechanisms composed of? With economic development, strengthening of international trade and integration, what is the evolution of the main infectious disease control? What are the financing and funding sources? What are the factors of affecting the funding mechanisms? What are the Global Polio and AIDS controlling funding mechanisms? How are funding mechanisms? How to optimize the financing mechanism for global infectious disease control?Based on the above issues, the perspective in this paper is the global public goods supply. Through the establishment of global funding mechanism analysis framework, combing the financing subjects, the evolution history of financing and sources of funds, analyzing financing mechanisms of Polio and AIDS in order to optimize the global infectious disease control funding mechanisms and providing policy recommendations.The paper is divided into seven chapters, Chapter1is an introduction and Chapter2-3is the basis of an analysis of the article. The Chapters4to7are historical research, influencing factors, typical cases and policy recommendations in the funding mechanism in the control of infectious diseases. For particular description:Chapter1is an introduction. It mainly includes putting forward the topic, the definition of the main concepts, research framework and content, research methods, innovation and deficiencies, etc.Chapter2is a literature review. It combs theoretical and empirical studies about the definition and classification of global public goods, supply of global public goods financing and financing in communicable disease control. It also makes a brief review of them.Chapter3analyzes the theory of infectious disease control and optimizing in the funding mechanisms. This chapter includes four parts:Firstly, phase characteristics of global infectious disease control and public goods property, the article divides phase characteristics into prevention phase and treatment phase, and analyses phase characteristics and public goods property. Secondly, essential factors analysis of financing mechanisms in the global infectious disease control, the article divides the financing mechanisms into financing subjects, financing methods, funding sources and incentive mechanism. Thirdly, global infectious disease control financing mechanism influencing factors, introducing economic and social influencing factors. Fourthly, performance evaluation of global infectious disease control financing mechanism, designing index system of financing mechanism performance evaluation and introducing calculating efficiency methods.Chapter4refers to the historical survey of the global financing mechanisms for infectious disease control. In the beginning of this chapter, financing mechanisms’ implementation is divided into three phases in principle-voluntary supply and government leading phase (before1950s), international organization leading phase (1950s-80s), and diversified financing phase (since1980s), in each of which the basic characteristics of financing mechanisms and their elements are summarized. Then the main factors affecting financing mechanisms in the diversified financing phase are analyzed. The econometric result shows that there may be a degree of substitution effect between its own funds and foreign funds in a country. With a country’s economic boost, the leading forces in the fight against infectious diseases shift gradually from international to domestic. The development of national economy and the establishment of a perfect infectious disease surveillance, early warning, prevention and control system are the key measures of controlling global infectious diseases.Chapter5presents the first financing mechanism of the global infectious disease control-an example of polio. Firstly, polio financing mechanism is divided into two phases-before and after the use of the vaccines. Also the characteristics of each phase and four elements of financing mechanisms are presented. The result shows government is the major financer before the use of the vaccines and fiscal appropriation and charity donations become the main sources of funds. But there are obvious differences in financing mechanisms, in the phase of vaccine’s development, industrialized countries’ eradication of polio, and global cooperation. International organizations and charities take on the leadership role. Secondly, the chapter conducts a performance evaluation on financing mechanisms. The result indicates that from a qualitative point of view, GPEI needs to be strengthened in reducing the risk of financing and maintaining the stability of funding sources. And from a quantitative point of view, GPEI financing mechanism works well, except the necessity to reduce the total financing cost, especially personnel expenses and administrative expenses, for the purpose of improving its economy and efficiency.Chapter6presents the second financing mechanism of the global infectious disease control-an example of AIDS. In the beginning, the Chapter analyzes the phase characteristics of the global AIDS control and its characteristics of public goods. Besides, it analyzes the funding mechanisms of AIDS control and prevention phase, as well as its treatment phase. The result reveals that unlike polio, there are two features of global AIDS control. First, a