A measles outbreak in the Federated States of Micronesia (FSM) in 2014, causing nearly 400 confirmed cases, cost nearly US$4 million (around US$10,000 per case), 88% of which was for a mass vaccination campaign, outbreak investigations, and other containment costs. While the U.S. government covered 2/3 of the costs, the economic burden to FSM — in labor and other costs of containing the outbreak, the direct costs of illness, and productivity losses — were the equivalent of the country’s entire education budget for one year.
According to the World Bank, the economic impact of the 2014-15 Ebola epidemic outlasted the epidemiological impact of outbreak, resulting in estimated losses of US$2.8 billion in Guinea, Liberia, and Sierra Leone (or 16% of their combined GDP).
Two meningococcal meningitis outbreaks in Brazil resulted in US$128,000 (9 cases, 2007) and US$34,000 (3 cases, 2011) in direct costs to the health system to investigate cases and manage the outbreak (including emergency vaccination). The investigation and response activities related to the 2011 outbreak alone cost $11,475 per case, and an additional $6,600 overall for supplemental disease surveillance activities.
The US state of Iowa incurred more than US$140,000 in direct costs of outbreak containment stemming from a single case of measles in an unvaccinated student infected overseas. Swift containment procedure limited the outbreak to 3 additional cases but included significant and costly steps including tracking down contacts of the infected student, establishing a measles information hotline, testing exposed medical staff for immunity, conducting measles vaccination clinics, and putting quarantines into effect.
Although even small outbreaks of highly contagious diseases can be exceedingly costly to contain, the value of containment to society is very high. Traditional economic evaluations of outbreaks which include just the costs of illness to individuals should be expanded to include the costs and value of containing the outbreak required to protect society.
A large meningococcal meningitis epidemic in Burkina Faso cost the health system an estimated US$7.1 million, representing nearly 2% of the country’s entire annual health budget.
In this study of a 2007 outbreak, 86% of the health system cost covered a reactive vaccination campaign using older polysaccharide vaccines. Routine vaccination with new, conjugate vaccines are expected to prevent or limit future outbreaks and thus reduce these costs.