A working paper for CGD with Mallika Snyder. The Sustainable Development Goals are an ambitious set of targets for global development progress by 2030 that were agreed by the United Nations in 2015. Amongst the 169 targets are a number that call for universal access, universal coverage, or universal eradication. These include ending extreme poverty and malnutrition alongside preventable under-5 deaths, ending a number of epidemics, providing universal access to sexual and reproductive health services, primary and secondary education, a range of infrastructure services, and legal identification. These have often been labeled “zero targets.” A review of the literature on meeting these zero targets suggests very high costs compared to available resources, but also that in many cases there remains a considerable gap between financing known technical solutions and achieving the outcomes called for in the SDGs. In some cases, we (even) lack the technical solutions required to achieve the zero targets, suggesting the need for research and development of new approaches.
A CGD Policy Paper with Kim Elliott and Janeen Madan. While the misuse of antimicrobials in human health is a key factor accelerating the emergence of drug resistance, we should not overlook the role of agriculture. In the livestock sector, a significant portion of antimicrobials are provided in subtherapeutic doses over long periods of time to speed growth and prevent disease, rather than to treat illness. Currently, the United States and countries across Europe are major users of antimicrobials in livestock, but there is rapid growth in key developing countries. Following the recent discovery of a bacterial gene in pigs and people that conveys resistance to a last resort antibiotic drug, addressing agriculture’s contribution to antimicrobial resistance is more urgent. Moreover, the fact that the gene was discovered within a relatively short time in both China and the United States underscores the global nature of the problem. Drug resistant superbugs do not respect borders. To date, however, there has been little concrete action at the global level.
This paper makes the case for a global treaty to reduce antimicrobial use in livestock. We propose that negotiations could begin with the two dozen or so key countries that account for the majority of global antimicrobial use in farm animals. This could help make significant inroads into the problem, even as those countries work to expand the treaty’s membership. Drawing on lessons learned from the Montreal Protocol on Substances that Deplete the Ozone Layer, the paper outlines a framework for a global treaty to reduce livestock’s contribution to the health threat posed by the spread of antimicrobial resistant bacteria.
A working paper with Justin Sandefur, Sarah Dykstra and Amanda Glassman. Since 2001, an aid consortium known as Gavi has accounted for over half of vaccination expenditure in the 75 eligible countries with an initial per capita GNI below $1,000. Regression discontinuity (RD) estimates show aid significantly displaced other immunization efforts and failed to increase vaccination rates for diseases covered by cheap, existing vaccines. For some newer and more expensive vaccines, i.e., Hib and rotavirus, we found large effects on vaccination and limited fungibility, though statistical significance is not robust. These RD estimates apply to middle-income countries near Gavi's eligibility threshold, and cannot rule out differential effects for the poorest countries. There's a policy brief that's an easier read.