Transcript Avian Influenza

Avian Influenza
Political, Social, and Economic
Dimensions of the Continuing
Threat from Emerging Infectious
Diseases
The Symposium
A multidisciplinary symposium
held
15 November 2005
at
The George Washington
University,
Washington DC
Cosponsored by:
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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
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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
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Demographic characteristics of susceptible population
Workforce reduction
Reduced social interaction
Pervasive insecurity
Issue
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Unstable pathogen evolving strains that infect
human hosts
No appreciable immunity in this generation
Medium of transmission – birds
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Domestic poultry – local transmission
Wildfowl – long-range transmission
Leap to human populations occurs repeatedly
Human-to-human transmission confers
pandemic risk
Problemmatique
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Disconnect among
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Public health, biomedical research communities
Development community
Government and decision-makers
Health sector
Economic threat
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To industry
To workforce
To community
To economic development gains
Uncertainties
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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
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Importance of surveillance
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Veterinary
Human (public health)
Objectives
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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
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Depopulation
Biosecurity
Vaccination
Cleaning and disinfection
Separation from wildfowl
Wet markets as risky venues for
contamination
Countermeasures - Human
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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
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Reduce social interaction, opportunities
 Surface decontamination (probably minor)
 Isolation & quarantine
Consequence mgmt
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Treatment for infected person
Prophylactic for population
Countermeasures Management
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Stockpiling
Public risk communication
Local ownership and support
Intersectoral coordination, partnerships
Training
Innovative use of existing platforms, infrastructure
for disease control
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Public health svcs infrastructure (e.g. immunizations)
Zoonotic disease control
Education, communications media
Avian Influenza as a
Transformational Process
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Emerging infections – dynamics
Emergency response – dealing with short-term issue
Underlying causes – longer view
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Emerging infections per se
Structural factors conditioning problem
Containment & response capabilities
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Surveillance, early warning
Vaccine technology
Risk communication to public
Underlying Causes
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Population density (human, animal)
Poverty and impoverished marketplaces
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Cultural processes
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Implications of depopulation without reimbursement
Business case for investment – protection + survival
Animal handling practices
Prevention
Partnerships
Robust, innovative partnerships to address root
causes
US President’s Announcement
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Response to emergency
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Accurate perception of risk
Value of preparedness
Time of response for effective containment is very
short
Historic opportunity
Policy issues for US
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Stockpiling
Vaccine development capacity
Measuring impact, cost-effectiveness
Global Impact
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Economic impact on poultry industry
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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
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Loss of income, increased income disparities
Loss and diversion of investment to less productive uses
Global Response
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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