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: 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