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1、PaUO1.nnValnsoosQ.2-qndPolicyResearchWorkingPaper10731MortalityCostsofandPolicyResponsestotheCOVID-19PandemicinCdted,IvoirePZOfnValnsoosQ.2-qndHemannPythagorePierreDotijbuetNdohASbhenSanogoJean-NoelAmantchiGogpuaOpopeOyakaTsbivuilaMatalaAdamaTraoreGastonSo砂。worldBankgroupHealth,NutritionandPopulatio
2、nGlobalPracticeMarch2024PolicyRESEARCHWorkingPaper10731AbstractCoted,Ivoire,thelargesteconomyintheWestAfricanEconomicandMonetaryrUnion,washitbyCOVID-19,whichclaimedmanylives.ThispaperestimatesCOVID-19mortalitycostsovertimeusingthevalueofastatisticallife.Usingamoreconservativeestimateofthevalueofasta
3、tisticallifeincomeelasticityrangingfrom1to1.4,theoverallCOVlD-19mortalitycostsinCotcd,IvoircsincethepandemicrangefromUS$100.4milliontoUS$284.3million.Consideringage-relatedadjustments,a3percentdiscountrate,andavalueofastatisticallifeincomeelastic-ityof1to1.4,theCOVID-19costsrangefromUS$5.4milliontoU
4、SS15.3million.Similarly,theCOVID-19mortalitycostsrangefromUSS6.8milliontoUS$19.3millionwitha5percentdiscountrateandavalueofastatisticallifeincomeelasticityof1to1.4.Moresignificantly,thefindingssuggestthatCOVID-19mortalitycostsstartedtodeclinein2021.Toenhanceprevention,preparedness,andresponsetofutur
5、epandemics,policymakerscouldconsiderallocatingpandemicfundingwithinnationalbudgets.Exploringpotentialpartnershipswithphilanthropicorganizationsandinternationalentitiescouldfurtherenhancedomesticresourcematchingefforts.ThispaperisaproductoftheHealth,NutritionandPopulationGlobalPractice.Itispartofalar
6、gereffortbytheWorldBanktoprovideopenaccesstoitsresearchandmakeacontributiontodevelopmentpolicydiscussionsaroundtheworld.PolicyResearchWorkingPapersarealsopostedontheWebatTheauthorsmaybecontactedathdonfbuetworldbank.org.TbcPoiityReseelopnentissues.Anol)jectieoftheseriesisto妒tbefindingoutquickly,eveni
7、ftbepresentationsarelessthanfullyf)olisbed.Thepaperscanythenamesoft!)tauthorsandshouldbecitedaccordingly.Tbefinding,interpretations,andconclusionsexpressedinthispaperareenfirefythose可theauthors.TheydonotnecrssarilyrrprvstrnttbeviewsoftbeInleniationalbankforReconstructionandDevtiopMenl/WorldBankandit
8、saffiliatedorganisation/,orthoseoftbeP,xecutheDireclcrsoftbeWorldBankortbepvmmentstheyrepresent.ProducedbytheResearchSupportTeamMortalityCostsofandPolicyResponsestotheCOVID-19PandemicinCoted,IvoireHermannPythagorePierreDonfouet1*,NdohAshkenSanogo1Jean-NoelAmantchiGogoua1,OpopeOyakaTshivuilaMatala1,A
9、damaTraore1,GastonSorgho1lTheWorldBankHealthNutritionandPopulationGlobalPractice,1818HStreet,NWWashington,D.C.20433USA.*Correspondingauthor,semail:hdonfouetworldbank.orgKeywords:COVID-19pandemic,valueOfstatisticallife.JE1.codes:D12,D61,I101. IntroductionSinceitsfirstcaseofCOVID-19,detectedonMarch11,
10、2020,Coted,Ivoirehasexperiencedrecurrentwavesofthepandemic,withthemostrecentendinginJanuary2022.TheresurgenceincaseshasbeendrivenbythespreadofhighlytransmissibleCOVID-19variants,lowCOVID-19vaccinationcoverage,increasingsocialinteractionsandtheinconsistentapplicationofpublichealthmeasures(e.g.,social
