March 5, 2013 -- In recent weeks, reports of H5N1 avian flu outbreaks have appeared in different corners of the globe, and the World Health Organization (WHO), and its sister organization, the World Organisation for Animal Health (OIE), are urging all countries to monitor a new coronavirus. Such news is a reminder that pandemics pose serious threats, and that preventing them should be a global health priority, according to World Bank health and agriculture experts.
The world got a glimpse of the economic and human toll a serious pandemic could take in 2003, when the SARS outbreak was contained after it killed 800 of the 8,000 people infected. It cost the world $54 billion—an enormous price tag.
The toll of the ongoing AIDS pandemic is also a sobering reminder of the high price of a contagion that was not detected and controlled early on. The most severe of the four flu pandemics in the last 100 years, the 1918 pandemic, killed between 50 million and 100 million people, out of a global population of 2 billion.
Because a novel flu virus could infect 30-40% of all people, in a worst-case scenario, business and consumer confidence would plummet, worker absenteeism would rise sharply, and public services would falter, says Olga Jonas, economic adviser for the World Bank health team. “Disruptions would propagate across economies and could include breakdowns of food distribution and public order in megacities,” she says.
A severe flu pandemic could cost 4.8% of global GDP, or more than $3 trillion—and it would hit the poor the hardest. The risk is rising because livestock and human densities increase alongside weak veterinary and public health systems in developing countries.
Next pandemic could be zoonotic
Three of four infectious pathogens and 80% of bioterror agents are now zoonotic – a category that includes influenzas, Ebola, brucellosis, rabies, leptospirosis. Zoonotic pathogens infect 2.4 billion people in developing countries every year, causing 2.2 million deaths.
“This is a formidable development issue, where the poorest, who often live closest to livestock or hunt wildlife for food, are most at risk,” says Bank livestock advisor Francois Le Gall. ”Not only is animal disease costly to farmers, but it also affects nutrition, poverty, food security, and trade, and in the case of zoonoses public health” he says.
Adding to these costs, pandemic risk arises when infectious pathogens are not rapidly and effectively controlled at their animal source and adapt to transmit readily from person to person.
Modest investments, big benefits
To reduce pandemic risk, disease outbreaks must be detected early, diagnosed correctly, and controlled effectively—which requires strong and coordinated veterinary and health systems.
“This will help stop contagion at the animal source and keep costs down. Every country needs to have such systems since a global network of defenses is only as strong as the weakest link,” says Le Gall. Health risks at the animal-human-environment interface can be reduced by strong veterinary and public health systems that use the “One Health” approach, he says.
To this end, veterinary and human health systems in developing countries will require $3.4 billion annually, compared with less than $450 million currently. A Bank report argues that this sustained level of investment is justified in view of at least $37 billion in annual expected benefits from prevented pandemics and other major outbreaks.
Experts argue that animal and human health systems that are robust enough to control avian flu will also thwart cholera, yellow fever, Newcastle disease, foot and mouth disease, leptospirosis, brucellosis, rabies, and other infectious diseases, in humans and in their livestock. Such systemic approaches are also needed to prevent antimicrobial resistance, which will render antibiotics ineffective.
From 2005-2010, donors contributed $3.9 billion to respond to H5N1 avian flu, financing systems to detect and control zoonotic diseases and prepare for a pandemic—the largest global multisectoral disease prevention program to date. Veterinary and human public health systems benefited from building capacity of staff in disease control, disease reporting and diagnostic capacities, enhancing preparedness, arranging compensation, and developing risk communication strategies.
The Bank administered a $127 million Avian and Human Influenza Facility, where the European Commission was the lead donor and key partner. The Facility, IDA and IBRD together provided $1.3 billion for 72 operations in 60 countries; eight operations are ongoing but will close within two years. Since 2010, donors have sharply reduced their support to pandemic prevention. “But substantial disease control capacity gaps remain in many developing countries, especially in veterinary services,” says Maryse Pierre-Louis, World Bank lead health specialist.
A new Bank policy note highlights the need to connect systems, professions, and disciplines to reduce pandemic risks. The Bank’s partnerships with the UN System Influenza Coordinator, OIE, WHO, and the Food and Agriculture Organization of the United Nations (FAO) remain key to advocating for global vigilance, prevention and preparedness.