Flu pandemic “inevitable” and to cost $800 billion say World Bank, WHO
Rhett A. Butler, mongabay.com
November 7, 2005
The potential economic cost of a pandemic of human influenza — which the World Health Organization (WHO) now says is “inevitable” — would top $800 billion according to a World Bank report released today.
While the bank concedes that “there are great uncertainties about the timing, virulence, and general scope of a future human flu pandemic,” it uses figures from the 2003 SARS outbreak and WHO projections to conclude that a flu
epidemic could cause at least $800 billion in economic damages over the course of a year.
WHO says that “Best case scenarios, modeled on the mild pandemic of 1968, project global excess deaths in the range 2 million to 7.4 million. Other estimates that factor in a more virulent virus, similar to that responsible for the deadly 1918 pandemic, estimate much higher numbers of deaths. Both scenarios are scientifically valid. The differences arise from the assumptions about the inherent lethality of the virus, which past experience has shown to vary greatly.”
Some experts believe the 1918 pandemic is a better model for the a future flu outbreak. In a May 2005 article in the New England Journal of Medicine, Michael T. Osterholm writes ” “Clinical, epidemiologic, and laboratory evidence suggests that a pandemic caused by the current H5N1 strain would be more likely to mimic the 1918 pandemic than those that occurred more recently. If we translate the rate of death associated with the 1918 influenza virus to that in the current population, there could be 1.7 million deaths in the United States and 180 million to 360 million deaths globally.”
The World Bank report looks at economic impact of the 2003 SARS outbreak in East Asia in an effort to forecast the potential cost of a future flu pandemic.
“The disruptions associated with SARS led to an immediate economic loss of perhaps 2 percent of East Asian regional GDP in the second quarter of 2003, even though only about 800 people ultimately died from this disease.” The bank’s report continues, “A 2 percent loss of global GDP during a global influenza pandemic would represent around $200 billion in just one quarter (or $800 billion over a whole year), and it is fair to assume the immediate shock during a flu epidemic could be even larger and last longer than SARS. The 1918 epidemic, for example, came in three waves, spread over two years.”
The current strain of avian flu that is of great concern to epidemiologists is significantly more deadly than SARS. Through October of last year, avian flu carries a 51% death rate, while the 2003 SARS outbreak had a death rate below 10%. This suggests that a flu outbreak could produce significant mortality, especially in developing countries where health systems are less sophisticated.
Some further points on bird flu as outlined by the World Bank.
- Avian influenza, also known as “bird flu,” is a contagious animal disease which normally infects birds and sometimes pigs. Researchers believe the H5N1 virus can infect all bird species, but domesticated poultry are particularly vulnerable to epidemic level infections.
- Recent reports have confirmed the spread of the H5N1 virus beyond its Asian stronghold from migratory birds to poultry in Russia and Kazakhstan. Outbreaks in both countries have been attributed to contact between domestic birds and wild waterfowl via shared water sources. Previously, the flu was only seen to move to wild birds from domestic poultry flocks.
- The disease was first seen in humans in 1997 in Hong Kong. All human cases are thought to have been contracted from exposure to infected birds. At this time there is no sustained evidence of human to human transmission.
- So far, the World Health Organization (WHO) estimates the impact on people has been limited to 57 human deaths out of 112 infections in Vietnam, Thailand, Cambodia, and Indonesia. The Food and Agriculture Organization (FAO) warns the virus continues to be detected in many parts of Vietnam and Indonesia, and in some parts of Cambodia, China, Thailand, and Lao PDR.
- The Bank is working closely with relevant governments, WHO, FAO, and other key partners to assess country readiness, assist with monitoring, advise on strategies, and share information. The Bank is also helping to analyze the potential economic impacts.
- In Vietnam, the Bank has a $5 million project to help the government set up animal disease surveillance systems and laboratories to provide diagnostic capabilities and to help improve public awareness about outbreaks.
- Addressing avian flu will require a long-term effort, a high degree of coordination, and a global strategy.