11、distancing,handwashing,andmaskwearing).Therewere88,064confirmedcasesofCOVID-19betweenJanuary3,2020,andFebruary15,2023(WHO.,2022).ThehighestincidenceofCOVID-19caseswasobservedinDecember2021duetotheOmicronvariant,whilethedeadliestwavewasassociatedwiththespreadoftheDeltavariantbetweenJulyandOctober2021
12、.AsofJanuary18,2024,atotalof835peoplehaddiedasaresultofCOVID-19.AlthoughthisnumberofdeathsmightnotseemhighcomparedtotheUnitedStates(US),whereCOVID-19isestimatedtohavecaused1,161,235deathsasofJanuary18,2024,themortalitycostsinCoted,Ivoiremightbehighforanationthatisstillworkingtobuildastrongandresilie
13、nthealthcaresystemandenhanceinclusiveandsustainableeconomicgrowth.Furthermore,sincethepandemicbegan,policymakersinCotedIvoirehavelackedevidenceofthelong-termdeathcostsassociatedwithCOVID-19.TheseestimatescouldgivepolicymakersaclearpictureofthemortalitycostsassociatedwithCOVID-19overtimeandhelpthemta
14、keaforwardapproachtobetterprevent,preparefor,andrespondtofuturepandemics.TheCOVID-19pandemichasspawnedaplethoraofresearcharticlesthatassessitscosts.AccordingtoanestimatebyCutlerandSummers(2020),thetotalcostofthepandemicintheUSisestimatedatmorethan$16trillion,orover90%ofthecountrysannualgrossdomestic
15、product.TheprematuredeathcostamountedtoUSS4.4trillion.InTiirkiye,Gokler&Metinta(2022)foundthattheprematuredeathcostduetoCOVID-19wasUS$227,396,694.EventhoughthesestudiesshedsomelightonthemortalitycostsassociatedwithCOVID-19,itisnotknownhowthesemortalitycostschangeovertime.1 COVID-19hasbeendescribedin
16、avarietyofwayssinceitsinception.Itwasreferredtoasapandemic,healthcrisis,publichealthemergencyofinternalconcern,anddisaster.Thecurrentstudyusesthebenefit-transfervalueofastatisticallife(VS1.)approachtoestimatetheCOVID-19mortalitycostsovertimeinCoted,Ivoire.Wealsoreviewthehealthpoliciesimplementedbypo
17、licymakerstocurbCOVID-19andproposeeffectivehealthpoliciestohelpthecountrybetterprevent,preparefor,andrespondtofuturepandemics.Inthenextsection,wedescribethemethodsusedtoestimatethemortalitycostsofCOVID-19overtimeinCoted,Ivoire.InSection3,resultsarepresentedwhereasinSection4,thefindingsarediscussedwi
18、thsomepolicyrecommendations.Section5concludes.2. MethodsInthispaper,WefirstestimatetheCOVID-19mortalitycostsinCotedIvoireusingtheVS1.,andthenconductadeskreviewtobetterunderstandthehealthpoliciesimplementedbypolicymakerstocurbCOVID-19.TheVS1.isanindividualsmarginalrateofsubstitutionbetweenmoneyandthe
19、riskofdyingoveragiventimeperiod(Hammitt,2000).TheVS1.representsthemonetaryvalueofriskreductionthatwouldsaveonestatisticallife,ratherthananidentifiedlifeThewordstatisticareferstosmallreductionsinthelikelihoodofdying.AsstatedbyCohenetal.(2015),statisticallivesarethosethatwillbelosttoknownriskfactorsin
20、thefutureunlessweintervene,butwhoseidentitieswewillneverknow,atleastforthetimebeing.Identifiedlivesarethosewhoseidentitieswecurrentlyknow.(Andersson,2008;1.isaARobinsonetal.,2019b).Weusethebenefit-transferVS1.approachtoestimatethemortalitycostsduetoCOVID-19overtimeinCoted11voire.Thebenefit-transferV
21、S1.approachextrapolatesfromvaluesfromhigherincomecountries,adjustingfordifferencesinincome,andtherateatwhichVS1.changesasincomechanges(incomeelasticityoftheVS1.).Thetransferisbasedon2013estimatesfortheUS.AllVS1.estimatesareadjustedforinflationusingtheGDPdeflator,aswellasforfuturechangesinrealincome.
