Abstract

How do global disease control priorities emerge? This paper examines the post-World War II histories of efforts to control three diseases – polio, malaria and tuberculosis – to investigate this issue. The paper draws from the policy studies literature to evaluate three models of the priority generation process. A rational model suggests logical selection based on global burden and the availability of cost-effective interventions. An incremental model suggests a drawn out process in which health priorities emerge gradually and interventions reach affected populations through slow diffusion. A punctuated equilibrium model suggests a more complex pattern: long periods of stability during which interventions are available only to select populations, punctuated by bursts of attention as these interventions spread across the globe in concentrated periods of time.

The paper finds that the punctuated equilibrium model corresponds most closely to efforts to control these three diseases. Bursts are associated with the convergence of three conditions: the widespread acceptance of the disease as a threat; a perception that human interventions can control disease transmission; and the formation of a transnational coalition of health actors concerned with fighting the disease. The generation of each condition requires considerable groundwork, the reason for long periods of stability. Initiatives take off rapidly when the conditions couple, the reason for bursts. The paper aims to spark additional research on the subject of global disease control agenda setting, a neglected issue in the health policy literature.