Using decision analysis to improve malaria control policy making.


Malaria and other vector-borne diseases represent a significant and growing burden in many tropical countries. Successfully addressing these threats will require policies that expand access to and use of existing control methods, such as insecticide-treated bed nets (ITNs) and artemesinin combination therapies (ACTs) for malaria, while weighing the costs and benefits of alternative approaches over time. This paper argues that decision analysis provides a valuable framework for formulating such policies and combating the emergence and re-emergence of malaria and other diseases. We outline five challenges that policy makers and practitioners face in the struggle against malaria, and demonstrate how decision analysis can help to address and overcome these challenges. A prototype decision analysis framework for malaria control in Tanzania is presented, highlighting the key components that a decision support tool should include. Developing and applying such a framework can promote stronger and more effective linkages between research and policy, ultimately helping to reduce the burden of malaria and other vector-borne diseases.





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Publication Info

Kramer, R, K Dickinson, R Anderson, VG Fowler, ML Miranda, CB Mutero, K Saterson, J Wiener, et al. (2009). Using decision analysis to improve malaria control policy making. Health Policy, 92(2-3). pp. 133–140. 10.1016/j.healthpol.2009.02.011 Retrieved from

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Randall Kramer

Juli Plant Grainger Professor Emeritus of Global Environmental Health

Before coming to Duke in 1988, he was on the faculty at Virginia Polytechnic Institute and State University. He has held visiting positions at IUCN--The World Conservation Union, the Economic Growth Center at Yale University, and the Indonesian Ministry of Forestry. He has served as a consultant to the World Bank, World Health Organization and other international organizations. He was named Duke University's Scholar Teacher of the Year in 2004.

Kramer's research is focused on the economics of ecosystem services and on global environmental health. He is currently conducting a study on the effects of human land use decisions on biodiversity, infectious disease transmission and human health in rural Madagascar. Recent research projects have used decision analysis and implementation science to evaluate the health, social and environmental impacts of alternative malaria control strategies in East Africa. He has also conducted research on health systems strengthening, economic valuation of lives saved from air pollution reduction. and the role of ecosystems services in protecting human health.


Marie Lynn Miranda

Adjunct Professor in the Division of Environmental Sciences and Policy

Dr. Miranda serves as the Director of the Children’s Environmental Health Initiative (CEHI) within the Nicholas School of the Environment, and is a faculty member in Duke’s Integrated Toxicology Program. With an educational background rooted in economic and mathematical modeling, her professional experiences integrate environmental health sciences with sound social policies. Dr. Miranda has extensive experience managing research projects using geographic information systems (GIS) based analysis focusing on children’s environmental health, with an emphasis on reproductive and developmental toxicants and childhood lead exposure. CEHI supports a series of environmental research projects emphasizing the special vulnerabilities of children. Current projects include: 1. A Centers for Disease Control and Prevention-funded grant that uses GIS technology to create household-level predictive models of lead exposure risks and seeks to replicate this predictor model across 27 counties in North Carolina; 2. A National Institute of Environmental Health Sciences-funded grant to replicate the lead exposure risk model in other regions of the United States; 3. A U.S. Department of Housing and Urban Development-funded project to evaluate the importance of crawl spaces as sources of mold contamination in the livable part of the home environment. 4. A Robert Wood Johnson Foundation-funded project with a focus GIS-based applications to support delivery of private and public health care services; 5. A Superfund Center Outreach Core project, part of Duke University’s NIEHS-funded Superfund Hazardous Substance Basic Research Center, that uses GIS-based models to compare the spatial distribution of children versus exposures to various contaminants and to provide outreach and education to communities in North Carolina and nationally. 6. PI-Thompson, Co-PI Miranda Howard Hughes Medical Institute Making Meaning of Genomic Information Curriculum development grant to improve Duke’s offerings to undergraduates related to genomics. Nicholas School subgrant focuses on gene-environment interactions. 7. PI-Schwartz; Miranda, Deputy Director NIEHS Center for Comparative Biology of Vulnerable Populations This project establishes an EHSRC on Duke University’s campus. 8. PI-Miranda NIH/Roadmap Initiative Center for Geospatial Medicine This project brings together seven investigators to develop an interdisciplinary research center that utilizes geospatial (GIS), molecular biological, genomic, epidemiological social and psychological technologies to develop systematic, spatially based methods for analyzing the pathways through which the environment, genetic, and psychosocial domains jointly shape child health and well being. Using neural tube defects as a prototype health endpoint, the researchers are developing a generalized framework for applying methods to a wide variety of endpoints, including autism, obesity, and ADHD. Dr. Miranda currently serves on the Durham County Lead Intervention Team, the North Carolina Ad Hoc Lead Advisory Committee, the North Carolina Lead Elimination Action Plan Strategic Planning Group, the North Carolina State Asthma Coalition, and the Board of Directors for the Alliance for Healthy Homes. * Gabel Chair in Environmental Ethics and Sustainable Environmental Management, (2000-2005) * Fellowships: A.B. Duke Scholar, Marshall, Truman, Eisenhower, the Lilly Foundation, the National Science Foundation, the AAUW American Fellowship Program, and the Harvard University Chiles Program. * Richard K. Lublin Distinguished Award for Teaching Excellence. * U.S. EPA Environmental Justice Achievement Award


