Applied political economy analysis covers a spectrum of appr

Applied political economy analysis covers a spectrum of approaches and tools that can assist policy makers with making decisions and identifying political strategies for reform. These can be applied at different levels, from national to subnational levels; to sectors or thematic areas; to specific projects or policy reforms; and they vary in terms of scope and focus. This spectrum extends from in-depth political economy analyses (which are detailed, theory-based “academic” analyses done by experts to provide rich contextual understanding of political economy drivers relating to specific contexts and events), to rapid-assessment studies (which are quick, problem-focused diagnostic assessments that can be carried out with minimal training in the method).
As highlighted by Rajesh Gupta (October issue), strategies for developing treatments for Ebola virus disease (EVD) need to be rethought. New treatments have to be safe and effective, and in this sense testing already-approved drugs for a new indication is a good approach. With the same philosophy in mind, there are old approaches that could be saving lives in the current outbreak of EVD. Hyperimmune serum from convalescent patients is regarded by WHO as a potential treatment for EVD. The rationale for convalescent serum treatment is provided by limited experiences during the Ebola outbreak in the Democratic Republic of Congo in 1995 and also from tests in non-human primates. Additionally, convalescent serum has been used in Spain and other countries to treat patients with EVD during the current outbreak. Nonetheless, obtaining convalescent serum is a difficult task and not free of risk. The logistics of identifying survivors is not easy. Also, blood from survivors needs to be tested to rule out presence of virus. Vaccinated individuals might represent a safer source of hyperimmune serum. Two Sulindac sulfide candidates will be tested soon in west Africa. If serum from vaccinated individuals has neutralising activity against the virus in cell models, this serum could be used as adjuvant therapy for EVD. In parallel, animal models could be developed to compare hyperimmune serum against a placebo. In the current scenario, this strategy could offer some hope to patients with this devastating disease.
Romulus Breban and colleagues (September issue) present modelling results of hepatitis C virus (HCV) interventions in Egypt. They suggest focusing interventions on people who regularly receive medical injections to achieve the greatest epidemiological effect on HCV transmission. However, we believe that universal treatment at 2·5 or even 15 years after infection (as presented in figure 5) is highly ambitious, as it would necessitate immediate identification and treatment of most of the people living with hepatitis C in Egypt. This process would demand substantial resources and the removal of many practical barriers. Although the proposed treatment coverage of the core group seems to be achievable, we would like to see the focused intervention analysed with more realistic general levels of treatment coverage to guide operational implementation. Breban and colleagues previously reported that the prevalence of HCV in people younger than 50 years in Egypt fell substantially between 1996 and 2004. This finding implies the HCV-infected population is ageing and that age is highly important in the progression of the epidemic, affecting future prevalence and thus continuing transmission. Decreasing prevalence is supported by evidence of falling HCV seroprevalence among blood donors, from 17·7% in 2000 to 7·6% in 2007. In Breban and colleagues\' modelling analysis, incidence was estimated from earlier data (2001–06) and age effects were excluded. As a result, the basic reproduction numbers calculated by Breban and colleagues might be overestimates, suggesting that less ambitious interventions might be sufficient to control the HCV epidemic.
We agree with James Jansson and David Wilson that universal treatment for hepatitis C virus (HCV) infection in Egypt is an ambitious public health strategy. This fact has been part of the motivation for our work. In our study, we identified that most HCV transmission in Egypt is caused by a core group of individuals undergoing frequent medical injections. The existing national treatment strategy does not target these individuals, who are thus treated in the same proportions as the general population, leading to only a small reduction in the basic reproduction number (R; from 3·54 to 3·03). However, individuals in this core group could be easily targeted with testing, prevention counselling, and treatment, as they identify themselves by accessing health care. Such targeted interventions could lead to a substantial reduction in R and, most importantly, HCV incidence. The origins of the HCV epidemic in Egypt are attributed to mass campaigns of parenteral anti-schistosomal therapy between the 1960s and the 1980s. Once these mass campaigns stopped, HCV transmission variables (key variables included in our model were frequency of medical injections, probability of reuse of injecting material, and infection probability by injection) decreased substantially. It is reasonable to assume that, since R depends strongly on these variables, R decreased substantially as well. However, HCV continued to be transmitted, to a lesser extent, through everyday medical procedures.