World Bank Avian Flu Initiatives
RELATED PRESS RELEASES FROM THE WORLD BANK AND WHO
Global meeting to develop common approach on avian influenza and human pandemic influenza
Joint News Release WHO/FAO/OIE/World Bank
4 November 2005
4 NOVEMBER 2005 | GENEVA — The H5N1 avian influenza virus is firmly established among animals in Asia and has begun to extend its reach into Europe. From 7-9 November, some 600 animal and human health experts, senior policy makers, economists and industry representatives will gather in Geneva to work towards a global consensus to control the virus in domestic animals and prepare for a potential human influenza pandemic.
The disease in animals caused by the H5N1 influenza virus has resulted in the culling of at least 150 million birds in the last two years. H5N1 remains for the moment an animal disease, but the World Health Organization (WHO) has warned that H5N1 is a virus that has the potential to ignite a human influenza pandemic.
Bird flu is frightening everyone even though it has yet to spread from human to human. In Europe, there has been a run on Tamiflu, a powerful antiviral medication known to help in the treatment of avian flu.
While no one can predict the timing or severity of the next influenza pandemic, governments around the world are taking the threat seriously. A series of international meetings held over the last ten weeks will culminate in the Geneva meeting. The meeting is co-organized by WHO, the Food and Agriculture Organisation (FAO), the World Organisation for Animal Health (OIE) and the World Bank. The goal of the meeting is to work towards a global consensus for controlling the disease in animals while simultaneously preparing for a potential human pandemic.
“This virus is very treacherous,” says Dr Margaret Chan, Representative of the WHO Director-General for Pandemic Influenza. “While we cannot predict when or if the H5N1 virus might spark a pandemic, we cannot ignore the warning signs.” Because influenza pandemics have typically caused enormous social and economic disruption, WHO is advising its member states to develop national strategies to cope with such a public health emergency, as well as coordinating with international partners to develop a comprehensive response.
The Geneva meeting will first consider how to contain the H5N1 virus in birds. “There is still a window of opportunity for substantially reducing the risk of a human pandemic evolving from H5N1 by controlling the virus at its source, in animals,” says Joseph Domenech, FAO Chief Veterinary Officer. As the FAO expects avian influenza to reach the Middle East and Africa in the near future, it is essential that the global community and affected countries mobilize more resources to combat the virus, which is thought to be spread in part by migratory birds, before it becomes embedded in new regions.
Strengthening disease surveillance systems worldwide will also be high on the agenda at the Geneva meeting. Early detection and rapid response mechanisms are essential to tracking the evolution of the H5N1 virus. Therefore, delegates will also discuss ways to strengthen veterinary and human health services so that any H5N1 cases–in animals or humans–will be identified quickly. “This is crucial for the prevention of any future global crisis associated with emerging animal diseases potentially transmissible to humans,” says Dr Bernard Vallat, Director-General of the World Organisation for Animal Health (OIE).
At the same time that animal control efforts are to be intensified, several critical issues related to potential human disease remain to be addressed. Meetings in the last several months have identified several key pandemic preparedness issues. For example, many countries are concerned about the lack of access to antiviral medicines and the antiquated production methods for human influenza vaccines. Communication with the public is also a critical issue. These and other topics will be on the agenda for the Geneva meeting.
The meeting comes after a recent gathering of experts in Geneva (2-3 November) to discuss the development of pandemic influenza vaccines. At present, at least ten vaccine developers in about as many countries are carrying out demonstration projects to develop and evaluate vaccines primarily against the H5N1 subtype. Participants expressed the need for continued sharing of technical information, strengthened international coordination of work related to pandemic influenza vaccines so as to avoid duplication of efforts, support to vaccine research initiatives in developing countries and integrating the science into the public health context.
“It’s impossible to exaggerate how important pandemic preparedness is, and how dire the consequences would be for the entire world if some of the worst-case scenarios for a human influenza pandemic were to unfold,” says James Adams, the World Bank’s Vice-President for Operations Policy and Country Services, and head of the Bank’s avian flu taskforce. The Geneva meeting will provide an opportunity for all international partners to mobilize the country commitment and financial resources needed to manage this global threat.