vaccine to prevent AIDS has not been developed, so AIDS treatment costs account for the majority of funds. Secondly, AIDS is somewhat regional, making AIDS funding mechanisms focus on how to motivate industrialized countries and relevant companies to develop vaccines, especially the development of vaccines specifically for African countries. Finally, a performance evaluation on AIDS financing mechanisms is made. The result indicates that from a qualitative point of view, UNAIDS needs to keep financing activities long-term and sustainable, maintain stable and diversified funds sources, and enhance the superiority of ways to finance. And from a quantitative point of view, UNAIDS financing mechanism works well, except the necessity to reduce the total financing cost, especially personnel expenses, for the purpose of improving its economy and efficiency.Chapter7is about the optimal directions of financing mechanisms in the global infectious diseases control. The optimizing direction is to reducing the total financing cost and raising the total financing income which aims at improving the operating performance of financing mechanisms. In order to raise more income, we should construct multi-level financers, explore new ways of financing, find stable sources of funding,and innovate in incentive and restraint mechanisms. At the same time, enhance the public nature of financing mechanisms by adjusting the allocation structure of the funds and allocating more resource to developing countries which is the responsibility of international organizations.This paper tries to innovate in the following aspects:Firstly, from the perspective of global public goods research, this paper analyzes the financing mechanisms and their elements of global infectious disease control. The result shows when global infectious diseases phases shift from the prevention phase shift to the treatment phase, its public goods characteristic is weakened, which changes the structure of financers from single to diversity. Taking polio and AIDS as examples, the paper analyzes the differences in financing mechanisms designed for global infectious diseases control, under different skill levels. This paper argues that the focuses on financing mechanisms in the two cases are promotion of vaccines (polio) and the research and development of vaccines (AIDS), respectively. Secondly, this paper uses the panel data model to analyze the factors affecting financing mechanisms for global infectious diseases control. Empirical result indicates the incidence of infectious diseases in a country has a significant amount of positive effects with its access to official development assistance (ODA), while the effect on the country’s spending on infectious diseases per capita is not significant. Real GDP per capita, measuring the level of a country’s economic development, is negatively correlated with ODA, although not significant. And Real GDP per capita is significantly positively correlated with per capita expenditure on infectious diseases of this country. Therefore, Substitution effect may exist between a country’s own funds and foreign funds in a degree. With the economy of a country boosting, the leading forces in the fight against infectious diseases shift gradually from international to domestic. The development of national economy and the establishment of a perfect infectious disease surveillance, early warning, prevention and control system are the key measures of controlling global infectious diseases.Thirdly, this paper establishes a qualitative index system of the performance evaluation of financing mechanisms for global infectious diseases control, including financers, way of financing, sources of funds and incentive and restraint mechanisms. Meanwhile, it estimates the efficiency of GPEI and UNAIDS financing mechanisms with non-parametric analysis (data envelopment analysis). The result shows that from a qualitative point of view, GPEI needs to work on reducing the risk of financing and maintaining the stability of funding sources and UNAIDS needs to keep financing activities long-term and sustainable, maintain stable and diversified funds sources, and enhance the superiority of ways to finance. From a quantitative point of view, GPEI and UNAIDS financing mechanisms work well, but they should reduce the total financing cost, especially personnel expenses and administrative expenses, for the purpose of improving its economy and efficiency.Fourthly, the purpose of optimizing financing mechanisms for global infectious diseases control is not only to improve the operation performance of financing mechanisms, but also to strengthen their public nature. Firstly, popularize health knowledge systematically, and especially ensure that developing countries can enjoy the interests brought by the advances in medical technology. And enhance the public nature of financing mechanisms. Secondly, as for the allocation of funds, international organizations should try to tilt the limited resources to developing countries, to help developing countries build domestic health infrastructure for delivering vaccines managing the treatment and supervising diseases and deaths, and improve their ability to control infectious diseases. |
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