22、WefollowbeststandardpracticesbytakingintoaccountthelowandcentralvaluesofVS1.(1.isaARobinsonetal.,2019a;1.isaARobinsonetal.,2019b).TheCOVID-19mortalitycostsarecalculatedbymultiplyingthetotalCOVID-19-relateddeathsbytheVS1.WeusethiscomputationtobetterunderstandthevalueofliveslostasaresultofCOVID-19over
23、time.TheVS1.forCoted,Ivoireisgivenbythefollowingformula:VS1.cotedlvoire=VS1.usa(淤鲁严(O-GNlUSA-WithVS1.cotedivoireancVS1.usa,theVS1.forCoted,IvoireandtheUnitedStates,respectively.TheGNIisthegrossnationalincome,andelasticityUsingdifferentincomeelasticityoftheVS1.values,weexaminetheuncertaintiesaroundth
24、eVS1.estimates.isthedegreeofchangeintheVS1.associatedwithachangeinincome.Furthermore,ageisconsideredbecauseCOVID-19hashadadisproportionatelynegativeeffectonelderlypeople.Asaresult,weestimateaconstantvalueperstatisticallifeyear(VS1.Y)(Aldy&Viscusi,2007).FollowingRobinsonetal.(2017a),wedividetheVS1.by
25、thediscountedexpectedlifeyearsremainingforanindividualattheaverageageofthepopulationbeingstudied.TheVS1.Y,whichisoftencalledthevalueofalifeyear,measureshowmuchpeoplearewillingtospendforachangeintheirlifeexpectancy.TheVS1.Yisgivenbythefollowingformula:T/CfV,-(cozedh，(Hre)Va1.i0tecIvore口-q+r)TIZrJWith
26、rand1.thediscountrateandtheremaininglifeexpectancy,respectively.Weapplythestandard3%discountrateandthe5%discountratethatHaackeretal.(2020)advisedforlow-andlower-middle-incomecountries.BasedoninformationfromtheWHOsGlobalHealthObservatoryDataRepository,weestimatethattheremaininglifeexpectancyishalfofC
27、oted,Ivoire,slifeexpectancyatbirth.TheCOVID-19mortalitycostsarecalculatedbymultiplyingtheVS1.YvaluesbythetotalnumberofdeathsassociatedwithCOVID-19.1.astly,wecarriedoutadeskanalysis(WorldBank.,2020a,b,2021,2022)tocomprehendthehealthpoliciesputinplacebypolicymakerstofightCOVID-19,andweprovideeffective
28、healthpolicyrecommendationstoassistthepolicymakersinCotedIvoireinbetterpreventing,preparingfor,andrespondingtofuturepandemics.Inthisstudy,weuseavarietyofdatasets.TheWHOdatabaseBasedondatafromtheWHOdatabase(atthetimeofwritingthispaper,therecordedCOVID-19deathsinCotedIvoirewereasfollows:134(2020),573(
29、2021),123(2022),and5(2023).ThecumulativetotalofCOVID-19deathsfrom2020to2023is835.InMay2023,theWorldHealthOrganization(WHO)liftedtheglobalhealthemergencydeclarationforCOVID-19.Furthermore,in2023,numerouscountriesdiscontinuedregulartrackingandreportingofnewCOVIDinfections.Asaresult,theyear2023isnotinc
30、ludedinthisstudy.providedtheCOVID-19data.ThelowandcentralvaluesoftheVS1.fortheUSarefromRobinsonetal.(2017b)andRobinsonandHammitt(2016).TheGNIandotherdatawereextractedfromtheWorldBankDevelopmentIndictors(WDI).3. Results3.1 EstimatesoftheCOVID-19mortalitycostsovertimeTable1showsthehistoricaltrendofCOV
