“This is the worst virus I’ve ever met in my long career.’’ Robert Webster, renowned avian influenza expert, on the H5N1 subtype

Toll of SARS Ontario: 375 probable and suspect cases, 44 deaths Ontario: 375 probable and suspect cases, 44 deaths Worldwide: ≈8,100 probable cases, 774 deaths Worldwide: ≈8,100 probable cases, 774 deaths C$1 billion in economic losses for Toronto C$1 billion in economic losses for Toronto US$60 billion in overall loss in demand and in business revenue in East and SE Asia* US$60 billion in overall loss in demand and in business revenue in East and SE Asia* (Source: Asian Development Bank)

Pandemic Projections United States 314,000 – 733,000 hospitalizations 314,000 – 733,000 hospitalizations Economic losses: Up to $166.5 billion Economic losses: Up to $166.5 billion (sources: 1st draft, US pandemic plan; CDC) Worldwide 6.4 mil to 28.1 mil hospitalizations 6.4 mil to 28.1 mil hospitalizations 874 mil to 1.6 bil require a doctor’s care 874 mil to 1.6 bil require a doctor’s care (Source: WHO)

“The point isn’t the exact number. The point is: Imagine a lot of people ill in a very short space of time. More than you’ve ever seen.” Martin Meltzer, health economist, CDC

Global Fatality Projections 2 million to 7.4 million 2 million to 7.4 million 100 million 100 million 180 million to 360 million 180 million to 360 million 1 billion 1 billion

“It is a big, big issue. I mean, it’s almost imponderable. “I have to admit: the more research I did, the more frightened I became.” Sherry Cooper, chief economist, BMO Nesbitt Burns

State of Global Planning ≈ 40 countries have drafted pandemic plans, of varying levels of detail. ≈ 40 countries have drafted pandemic plans, of varying levels of detail. –31 of those are countries in the WHO’s European region. –2 nd iteration of U.S. plan expected shortly

“Any way to address stockpiling issues is going to be resource intensive and expensive. “There’s nothing on the cheap.” Dr. Keiji Fukuda, WHO

Antiviral stockpiling ≈30 countries have ordered antiviral drugs. Delivery staggered. ≈30 countries have ordered antiviral drugs. Delivery staggered. –U.S. : 2.3 mil courses Tamiflu in stock. Will buy additional 20 mil courses.  84,300 courses of Relenza in stock. –Canada: enough drug in hand to treat ≈ 8 % of the population. –Australia: enough drug in stock to treat 16 % of its people. –Finland: enough drug in stock to treat 25 % of its people. –UK: To buy ≈15 mil treatment courses, half this year, half next. ≈30 countries have ordered antiviral drugs. Delivery staggered. ≈30 countries have ordered antiviral drugs. Delivery staggered. –U.S. : 2.3 mil courses Tamiflu in stock. Will buy additional 20 mil courses.  84,300 courses of Relenza in stock. –Canada: enough drug in hand to treat ≈ 8 % of the population. –Australia: enough drug in stock to treat 16 % of its people. –Finland: enough drug in stock to treat 25 % of its people. –UK: To buy ≈15 mil treatment courses, half this year, half next.

H5N1 vaccines Vaccine production Vaccine production –U.S. has completed Phase 1 testing of an H5N1 vaccine –Japan, Australia, Canada, Britain, France are working on or have stated intentions to make H5N1 vaccine for testing or stockpiling –Several companies (Sanofi, GSK) working on an H5N1 vaccine for own purposes. Vaccine production Vaccine production –U.S. has completed Phase 1 testing of an H5N1 vaccine –Japan, Australia, Canada, Britain, France are working on or have stated intentions to make H5N1 vaccine for testing or stockpiling –Several companies (Sanofi, GSK) working on an H5N1 vaccine for own purposes.

Vaccine Production Capacity Global: ≈900 mil 15 mcg doses/year Global: ≈900 mil 15 mcg doses/year U.S.: ≈180 mil single doses/year (excluding MedImmune’s FluMist) U.S.: ≈180 mil single doses/year (excluding MedImmune’s FluMist)

Capacity to Vaccinate NIH testing shows 2 x 90 mcg of vaccine needed to produce good immune response. Based on that dosing regime: - Global output: 75 mil people/year - U.S. output: 15 mil people/year

Candling eggs used for growing influenza virus

“Infectious disease experts are quaking in their boots, and then they are harnessing their fears, setting priorities, planning and preparing. “The public needs to go through the same process.” Peter Sandman, risk communications specialist

Private Tamiflu sales U.S. sales more than 3 times higher for Jan.-June 2005 than all of U.S. sales more than 3 times higher for Jan.-June 2005 than all of Canadian sales for 12 months to June times higher than sales for entire Canadian sales for 12 months to June times higher than sales for entire New Zealand sales up 500 per cent this year over last. New Zealand sales up 500 per cent this year over last.

“What I’ve argued many, many places is that what we might face is a gigantic catastrophe. And what we ought to be trying to do is to turn that gigantic catastrophe into an ordinary disaster. “That would be a laudable human goal.’’ Dr. David Fedson, retired Aventis executive Dr. David Fedson, retired Aventis executive