Avian Influenza

Political, Social, and Economic Dimensions of the Continuing

Threat from Emerging Infectious Diseases

The Symposium

A multidisciplinary symposium held15 November 2005

at The George Washington

University,Washington DC

Cosponsored by: International Resource

Group (IRG) Dept. of Environmental and

Occupational Health, GW School of Public Health and Health Services

Speakers James Adams, World Bank Bruce Gellis, DHHS Panelists on Public Health

(see program) Panelists on Economic

Impact(see program)

Asif Shaikh, IRG Tee L. Guidotti, GWUMC

This summary integrates material from all speakers.

Significance of avian influenza Potential pandemic of historic consequence Model for emerging infectious disease mgmt Economic disruptor

Poultry as commodity Cost of countermeasures (very high) Food security (not food safety) Loss of consumer demand Loss of critical human resources

Demographic characteristics of susceptible population Workforce reduction

Reduced social interaction Pervasive insecurity

Issue

Unstable pathogen evolving strains that infect human hosts

No appreciable immunity in this generation Medium of transmission – birds

Domestic poultry – local transmission Wildfowl – long-range transmission

Leap to human populations occurs repeatedly Human-to-human transmission confers

pandemic risk

Problemmatique

Disconnect among Public health, biomedical research communities Development community Government and decision-makers Health sector

Economic threat To industry To workforce To community To economic development gains

Uncertainties

Virus spreads in domestic bird populations Disincentives to report sick birds, flocks Migratory wildfowl – longer-range

transmission Virus infecting mammals, human host Human-to-human transmission Lag to vaccine production; under-capacity Efficacy of oseltamivir, zanamivir

Countermeasures - General

Importance of surveillance Veterinary Human (public health)

Objectives Eradication (containment probably more realistic) Barriers to spread in avian populations Barriers to human infection Slow down rate of genetic events Consequence mgmt, protection of econ gains

Countermeasures - Avian

Depopulation Biosecurity Vaccination Cleaning and disinfection Separation from wildfowl Wet markets as risky venues for

contamination

Countermeasures - Human Decrease probability (p) of leap to humans

Decrease probability (rare event) by animal handling practices Occupational health measures

Reduce p human-to-human transmission Immunization Antiviral medication

Treatment for infected person Prophylactic for population

Reduce social interaction, opportunities Surface decontamination (probably minor) Isolation & quarantine

Consequence mgmt

Countermeasures - Management

Stockpiling Public risk communication Local ownership and support Intersectoral coordination, partnerships Training Innovative use of existing platforms, infrastructure

for disease control Public health svcs infrastructure (e.g. immunizations) Zoonotic disease control Education, communications media

Avian Influenza as a Transformational Process

Emerging infections – dynamics Emergency response – dealing with short-term

issue Underlying causes – longer view

Emerging infections per se Structural factors conditioning problem

Containment & response capabilities Surveillance, early warning Vaccine technology Risk communication to public

Underlying Causes

Population density (human, animal) Poverty and impoverished marketplaces

Implications of depopulation without reimbursement Business case for investment – protection + survival

Cultural processes Animal handling practices Prevention Partnerships

Robust, innovative partnerships to address root causes

US President’s Announcement

Response to emergency Accurate perception of risk Value of preparedness

Time of response for effective containment is very short

Historic opportunity Policy issues for US

Stockpiling Vaccine development capacity Measuring impact, cost-effectiveness

Global Impact

Economic impact on poultry industry As commodity As source of nutrition Consumer preferences Loss of local start-up business opportunity

Public health impact has economic impact Public health interventions also impose costs Economic effects also have secondary health

effects Loss of income, increased income disparities Loss and diversion of investment to less productive uses

Global Response Countermeasures, which carry expense Poultry industry

Disproportionate relative value in many developing economies Substitute economic opportunities Substitute protein, nutritional sources

Drop in consumer demand – how to support demand Retail sales Pandemic: reduction in human population?? Diverted economic resources – health care

Workforce, critical infrastructure protection Distribution in time, space affects response Economic incentives