The Impact of Dengue Fever in Early Life on Human Capital Formation

I will investigate the impact dengue fever has on human capital formation considering exposure at different stages of early life and childhood and will provide causal estimates on the additional the societal costs of the disease so far neglected in the literature.

Background
Dengue fever is a mosquito-borne viral disease causing a flu-like illness occurring mostly in tropical and sub-tropical countries. With no vaccine or treatment available, the medical focus is on rehydration and on managing the symptoms including high temperature, severe headaches and bone, muscle and joint pain with the vast majority of patients recovering fully after 10-14 days. Dengue fever has expanded considerably over the past 50 years fuelled by increased urbanization and individual travel and today affects an estimated 390 million people in 128 countries. The World Health Organizations has called dengue fever the fastest spreading mosquito-borne disease worldwide with 'epidemic potential' putting the health of about half of the world's population at risk.

Contribution
Despite the relatively low mortality from the disease, dengue fever is associated with considerable socio-economic costs and there is a large body of literature providing estimates of the costs of the disease. The proposed research will help to overcome these shortcomings in existing cost estimates of the disease by explicitly providing estimates on the effects dengue fever may have from exposure in early life and childhood on a range of measures of human capital development. The research also contributes to the literature on disease burden by applying cutting-edge impact evaluation techniques mostly borrowed from labour economics to overcome methodological shortcomings that plague the literature on the cost of diseases. The proposed research will also make a contribution by combining large sets of microdata on individual dengue infections with individual educational outcomes for Brazil, a major country affected by dengue and by making this data available to the research community.

Research questions
The proposed research will address three related research questions. In the first project I will estimate the effect of dengue exposure of an unborn child during time in-utero on long-term outcomes, in particular a wide range of educational outcomes and health outcomes of children. The second part of the analysis will involve investigating the contemporaneous effect of dengue on human capital by focusing on infections of school-aged children and the effect on short-term and longer-term schooling outcomes. The third project will investigate the effects on schooling outcomes of children of the infection and subsequent absenteeism of their teachers by linking individual dengue infections to the universe of Brazilian teachers. In addition I will investigate whether parental dengue infections impact the schooling outcomes of their children by linking the data of dengue infections with parental information.

Societal impact
Accurate and more comprehensive estimates of the economic cost of dengue fever are crucial for a wide range of related policies in Brazil and in the other countries affected by dengue. The results from the proposed research will be important for more accurate cost-benefit analyses, which are an important evidence-base for decisions on dengue vector control programmes. In addition, six candidates for a dengue vaccine are at various stages of development; and Brazil, among other countries, will need to consider the introduction of a vaccine in the near future and then to target the subpopulations most in need when designing its immunization programme.

A. Who will benefit?
New estimates show that half of the world's population is at risk of dengue fever and an estimated 390 million people in more than 100 countries each year are infected with the disease. Research on the true societal cost of dengue therefore potentially benefits a large portion of the global population by directing resources where they are most efficiently used and hence improving health, educational attainment and wellbeing in the population.
The users of the proposed research include:
1) The population at risk of infection with dengue in more than 100 countries, among them in particular pregnant mothers and their unborn children, newborns and small children, school age children in countries with dengue exposure.
2) International users of cost estimations of infectious diseases - including dengue - and concerned with public recommendations on immunization schedules such as the WHO, the International Vaccine Institute, the International Vaccine Access Center, the Sabin Vaccine Institute, the Centers for Disease Control and Prevention.
3) National health ministries and public health institutions in countries affected by dengue and responsible for dengue vector control programmes and the introduction of a potential future vaccine.
4) Education ministries and decision makers in education responsible for the design of remedial education programmes for children affected by school absences due to infectious diseases, including dengue fever.
5) Research organizations and consortia working on dengue and other tropical diseases including the International Research Consortium on Dengue Risk Assessment, Management and Surveillance (IDAMS), Special Programme for Research and Training in Tropical Diseases (TDR), the Eliminate Dengue Program, the Break Dengue programme, and many national research initiatives.
6) International and national funders on tropical diseases research, including the Gates Foundation, Wellcome Trust, Institute Pasteur, and national governments.
7) Research initiatives and the pharmaceutical industry involved in the development and testing of dengue vaccines and other infectious diseases (Institute Butantan, Dengue vaccine Initiative, Sanofi Pateur, Inviragen/Takeda, GlaxoSmithKline, Merck).
8) In Brazil: The Ministry of Health and the Ministry of Education, the National Health Foundation (FUNASA) with its National Programme for the Control of Dengue, and state and municipal secretariats responsible for health and education.
B. How will they benefit from the research?
The research results will inform policy makers and public health officials on the so far undocumented costs of the disease resulting from its impact on human capital formation and educational and health outcomes of affected children.
The results will improve cost estimates using causal estimates based on vigorous econometric techniques using high quality and large sets of microdata.
These improved cost estimates are crucial for the evidence-based policy debate of state and non-state stakeholders for the design and implementation of dengue control programmes and intervention strategies.
The results will be important for the adoption decisions of future dengue vaccines currently in the final testing stages and for demand estimates of dengue vaccines for policy makers and producers.
The estimates are important for the tailoring of dengue control programmes and immunization schedules by improving cost efficiency of the interventions by targeting subpopulations with the highest costs ((un-born) children, pregnant women, women of fertile age, teachers etc.).
The results will also be important for the targeting of public awareness campaigns on more specific target groups.
The cost estimates can be crucial to directing funding for research on infectious diseases towards where funds are most effective.
The results are important more generally showcasing how infectious diseases can impact human capital formation.