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Health economics, Applied econometrics, Epidemiological and economic simulation modeling, Impact evaluation, AIDS.
Mead Over is a senior fellow at the Center for Global Development researching economics of efficient, effective, and cost-effective health interventions in developing countries. Much of his work since 1987, first at the World Bank and now at the CGD, is on the economics of the AIDS epidemic. After work on the economic impact of the AIDS epidemic and on cost-effective interventions, he co-authored the Bank’s first comprehensive treatment of the economics of AIDS in the book, Confronting AIDS: Public Priorities for a Global Epidemic(1997,1999). His most recent book is Achieving an AIDS Transition: Preventing Infections to Sustain Treatment (2011)in which he offers options, for donors, recipients, activists and other participants in the fight against HIV, to reverse the trend in the epidemic through better prevention. His previous publications include The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand (2006). Other papers examine the economics of preventing and of treating malaria. In addition to ongoing work on the determinants of adherence to AIDS treatment in poor countries, he is working on optimal pricing of health care services at the periphery, on the measurement and explanation of the efficiency of health service delivery in poor countries and on optimal interventions to control a global influenza pandemic.
In addition to his numerous research projects at the Center, Over currently serves as a member of PEPFAR’s Scientific Advisory Board and as a member of the Steering Committee of the HIV/AIDS modeling consortium funded by the Bill & Melinda Gates Foundation.
Recruited to the World Bank as a Health Economist in 1986, Mead Over advanced to the position of Lead Health Economist in the Development Research Group, before leaving the World Bank to join the Center for Global Development in 2006. Each spring since 2005, he has taught a module on “Modeling the Cost-Effectiveness of Interventions against Infectious Diseases” as part of the master’s degree program in health economics for developing countries at the Centre d'Etudes et de Recherches sur le Développement International (CERDI) at the University of the Auvergne, Clermont-Ferrand, France.
"Evaluating the Impact of Organizational Reforms in Hospitals," with Naoko Watanabe, Chapter 3 in A. Preker and A.Harding (eds.) Innovations in health service delivery: The corporatization of public hospitals. World Bank, March 2003
You’ve probably already heard about the pharma outrage du jour. In short: start-up Turing Pharmaceuticals, led by combative ex-hedge fund manager Martin Shkreli, recently acquired Daraprim, a 60+ year-old drug to treat a parasitic infection called toxoplasmosis – the only available treatment for this rare infection – which can become deadly for HIV+ individuals and others with weakened immune systems. Turing then promptly raised the price by more than 5000%, from $13.50 to $750 per tablet, such that a single individual’s treatment can now cost up to $634,000.
Remarkable progress has been made in the global fight against HIV/AIDS. The number of people receiving treatment in low- and middle-income countries increased from 300,000 in 2003 to 13.7 million in 2015, including 7 million supported by the United States. These gains are primarily attributable to a 2003 US government initiative called PEPFAR (the President’s Emergency Plan for AIDS Relief) that provided major new multiyear funding for global HIV/AIDS and created a new entity, the Office of the Global AIDS Coordinator, headed by an ambassador-rank Global AIDS Coordinator who is authorized to allocate PEPFAR’s resources and coordinate all US bilateral and multilateral activities on HIV/AIDS.
However, without dramatic changes to PEPFAR, the next president risks being held responsible for the failure of a program that until now has been one of the United States’ proudest foreign assistance achievements. And because PEPFAR is a major component of US foreign assistance spending, the next president’s choices about PEPFAR will heavily influence any subsequent assessments of his or her humanitarian foreign assistance policies.
In this series of briefs, Center for Global Development experts present concrete, practical policy proposals that will promote growth and reduce poverty abroad. Each can make a difference at virtually no incremental cost to US taxpayers. Together, they can help secure America’s preeminence as a development and security power and partner.
The South African government is currently discussing various alternative approaches to the further expansion of antiretroviral treatment (ART) in public-sector facilities. Alternatives under consideration include the criteria under which a patient would be eligible for free care, the level of coverage with testing and care, how much of the care will be delivered in small facilities located closer to the patients, and how to assure linkage to care and subsequent adherence by ART patients.
Five million people in poor countries are receiving AIDS treatment, but international AIDS policy is still in crisis. This book shows how to reach an “AIDS transition,” which would keep AIDS deaths down by sustaining treatment while pushing new infections even lower, so that the total number of people living with HIV/AIDS finally begins to decline.
The January 12th earthquake in Haiti is the most lethal natural disaster of the past 20 years. On February 12th, the Associated Press reported that official Haitian government estimates of the dead had been revised upwards, now reaching 230,000 dead. Furthermore, the number could be much higher, since the government admits they have not yet been able to count all the bodies and they have excluded those buried by families or in private cemeteries. As the figure below shows, this new total surpasses the 225,000 dead in the 2004 Indian Ocean tsunami, and dwarfs the death tolls from recent earthquakes in Pakistan-controlled Kashmir and Sichuan, China.
Last year, PEPFAR submitted guidelines which encouraged country staff to submit a proposal to conduct an “impact evaluation” (IE) as part of their annual Country Operation Plan (COP). Subsequently, they received four submissions, of which three were funded. But they also learned that many PEPFAR staff – who are mostly program implementers, or the managers of program implementers – didn’t fully understand what they were being asked to do; what does PEPFAR mean by “impact evaluations”?
This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. We ultimately provide a synthesis to guide policy makers as to when and how 'results-based' incentive contracts can be used in practice.
Counting the number of patients on treatment is no longer enough. For years even the friendliest critics of the global struggle against AIDS have pointed out that this metric unfairly neglects the people who are not put on treatment and then die, largely because their deaths are uncounted except in so far as they increase the treatment “coverage rate.” This diverts attention from the challenge of assuring that patients are retained on treatment and remain alive and healthy, rather than failing treatment and dying, sometimes after only a few months.
The Center for Global Development presents a seminar and discussion on
Prices, Diagnostic Tests and the Demand for Malaria Treatment: Evidence from a Randomized Trial
Harvard School of Public Health & Brookings Institution
With discussantRachel Nugent
Center for Global Development
Moderated by Mead Over
Center for Global Development Tuesday, June 29, 201012:00pm--1:30pmA light lunch will be served
atCenter for Global Development Lobby-level Conference Center1800 Massachusetts Avenue, NW, Washington, DC
Summary: CGD recently issued a major report on global drug resistance. CGD’s working group pointed to inappropriate use of medicines as a major driver of drug resistance across all major developing country diseases. This seminar will present results of new research on how to reduce the overuse and misuse of anti-malarials through better diagnosis of malaria. Due to widespread parasite resistance and high costs of Artemisinin Combination Therapies (ACTs), fewer than 15% of children with malaria are treated with effective medicines. The Affordable Medicines Facility for malaria (AMFm) is an initiative to subsidize the bulk of the cost of ACTs to suppliers, in part by dramatically reducing the final price of ACTs to consumers in the retail sector, or drug shops (where malaria treatment is most commonly sought). However, because the majority of people seeking malaria treatment in drug shops have received no formal diagnosis, substantial increases in access to ACTs may lead to inappropriate utilization of the drug. A high rate of overtreatment with ACTs is problematic, wasting subsidy funds and potentially stimulating the evolution of resistance. This paper reports on a field experiment from Western Kenya in which subsidized ACTs, along with subsidized Rapid Diagnostic Tests (RDTs), were made available in drug shops. We explore whether the targeting of the ACT subsidy to people with confirmed malaria could be improved by creating financial incentives for individuals to be tested before purchasing ACTs.