Person: Kremer, Michael
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Kremer, Michael
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Publication Water and Human Well Being: An Executive Session on Grand Challenges of the Sustainability Transition(Center for International Development at Harvard University, 2009-11) Zwane, Alix Peterson; Kremer, Michael; Meeks, RobynThe Executive Session on Water and Human Well Being was convened by the Harvard Kennedy School of Government and Venice International University on July 20–21, 2009. This high-level gathering was organized to create a unique space for dialog between policymakers, academics, and sector experts to move beyond the truism that “water is life” towards actionable solutions for making water a force for improved human health and well being in the development agenda. Discussion focused on sharing new evidence from applied research on game-changing technologies and human behavior that affect environmental health outcomes. In addition, sessions addressed strategies to move beyond promising pilot projects to scalable programs; public, private, and integrated approaches were considered. The interconnections between sustainability and scale were explored, giving policymakers an explicit opportunity to help shape the research agenda of leading biomedical and social scientists working at the intersection of water and health. The session was one in a series on Grand Challenges of the Sustainability Transition organized by the Sustainability Science Program at Harvard University with the generous support of the Italian Ministry for Environment, Land, and Sea.Publication Many Children Left Behind? Textbooks and Test Scores in Kenya(Center for International Development at Harvard University, 2007-08) Glewwe, Paul; Kremer, Michael; Moulin, SylvieA randomized evaluation suggests that a program which provided official textbooks to randomly selected rural Kenyan primary schools did not increase test scores for the average student. In contrast, the previous literature suggests that textbook provision has a large impact on test scores. Disaggregating the results by students’ initial academic achievement suggests a potential explanation for the lack of an overall impact. Textbooks increased scores for students with high initial academic achievement and increased the probability that the students who had made it to the selective final year of primary school would go on to secondary school. However, students with weaker academic backgrounds did not benefit from the textbooks. Many pupils could not read the textbooks, which are written in English, most students’ third language. The results are consistent with the hypothesis that the Kenyan education system and curricular materials are oriented to the academically strongest students rather than to typical students. More generally, many students may be left behind in societies that combine 1) a centralized, unified education system; 2) the heterogeneity in student preparation associated with rapid expansion of education; and 3) disproportionate elite power.Publication Advance Market Commitments for Vaccines Against Neglected Diseases: Estimating Costs and Effectiveness(Center for International Development at Harvard University, 2006-07) Berndt, Ernst R.; Glennerster, Rachel; Kremer, Michael; Jean, Lee; Levine, Ruth; Weizsäcker, Georg; Williams, HeidiThe G8 is considering committing to purchase vaccines against diseases concentrated in low-income countries (if and when desirable vaccines are developed) as a way to spur research and development on vaccines for these diseases. Under such an “advance market commitment,” one or more sponsors would commit to a minimum price to be paid per person immunized for an eligible product, up to a certain number of individuals immunized. For additional purchases, the price would eventually drop to close to marginal cost. If no suitable product were developed, no payments would be made. We estimate the offer size which would make revenues similar to the revenues realized from investments in typical existing commercial pharmaceutical products, as well as the degree to which various model contracts and assumptions would affect the cost-effectiveness of such a commitment. We make adjustments for lower marketing costs under an advance market commitment and the risk that a developer may have to share the market with subsequent developers. We also show how this second risk could be reduced, and money saved, by introducing a superiority clause to a commitment. Under conservative assumptions, we document that a commitment comparable in value to sales earned by the average of a sample of recently launched commercial products (adjusted for lower marketing costs) would be a highly cost-effective way to address HIV/AIDS, malaria, and tuberculosis. Sensitivity analyses suggest most characteristics of a hypothetical vaccine would have little effect on the cost-effectiveness, but that the duration of protection conferred by a vaccine strongly affects potential cost-effectiveness. Readers can conduct their own sensitivity analyses employing a web-based spreadsheet tool.Publication When is Prevention More Profitable than Cure? The Impact of Time-Varying Consumer