Brandeis economist crunches numbers to save kids' lives

WALTHAM -- There's a battle being waged from this bucolic hilltop campus. The enemy is thousands of miles away: dengue fever and other tropical diseases that sicken millions every year, many of them children.

Among those leading the charge is Donald S. Shepard, a slightly built, soft-spoken economist who even at 59 manages to look boyish. His headquarters is an office at Brandeis University crammed from floor to ceiling with books and journals.

Dengue fever is a mosquito-borne virus most prevalent in Southeast Asia and Latin America. Its name originally meant "bone break," referring to the debilitating pain it causes. Most of its victims are young children, and their survival depends on getting the right treatment at just the right time.

"It's a disease that's feared in communities where it still exists," said Shepard. "Whether you'll have a case where you just get a fever or much worse is, at the beginning, unknown."

About 50 million people are infected each year, according to estimates from the World Health Organization. Without proper treatment, up to 20 percent of those people could die of dengue hemorrhagic fever, its most severe form.

As a health economist, Shepard doesn't administer shots or formulate vaccines. His specialty is dollars, specifically tallying all the costs associated with caring for a disease victim. And as a professor at Brandeis's Schneider Institute for Health Policy, he is teaching the next generation of economists how to get the most for the medical dollar.

Shepard is no bean counter. He is acutely aware that behind every number is a person, possibly one who is very sick.

Targeting prevention

Armed with figures, he can show governments -- in the United States and abroad -- and aid groups just how much they can save by preventing disease in the first place.

Shepard spends much of his time as a researcher for the Pediatric Dengue Vaccine Initiative, which is working to develop and promote vaccines against the disease.

In a study of dengue cases in Thailand, his team found that the average patient spends 4.3 days in the hospital. Meanwhile, the patient's family collectively lose an average of 23 working days each year taking time off to provide meals, personal care, emotional support, baby sitting, and other services.

Shepard and his research team determined that the family ends up losing about $261 in wages in a country where the average per capita yearly income is just over $2,700.

"On average, it would be the equivalent of a month and a half of income. For a very poor family, more than a month and a half," Shepard said. "So the burden is quite substantial."

Tough interviews

In conducting field interviews, researchers face cultural and language barriers. They have to be part scientist, part detective, part anthropologist, and part confidante. Not to mention diplomat: questions of money and illness are often taboo.

Dr. Scott B. Halstead, the director of the vaccine initiative, said Shepard is remarkable for three things -- his intelligence, his empathy, and, most of all, his spirit.

"It's important to work with people who like what they're doing," Halstead said. "That's certainly Don's characteristic. He's enthusiastic with our colleagues, and with students, and the people he deals with."

Halstead said Shepard's painstaking work lays the foundation upon which headline-making drug treatment and vaccine programs are built.

"It's the flip side of health care and disease, which is, 'What is the impact of the disease upon a person, upon a family, upon a community?' " Halstead said. "It's really a very important part of the whole story that tends to get collected silently.

"Money talks, and it makes a big difference. It's the economic stability of families and societies and whole countries."

An early passion

Shepard showed a passion for solving problems even as a young boy in New Jersey, where his father was a grocery store executive and his mother a homemaker.

He had dreams of becoming an engineer, and he challenged himself by seeing what all he could assemble with an Erector Set. After building a primitive drum machine, he tried to make a more complex version equivalent to a player piano, but "the sophistication of doing that was a little beyond what an Erector Set could do."

Shepard went to high school at Phillips Academy in Andover, then earned his bachelor's in mathematics, with applications in economics, at Harvard University. There he also obtained a master's and doctorate in public policy.

In 1968, while still at Harvard, he volunteered for a Peace Corps-like program that sent him to a Kenyan university to lecture in computer science. At the time, he said, the African nation had only two computers. He and some colleagues managed to corral one to develop a program for processing college applicants.

He decided that if he was going to spend his life working with numbers, he wanted to make sure it was in the service of people, not theory. His favorite problems share three elements: something quantifiable, something counterintuitive, and the result something practical.

Shepard's research was used to persuade Ivory Coast officials that expanding measles vaccinations for children could eliminate 38,000 cases of the disease and 1,100 deaths per year.

More than formulas

"One can do formulas and papers, but behind that are decisions of resources -- that of parents' time and money in bringing their children in, governments who provide the resources, and the international donors who provide the money," said Shepard. "That... was the satisfaction that children generate."

Shepard, who is married with two grown children, lives in Wellesley when he's not making visits in the field and to conferences around the world.

Over the last two years, he has visited Malaysia, Cambodia, Thailand, Rwanda, South Korea, England, Spain, Mongolia, China, and Kenya.

And this week found him in India for a conference about his old nemesis: dengue fever.

Stephanie V. Siek can be reached via e-mail at ssiek@globe.com.