31、ID-19mortalitycostsinCotedIvoire.AstheincomeelasticityoftheVS1.risesovertime,regardlessofthevaluesofthecentralUSVS1.orlowUSVS1.,theVS1.forCotedIvoiredropsalongwithmortalitycosts.TheCotedIvoireVS1.(PanelAofTable1),forexample,swingsfromUS$734,103.81toUS$259,313.96basedonthecentralUSVS1.,indicatingadro
32、pof64.68%oftheVS1.whentheincomeelasticityoftheVS1.risesfrom1to1.4.Similarly,fortheyear2020,themortalitycostsattributabletoCOVID-19dropfromUS$98,369,910.86toUS$34,748,070.04,indicatingadecreaseinthemortalitycostsattributabletotheCOVID-19pandemicof64.68%.WithanincomeelasticityoftheVS1.of1,itisinterest
33、ingtoobservethatstartingin2021,COVID-19-relatedmortalitycostsdroppedprecipitously,reachingUS$90,294,768.92in2022.UsinganincomeelasticityoftheVS1.of1.4(PanelAofTable1),themortalitycostsduetotheCOVID-19pandemicdecreasedfromUS$148,586,896.52(2021)toUS$31,895,616.53(2022).Thisdecreasingpatternofmortalit
34、ycostsduetoCOVID-19issubstantiatedwhenthelowUSVS1.estimatesareused(PanelBofTable1).WithanincomeelasticityoftheVS1.of1,themortalitycostsassociatedwithCOVID-19fellbeginningin2021andreachedUS$42,137,558.83in2022.Table1:COVID-19mortalitycostsinCoted,IvoireovertimePanelA:CentralvaluesMortalitycostsElasti
35、cityValueofastatisticallife2020202120221734103.8198369910.86420641484.5090294768.921.4259313.9634748070.04148586896.5231895616.53PanelB:1.owvaluesElasticityValueofastatisticallifeMortalitycosts1342581.7845905958.40196299359.4342137558.831.4121013.1816215766.0269340551.7114884621.05Notes:Thetermelast
36、icityreferstothevalueofastatisticallife(VS1.),sincomeelasticity,ortheproportionalchangeintheVS1.broughtonbyachangeinincome.AllestimatesareperformedusingacentralvalueofVS1.=USS9OOO000,andUSAGNIpercapita(PPP,currentinternationalUS$)=54380for2013.ThelowvaluesofVS1.areequaltoUS$4,200,000fortheUSA.AllVS1
37、.estimatesareadjustedforinflationusingtheGDPdeflator,aswellasforpotentialchangesinrealincome.AllestimatesareinUSS.Table2indicatesthecostsofCOVID-19deathssincethepandemicbeganwhiletakingintoconsiderationthefactthatthediseasedisproportionatelyaffectstheveryold.TwofindingsemergefromTable2.Themortalityc
38、ostsdecreased,regardlessofthediscountrateapplied.Forinstance,PanelBofTable2showsthatthemortalitycostsassociatedwithCOVID-19rangefromUS$31,100,23.79(2020)toUS$2,854,723.33(2022)usinga5%discountrate,lowUSVS1.estimates,andaconstantincomeelasticityofVS1.Furthermore,thefindingsofthestudysupportareduction
39、inthecostsofCOVID-19deathsbeginningin2021.ThisobservationholdstrueregardlessoftheincomeelasticityofVS1.orthediscountrateapplied.3.2 HealthpoliciesusedtocurbCOVID-19inCoted,IvoireThissubsectionpresentstheresultsofourdeskreviewofthevariouspoliciesandinstrumentsemployedbyCoted,Ivoire,sdecision-makersto