Jonathan B. Wiener

William R. Perkins Distinguished Professor of Law

Jonathan B. Wiener is the William R. Perkins Professor of Law at Duke Law School, Professor of Environmental Policy at the Nicholas School of the Environment, and Professor of Public Policy at the Sanford School of Public Policy, at Duke University.  He is the Co-Director of the Duke Center on Risk in the Science & Society Initiative. 

He served as President of the Society for Risk Analysis (SRA) in 2008, and he co-chaired the SRA's World Congress on Risk in Sydney Australia in 2012.  In 2003 he received SRA’s Chauncey Starr Young Risk Analyst Award, and in 2014 he received SRA’s Richard J. Burk Outstanding Service Award.  From 2015-19 he co-directed the Rethinking Regulation program at Duke, and from 2007-15 he directed the JD-LLM Program in International and Comparative Law at Duke Law School.  From 2000-05 he was the founding Faculty Director of the Duke Center for Environmental Solutions, which was then expanded into the Nicholas Institute for Environmental Policy Solutions, for which he served as chair of the faculty advisory committee from 2007-10.

He is a University Fellow of Resources for the Future (RFF); a Public Member of the Administrative Conference of the United States (ACUS); a past board member of the Society for Benefit-Cost Analysis (SBCA); and an affiliated faculty member of the environment program at Duke Kunshan University (DKU) and of the Harvard Center for Risk Analysis (HCRA).  He is a member of advisory committees at the NYU Institute for Policy Integrity, the International Risk Governance Council (IRGC), the Chaire Economie du Climat (CEC), and the Cambridge Centre for the Study of Existential Risk (CSER).  He has been a member of the Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (Working Group III) (2014), and the study team on “Environmental Risk Management” for the China Council for International Cooperation on Environment and Development (CCICED) (2015). 

His publications include the books Policy Shock: Recalibrating Risk and Regulation after Oil Spills, Nuclear Accidents, and Financial Crises (Cambridge University Press, 2017 [paperback 2020], with Ed Balleisen, Lori Bennear, and Kim Krawiec); The Reality of Precaution: Comparing Risk Regulation in the United States and Europe (RFF/Routledge, 2011, with Michael Rogers, Jim Hammitt, and Peter Sand), Reconstructing Climate Policy (AEI Press 2003, with Richard Stewart) and Risk vs. Risk (Harvard University Press 1995, with John Graham [Chinese translation, 2018]), and more than 100 articles in journals in law, policy, economics, risk and science.  He has been a visiting professor at Harvard Law School, the University of Chicago Law School, NYU Law School, Université Paris Ouest Nanterre La Défense, Université Paris-Dauphine, Sciences Po, and EHESS and CIRED in Paris.

Before coming to Duke, he served at the White House Council of Economic Advisers (CEA), at the Office of Science and Technology Policy (OSTP), and at the US Department of Justice (DOJ/ENRD), in the first Bush and Clinton administrations. He helped negotiate the Framework Convention on Climate Change, attended the Rio Earth Summit in 1992, and helped draft Executive Order 12866 (1993).  He also helped organize the Americorps National Service program in 1993, the annual City Year servathon in Boston in 1989, and the D.C. Cares servathon in Washington D.C. in 1991; served on the North Carolina State Commission on National and Community Service from 1994-98; and founded the "Dedicated to Durham" community service day held at Duke Law School since 1995.

He clerked for Judge (now U.S. Supreme Court Justice) Stephen G. Breyer on the U.S. Court of Appeals in Boston in 1988-89, and for Chief Judge Jack B. Weinstein on the U.S. District Court in New York in 1987-88. He received his A.B. in economics (1984) and J.D. (1987) from Harvard University, where he was a research assistant at the NBER, assistant coach of the 1985 college debate champions, and an editor of the Harvard Law Review.

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