“For the first time in human history, we have a chance to prepare ourselves for a pandemic before it arrives,” says Dr Chan. “It is incumbent upon the global community to act now.”
New Global Program to Deal with Avian Flu
World Bank News Release
4 November 2005
November 4, 2005—Funds from a new World Bank US$300 to $500 million avian flu program are expected to start flowing to countries within weeks to help them combat the deadly virus.
The Bank is now finalizing its plans for the new funding program, while at the same time preparing to take part in an international conference in Geneva on avian flu in poultry and birds and planning for a possible human pandemic.
The World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE) and the World Bank are co-sponsoring the meeting from November 7 to 9, at WHO headquarters in Geneva.
The Bank’s Vice President for Operations Policy and Country Services, Jim Adams, says the Geneva meeting is designed to allow donors and the international organizations to sit at the same table as affected countries and identify needs at the country level.
Adams, who’s leading the Bank’s delegation to the conference, says the aim is to begin work on putting country programs in place to deal with avian flu, which would then be eligible for funding.
“We’re actually working very closely together with the UN system – with WHO, FAO and OIE – to work jointly to help countries put in place these needs assessments so that the technical requirements are properly identified, so countries can put together programs,” Adams says.
As a first step, the Bank is preparing to go to its Board with its own financing mechanism worth up to US$500 million dollars to help countries in the initial phase.
“We have the financial resources to move quickly,” Adams says.
“Obviously one of the things we can do is provide funding to support these country programs to supplement government resources, to strengthen the veterinary systems and to put in place culling and vaccine programs for animals.”
Another component Adams says will be funding to strengthen the health systems of countries for surveillance, which must be integrated with the animal side.
Adams says the funding mechanism similar to that used by the Bank for funding its AIDS programs in Africa would allow low- income countries immediate access to grants and soft loans from the Bank’s lending arm, the International Development Association.
Mobilizing Other Donors
However the plan for funding for countries extends beyond that.
“Given the global threat and the global implications of this, one of the things we also see ourselves doing is mobilizing grant funding from other donors,” Adams says. “Now to the extent those donors then want to substitute for the Bank funding, we’ll obviously welcome and encourage that.”
“But I think the important role that Bank resources can play upfront is to be available immediately.”
Adams says he expects the funding plan to go before the Bank’s Board of Directors, right after the Geneva meeting.
“If that’s approved, then we hope within the month to move forward with this operation to provide funding on a global basis.”
Multi Donor Trust Fund
The Bank is discussing with donors like the European Commission, as well as the WHO, FAO and OIE, the setting up of a multi donor trust fund with the specific aim of supporting country level activities to combat avian flu.
“The European community has taken the lead in this and we expect to meet in Beijing in January. By then we hope to have specific proposals for the structure of a funding mechanism,” Adams says.
“It may well be that some countries are prepared to commit funds before then. But we hope by early next year to have that trust fund available. “
In parallel, the Bank is supporting funding for our partner organizations in the UN for their priority needs.
But he says the move to establish a global trust fund highlights the importance of the Bank moving forward now “so that in the interim period, funding is available to countries with good investment proposals.”
Adams says he expects initial funding from the Bank would go to some countries in Asia as well as in Europe.
“I think with the spread of the disease and the instances of the disease that have emerged, both in Russia, Turkey and Moldova, we’re seeing interest from Europe as well.”
Adams says it’s important in dealing with the disease in animals to move quickly and effectively.
“One of the things that we learned from Korea and Japan was the aggressive action of those two governments in dealing with the problem has in fact eliminated the problem in those two countries.”
He says key elements in helping countries cope with avian flu outbreaks among animals is improving access to veterinary services and providing proper compensation for culling and for farmers reporting cases of avian flu.
“Another experience from programs to date is that if governments provide proper compensation for culling programs, and identify outside of those culled areas, the areas that have to be vaccinated, then those programs are successful.
“Obviously for farmers particularly poor rural farmers this is their income. If they are properly compensated and paid an appropriate market price for their animals, culling programs will be successful. If they’re not properly compensated, experience shows, they’ll find another way of getting animals to market and the problem will expand.
