Influenza PandemicsAligning Solutions for Institutions and Individuals: Influenza Pandemics Aligning Solutions for Institutions and Individuals Max J. Rudolph, FSA CFA MAAA Rudolph Financial Consulting, LLC Iowa Actuarial Club February 23, 2007


Teachable Moment?: Teachable Moment?


Topics: Topics Overview/History of Pandemic Risk Recent Developments Risk to Insurers/Institutions Discussion of SOA Pandemic Research Project


Overview/History: Overview/History Recently 3-4 influenza pandemics per century 20th century 1968 Hong Kong flu (H3N2) 50% of deaths above age 65 Many of rest were young 1957 Asian flu (H2N2) 65% of deaths above age 65 1918 Spanish flu (H1N1) 99% of deaths below age 65


Pandemics: Pandemics Definition New strain of virus with limited immunity Ability to infect humans Ability to transmit between humans (H2H) Multiple waves common Mutations attack different groups in each wave High morbidity (25-30%), low mortality (<<1%) Global is local, and local is global


Phases of Pandemic Alert: Phases of Pandemic Alert Inter-pandemic phase 1 low risk of human cases 2 new virus in animals, no human cases Pandemic Alert Period 3 very limited H2H 4 new virus with H2H cases 5 significant H2H transmission Pandemic 6 efficient/sustained H2H transmission


Why a severe scenario could happen: Why a severe scenario could happen Supply chain constraints Health care Food/Energy/Services Virus mutations build resistance to drugs At risk population (HIV, cancer, diabetes) Poverty and malnutrition Reaction time Travel Vaccines take 6-9 months to develop


Why a severe scenario won’t happen: Why a severe scenario won’t happen Better health care Intensive care units Germ theory Antibiotics Antivirals Better coordination between human and animal disease researchers Working toward a vaccine


Influenza Basics: Influenza Basics 8 genes made of RNA Can live for up to 2 days on hard surfaces (air?) lungs are only human cells with the right enzyme RNA mutates easily (DNA does not) Proteins Hemagglutinin (H) helps flu to enter cell Neuraminidase (N) helps flu spread from cell 2006 vaccine (set Feb 2006) H3N2, H1N1


1918-20 Pandemic: 1918-20 Pandemic Worst in recorded history 50 to 100 million died worldwide Mostly fall 1918 675,000 died in US Virus mutated directly from birds Other recent pandemics used reassortment (pigs) Could it be repeated? Developed world impacted less Sanitation Better able to deal with secondary infections Smaller percentage aged 20-40


Background on 1918: Background on 1918 WWI Poison gas Crowded conditions Bond drives Politicians overrode health inspectors recall China’s response to SARS Fear/rumor


Abnormal Mortality Curve: Abnormal Mortality Curve W shaped curve experienced in 1918 Peak for ages 20-40 50% of deaths Immune system turns on self Limited impact over 65


Mortality Curve: U or W Shape?: Mortality Curve: U or W Shape? Source: 1918 Influenza: the Mother of All Pandemics Jeffery K. Taubenberger* and David M. Morens†


Symptoms: Symptoms Very sudden: 1-2 hours healthy to sick Fevers: 101-105 degrees Eyes burn Severe aches in muscles, joints, backs, heads As if they had “been beaten all over by a club” Patient drowns – fluid in lungs (ARDS)


First Wave: First Wave Spring 1918 - normal flu Very contagious – especially for young, healthy adults


Second Wave: Second Wave Late summer/fall 1918 – deadly Some protection if infected by first wave Secondary infections Pneumonia Heart Neurological


The Numbers: The Numbers About 25% contracted flu and 20-100 million died worldwide US: 25% morbidity, 2.5% mortality .25 * .025 = .6% excess mortality 675,000 died in US (population is 3 times larger today) More US deaths than all 20th century combat deaths


Impact of Poverty: Impact of Poverty Combination of poverty/secondary infections drives greater impact in 3rd world countries Large percentage of overall mortality 1918 - India/Russia/Iran had 7-10% die High risk today HIV/TB/malaria Areas of malnutrition Africa


