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
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