Strategic Uncertainties Surrounding Mosquito-Borne Disease Policy-Making in the Netherlands: A Game Theoretic Analysis

Broekhuizen, Henk; Bekius, Femke; De Best, Pauline A.; Bekker, Marleen

Strategic Uncertainties Surrounding Mosquito-Borne Disease Policy-Making in the Netherlands: A Game Theoretic Analysis

Articles in Press

Document Type : Original Article

Authors

Henk Broekhuizen ¹^{, 2}

Femke Bekius ³

Pauline A. de Best ⁴^{, 5}

Marleen Bekker ¹

¹ Health and Society Group, Department of Social Sciences, Wageningen University and Research, Wageningen, The Netherlands

² Department of Epidemiology, Health Promotion, and Policy Advice, GGD Twente, Enschede, The Netherlands

³ Department of Methodology, Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands

⁴ Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands

⁵ National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

Abstract

Background
One Health decisions are challenging due to substantive and strategic uncertainty. This study aims to map and interpret strategic uncertainties surrounding a specific One Health issue (mosquito-borne disease [MBD] policy) in the Netherlands.

Methods
We used a game-theoretic framework to identify games from 26 interviews with key actors about strategic uncertainty. For each game we identified the context (where the game is played), the actors (who is playing), the content (what are the issues and outcomes), and the process (how the game has developed and what strategies were employed). Games with the same set of actors and overlapping content were clustered together.

Results
We identified 15 games, centered mostly around trade-offs between domains (human health, animal health, and the environment) and dilemma’s inherent to prevention policy. We identified three game clusters. Multi-level governance forms the context around MBD policy. It consists of a game involving issues around climate adaptation, infectious disease policy, and biodiversity. This game is played across time and hierarchical levels (local, regional, national), giving rise to cascade dynamics. In this governance context, actors deal with responsibilities around invasive mosquito control. This second cluster is characterized by a dilemma between acting (and bearing the cost) and waiting for someone else to act; and a game represented by a central notification hub. Finally, the zoonotic structure was developed to bridge domains and gives rise to a various games representing the tension between actors’ own and shared interests, power and information asymmetries, and acting versus not acting for their own benefit.

Conclusion
We argue for an actor-centered approach and more awareness of strategic uncertainties among involved actors in MBD policy to reduce strategic risks inherent in the identified game archetypes. We provide policy recommendations for anticipating, reducing or dealing with the associated strategic risks towards better MBD prevention.

Keywords

Evidence-Based Policy

Governance

Public Health Policy

The Netherlands

Zoonosis

Mosquito-Borne Disease

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