Current: Bird Flu (H5N1): Current: Bird Flu (H5N1) All influenza strains come from birds Reassortment/Adaptive mutation H5N1 is responsible for current bird pandemic Watch for clusters as virus mutates H2H strain likely less virulent


Current Statistics (WHO Feb 16): Current Statistics (WHO Feb 16) 2003: 4 cases, 4 deaths 2004: 46 cases, 32 deaths 2005: 97 cases, 42 deaths 2006: 116 cases, 80 deaths 2007: 11 cases, 9 deaths Total: 274 cases, 167 deaths 61% mortality qx rising since September 2006


Risk to Insurers: Risk to Insurers Insurance risk Mortality and morbidity Economic risk (liquidity) Global recession likely Counterparty risk Reinsurer solvency Business continuity Claims and customer service


Pandemic ScenariosUS Dept HHS: Pandemic Scenarios US Dept HHS


What is the cost?: What is the cost? Life Insurers (per ACLI 2005 Fact Book) Gross Net Amount at Risk $16.5 trillion Statutory Surplus $250 billion Excess deaths 0.6% Cost: Flat Extra (before tax benefit and reinsurance) $99 billion or 40% of surplus Reinsurance ceded – face amount $1.9 trillion Other factors – health, payout annuities, GMDB


Insured vs. Population Mortality: Insured vs. Population Mortality Insured mortality about 60% of population 60% have life insurance Factors favoring insured mortality: Socio-economic Health insurance Nonsmoking Disease burden BUT 1918 flu killed healthiest


Flu Season of 1999-2000: Flu Season of 1999-2000 Annual flu arrived early System caught unprepared, no capacity Equipment shortfalls Nurse shortage


Economic Risk: Economic Risk Global recession: estimated GDP drop of 3% Asset default rate will spike Interest rates will reduce (offset) Who will buy your assets? Liquidity event?


Counterparty Risk: Counterparty Risk Reinsurers have low Reserves set aside relative to Face Amount Other catastrophes will not go away 12 to 18 month event Might not be able to pay promptly, if at all Will direct writers survive if reinsurers fail?


Business Continuity Risk: Business Continuity Risk Advance planning and communication is critical Minimal notice once clusters form High absenteeism due to sick, caring for family Assume 40-50% Succession planning Multiple locations (field offices/international)


SOA Study: SOA Study Actuaries consider mortality risk our specialty Insurance Information Institute (Weisbart) estimates of mortality claims surge risk Moderate scenario: $31 B Severe scenario: $133 B SOA research project to be released in the next month


Issues: Issues Just-in-time supply chain Hospitals: oxygen, gloves, ventilators Individuals: medicine, parts, food, energy, garbage Will FedEx, UPS and US Post Office deliver Pockets of social unrest? Back up plans rely on internet Allocation Vaccines Hospital beds Emergency personnel Economic: no built in recovery


Advice: Advice What should you do? React proactively Set up internal influenza team HR practices (send sick home, pay practices) Reinsurer risk Telecommuting/multiple shifts Privacy issues Stockpile supplies Advice for employees Use available resources from county, CDC, WHO


Bibliography: Bibliography America’s Forgotten Pandemic Alfred W. Crosby Flu: The Story of the Great Influenza Pandemic Gina Kolata The Great Influenza: The Epic Story of the Greatest Pandemic in History John M. Barry The Monster at Our Door: The Global Threat of Avian Flu Mike Davis


“With the recent development of hygiene and sanitation as marked as it is, the world felt safe against the possibilities of any new conflagration from influenza. But the experience of the last two years has demonstrated that we are not so far advanced in our knowledge of this disease, of its cause and of the methods of its control as we thought we were.”: “With the recent development of hygiene and sanitation as marked as it is, the world felt safe against the possibilities of any new conflagration from influenza. But the experience of the last two years has demonstrated that we are not so far advanced in our knowledge of this disease, of its cause and of the methods of its control as we thought we were.” James D. Craig and Louis I. Dublin Actuarial Society of America Transactions (Vol. XX, Part 1 No. 61)


Thank you!: Thank you! Max.Rudolph@rudolphfinancialconsulting.com (402) 895-0829 www.rudolphfinancialconsulting.com