“And experience shows if you get the animal side right, one substantially reduces the risk of a human pandemic.”
Overall Adams stresses that the problem of avian flu is “not a problem simply this year.”
That’s why he says strengthening veterinary systems needs to be done, and adequate surveillance systems put in place over the longer term to deal with the potential threat to people.
“We hope by combining short term interventions and longer term institutional development we can essentially deal with the problem more broadly.”
World Bank Avian Flu Initiatives
World Bank News Release
7 November 2005
The World Bank is playing a convening role in helping deal with this issue by bringing different sectors and countries together to develop national integrated plans.
The Bank believes addressing avian flu will require a long-term effort, a high degree of coordination, as well as a global strategy.
While the Food and Agricultural Organization(FAO), the World Organisation for Animal Health (OIE), and World Health Organization (WHO) are positioned to help address scientific and technical issues, the Bank also has ongoing health and rural development programs in most of the affected countries, which can help bring together and coordinate national agencies and international experts.
The Bank’s comparative advantage lies in its capacity to put avian flu on the development agenda: raising awareness and mobilizing finances, building capacity, sharing knowledge, and bringing together health officials, animal disease experts, and ministry officials from different countries.
In Vietnam, the Bank has a $5 million project to help the government set up animal disease surveillance systems and laboratories to provide diagnostic capabilities and to help improve public awareness about outbreaks.
The UN Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE) have developed — with input from the World Bank — a three-phase strategy for Cambodia, Vietnam, and Lao PDR which is aimed at containing the outbreak and then gradually eradicating it from domestic poultry and ducks. This effort is in the beginning phase.
Taking Concrete Actions on Bird Flu
The Bank’s rural development team in Vietnam is led by a veterinarian. So we had the expertise in place to help set up animal disease surveillance systems and laboratories to provide diagnostic capabilities. It was clear that — together with our partner organizations, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) — we were able to help the government monitor the progression of the disease much better than during the outbreak 18 months ago.
Applying the Lessons of the Past
The lessons from SARS and other outbreaks are very much on the minds of many people in East Asia. One lesson is the importance of bringing the different players together and to getting them to work together at an early stage. For instance, in 2004, we were able to bring together Vietnam health officials with doctors and researchers in Australia using the Global Learning Development Network’s videoconferencing capabilities.
SARS also reiterated the importance of responding quickly and in a coordinated manner. We need to make certain governments are taking the lead, and then we can help facilitate access to expert technical partners and other donors. To seriously address avian flu, we will need to have preventative measures well advanced by the time the weather turns cold, because the disease is likely to spread faster in the winter months.
Another important lesson from past global experience is that it is preferable to respond as quickly as possible on the core animal health issue. If we fail to aggressively assert control over animal outbreaks, it’s a foregone conclusion the spread to humans will be even more dramatic. No one likes to see on the news the large-scale culling of animals, however it is a necessary part of the long-term strategy so countries can limit the impacts on human health. It is important, especially at this early stage of the emergency, to keep the animal health issues front and center. Ultimately, however, the majority of funding will go to the human health responses.
Another key lesson from past outbreaks has been that our responses need to be forward looking and must be designed to control the spread of infectious disease as a holistic approach Our work to address outbreaks needs to help countries be prepared to respond to avian flu, SARS, or similar diseases in a long-lasting manner, which helps build capacity in the region. We want our assistance to countries to be relevant for other risks and other situations so crucial resources are not wasted.
Both at the national and international level, widespread concern about the potential spread of the disease has resulted in intensive discussion and collaboration among governments and international organizations.
At the national level, affected governments are developing response strategies which will ensure more effective measures are taken early on in future outbreaks. The World Health Organzation and other international agencies are also working together with governments to develop general guidelines for responding to future outbreaks.
Based on lessons learned from the recent outbreaks of SARS and influenza in the region, governments and agencies are now giving greater priority to preventative measures, early international coordination, and collaborative response efforts.
For more information on the World Bank and avian flu, please see our website.
This news item contains modified press releases from the World Bank and WHO.