40、tackletheCOVID-19outbreak.ThegovernmentsetupaNationalSteeringCommitteeforcoordination,COVID-19prevention,andcontroltocurbthepandemic.ThisCommittee,whichwasadoptedonMarch23,2020,washeadedbythePrimeMinister,andcomprisedasecretariatprovidedbytheMinistryofHealth(MoH),aswellasmanysubcommitteesandactionun
41、itsineachsector.TheSteeringCommitteeoverseesandoffersstrategicandpolicydirectionforthegovernmentsdisasterresponse.Italsocoordinatestheworkoftheothercommitteesandmobilizesresourcesforthegovernmentsemergencyresponseplan.ThesecretariatoftheSteeringCommitteeisledbytheMoH.TheMoHservesasthesecretariatfort
42、heSteeringCommittee.Attheoperationallevel,theMoH,smainbodyformultisectoralcoordinationofpublichealthemergencyresponses,calledtheCentreforPublicHealthEmergencyOperations(COUSP),whichischairedbytheNationalPublicHygieneInstitute,hasbeenactivated.TheCOUSPinvitedallkeystakeholdersinhealth,includingtheWor
43、ldBankandWorldHealthOrganization,toattendtheweeklycoordinationmeeting.TheCOVlD-19operationalresponseisledbytheGeneralDirectorofHealth,whoreportstotheMoH.Furthermore,thecountryhastakenstepstoacquirevaccinesastheyaredeveloped.Followingaslowstart,Coted,Ivoire,sCOVID-19vaccinationcampaignhaspickedupspee
44、d.OnMarch1,2021,thevaccinationcampaignwaslaunched.However,highlevelsofmisinformation,lackoftrustinthevaccine,andvaccinehesitancyhamperedvaccineuptake,andthevaccinationrateremainedaround2,000dosesadministeredperday.Dailyvaccinationratesrosetoover20,000bymid-April2021atthestartofastrongcommunicationan
45、dcommunitymobilizationeffort,andtoalmost150,000bymid-December2021afterthevaccinecampaignwasintensifiedinresponsetothethirdwaveoftheoutbreak.COVID-19vaccinesupplywasinitiallyunpredictable,owingtolimitedglobalvaccineproductionandinequitabledistribution.SinceAugust2021,supplyanddonationshaveincreased,a
46、ndthepriorityhasshiftedtoimprovingdeploymentcapacitytomeetthe70%coveragetargetandadministerbsterdoses,aswellasstrengtheningnationalpublichealthpreparednesssystems.Only1.9millionCOVID-19doseswereadministeredinCoted,Ivoireduringthefirstfivemonthsofthecampaign.Disruptionsintheavailabilityofspecificvacc
47、ines(e.g.,AstraZeneca),combinedwithinconsistentdeliveryschedulesofavailablevaccines,resultedinCoted,Ivoirehavingvaccinestock-outs,whichharmedthecampaign.VaccinedeliverieshaveincreasedsinceAugust2021,with19.7milliondosesdeliveredover18months(August2020-March16,2022),andthegovernmenthassinceintensifie
48、dthevaccinationcampaigntospeedupvaccinedeployment.AsofFebruary19,2023,atotalof25,263,932vaccinedosesPleaseseehavebeenadministered.Thecountry,scurrentchallengeistoi)createagrowingandconsistentdemandforCOVID-19vaccinations,(ii)strengthentheresilienceofthehealthsystem,and(iii)acceleratetheIvorianeconomysrecovery.Despitethesemeasures,thefightagainstCOVID-19hasgonethroughdifficulties.RevenuesplummetedduringtheCOVID-19pandemicin2020,despiteadramaticincreaseingovernmentspendingtoaddressthehealthand