Heterogeneity(Center for International Development at Harvard University, 2013-01) Kremer, Michael; Snyder, ChristopherWe argue that in pharmaceutical markets, variation in the arrival time of consumer heterogeneity creates differences between a producer’s ability to extract consumer surplus with preventives and treatments, potentially distorting R&D decisions. If consumers vary only in disease risk, revenue from treatments—sold after the disease is contracted, when disease risk is no longer a source of private information—always exceeds revenue from preventives. The revenue ratio can be arbitrarily high for sufficiently skewed distributions of disease risk. Under some circumstances, heterogeneity in harm from a disease, learned after a disease is contracted, can lead revenue from a treatment to exceed revenue from a preventative. Calibrations suggest that skewness in the U.S. distribution of HIV risk would lead firms to earn only half the revenue from a vaccine as from a drug. Empirical tests are consistent with the predictions of the model that vaccines are less likely to be developed for diseases with substantial disease-risk heterogeneity.Publication The Case for Mass Treatment of Intestinal Helminths in Endemic Areas(Public Library of Science, 2015) Hicks, Joan Hamory; Kremer, Michael; Miguel, EdwardTwo articles published earlier this year in the International Journal of Epidemiology [1,2] have re-ignited the debate over the World Health Organization’s long-held recommendation of mass-treatment of intestinal helminths in endemic areas. In this note, we discuss the content and relevance of these articles to the policy debate, and review the broader research literature on the educational and economic impacts of deworming. We conclude that existing evidence still indicates that mass deworming is a cost-effective health investment for governments in low-income countries where worm infections are widespread.Publication More Evidence on the Effects of Deworming: What Lessons Can We Learn?(The American Society of Tropical Medicine and Hygiene, 2017) Croke, Kevin; Hsu, Eric; Kremer, MichaelPublication Should the WHO withdraw support for mass deworming?(Public Library of Science, 2017) Croke, Kevin; Hicks, Joan Hamory; Hsu, Eric; Kremer, Michael; Miguel, EdwardPublication Targeting health subsidies through a nonprice mechanism: A randomized controlled trial in Kenya(American Association for the Advancement of Science (AAAS), 2016) Dupas, P.; Hoffmann, V.; Kremer, Michael; Zwane, A. P.Free provision of preventive health products in the developing world can dramatically increase access. A concern about free provision is that people who receive health products for free may not use them, with associated wasted resources. We report on a randomized controlled trial in Kenya of a screening mechanism combining free provision of dilute chlorine solution for water treatment with a small non-monetary cost (monthly voucher redemption) for households to obtain the product. Relative to a free distribution program, this mechanism reduces the quantity of chlorine procured by 60 percentage points, but reduces the share of households whose stored water tests positive for chlorine residual by only one percentage point, dramatically improving the tradeoff between errors of inclusion and exclusion.Publication Early-Life Malaria Exposure and Adult Outcomes: Evidence from Malaria Eradication in India(American Economic Association, 2010) Cutler, David; Fung, Winnie; Kremer, Michael; Singhal, Monica; Vogl, TomWe examine the effects of exposure to malaria in early childhood on educational attainment and economic status in adulthood by exploiting geographic variation in malaria prevalence in India prior to a nationwide eradication program in the 1950s. We find that the program led to modest increases in household per capita consumption for prime age men, and the effects for men are larger than those for women in most specifications. We find no evidence of increased educational attainment for men, and mixed evidence for women.Publication Being Surveyed Can Change Later Behavior and Related Parameter Estimates(National Academy of Sciences, 2011) Zwane, A. P.; Zinman, J.; Van Dusen, E.; Pariente, W.; Null, C.; Miguel, E.; Kremer, Michael; Karlan, D. S.; Hornbeck, Richard; Gine, X.; Duflo, E.; Devoto, F.; Crepon, B.; Banerjee, A.Does completing a household survey change the later behavior of those surveyed? In three field studies of health and two of microlending, we randomly assigned subjects to be surveyed about health and/or household finances and then measured subsequent use of a related product with data that does not rely on subjects' self-reports. In the three health experiments, we find that being surveyed increases use of water treatment products and take-up of medical insurance. Frequent surveys on reported diarrhea also led to biased estimates of the impact of improved source water quality. In two microlending studies, we do not find an effect of being surveyed on borrowing behavior. The results suggest that limited attention could play an important but context-dependent role in consumer choice, with the implication that researchers should reconsider whether, how, and how much to survey their subjects