Ivian Influuenza- Hussein Sabit


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Ivian flu pandemic and socioeconomic impact


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23/07/2011 Hussein Sabit, Ph.D-MUST 2 A pandemic influenza is a global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population, causes serious illness in people, and then spreads easily from person to person worldwide. Many scientists believe it is only a matter of time until the next influenza pandemic occurs. An avian influenza pandemic "could kill millions of people, cripple economies, bring international trade and travel to a standstill and even jeopardize political stability. Preventive measures including provision of vaccines and anti viral drugs are required for treatment.

Pandemics and Pandemic Threats since 1900:

23/07/2011 Hussein Sabit, Ph.D-MUST 3 Pandemics and Pandemic Threats since 1900 1918: Spanish Flu 1957: Asian Flu 1968: Hong Kong Flu 1976: Swine Flu Threat 1977: Russian Flu Threat 1997: Avian Flu Threat In 1999, another novel avian flu virus - A/H9N2 - was found that caused illnesses in two children in Hong Kong.

The next pandemic:

23/07/2011 Hussein Sabit, Ph.D-MUST 4 The next pandemic During the 1918 Spanish Flu , an estimated 25-50 million people perished. By comparing population data from 1918 to that of today, the estimated fatalities would range between 180 million and 360 million people worldwide.

Socio-economic conditions of poor surveillance:

23/07/2011 Hussein Sabit, Ph.D-MUST 5 Socio-economic conditions of poor surveillance Developing countries have conventional style of bird and livestock production and marketing. Lack of education and awareness multiplies the task of surveillance and prevention. Resources are not available to prepare for the pandemic.

Bio-safety in developing countries:

23/07/2011 Hussein Sabit, Ph.D-MUST 6 Bio-safety in developing countries Developing countries like Egypt do not have enough funds to control the pandemic. Developed countries can have stockpiles of vaccines and anti-viral drugs. In developing countries; basic health facilities are not in the access of common man. Bio safety is almost unknown in the rural areas.

Priority allocation:

23/07/2011 Hussein Sabit, Ph.D-MUST 7 Priority allocation In pandemic the major ethical issue is priority settings for the allocation of funds and healthcare facilities. For developing countries it is not possible to arrange stockpiles for the whole population. Low income and developing countries need to have an infrastructure for primary care and prevention.

Also :

23/07/2011 Hussein Sabit, Ph.D-MUST 8 Also Scarcity of funds. Unlike SARS Influenza spreads very rapidly everyone in any situation and position can be the victim. Vaccination to protect a large unaffected group may not be possible. Control and treatment can have the priority in the low income countries.

How is Avian Influenza spread?:

23/07/2011 Hussein Sabit, Ph.D-MUST 9 Animal & human populations in close proximity - farm animals and pets in/under/next to houses - live animal markets (many species from many countries) Poor agricultural practices - inadequate infection control on farms - poultry excrement used in agriculture (e.g. fed to pigs) Poor food hygiene - food preparation practices - consumption of raw/undercooked meat Frequent travel/trade involving humans and birds - movement of people/animals among farms - legal and illegal animal trade - wild bird migration How is Avian Influenza spread?

“Take Home” Lessons :

23/07/2011 Hussein Sabit, Ph.D-MUST 10 “Take Home” Lessons To-date: H5N1 principally an “animal” based infection. Spreading of virus appears linked to a combination of bird migration and unregulated “bird trade”. Effective response needs to be “cross-sectoral” spanning animal and human health. Early detection and rapid response to outbreaks essential for containment. National “leadership” is critical.

International Response:

23/07/2011 Hussein Sabit, Ph.D-MUST 11 International Response WHO and FAO providing international leadership. International Partnership & international coordination $1.9 billion pledged by international community at Beijing Conference –January 2006 U.S. pledged $334 million – and is actively working in more than 50 countries to contain AI.

International AI Strategy :

23/07/2011 Hussein Sabit, Ph.D-MUST 12 International AI Strategy Goal : to contain and mitigate the effect of an outbreak of pandemic influenza. Objectives: prevent and contain H5N1 outbreaks in animals. prevent animal-to-human infections. prepare for a human influenza pandemic

International AI Strategy:

23/07/2011 Hussein Sabit, Ph.D-MUST 13 International AI Strategy Tactical Pillars: Preparedness and Planning Early Warning Surveillance & Diagnosis Rapid Response and Containment Stockpiling and Deployment of key commodities

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socio-economic effects:

23/07/2011 Hussein Sabit, Ph.D-MUST 15 socio-economic effects The avian influenza is one of today's biggest threats to the World's socio-economic health. First, there are two levels on which to look at possible costs and impacts. First, the probability increases that the virus will enter a second stage (permanently) and spread from human-to-human thus causing a world wide pandemic and greater costs than the current situation.


23/07/2011 Hussein Sabit, Ph.D-MUST 16 Cont. Second , the economic and social aspects are an important part of the this problem. In general, there are two kinds of economic costs coming from the avian influenza. The cost of increased sickness and death of humans and birds. The second cost is of the strategies by the public and private sector to prevent, control, and or cope with the illness and death attributed to the avian influenza.

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23/07/2011 Hussein Sabit, Ph.D-MUST 17 More problematic would be the economic impact of citizens trying to avoid infection by limiting personal contact with other citizens. This was a response of people during the outbreak of SARS. This triggered absenteeism in the workplace, disruption of production and a shift toward costly procedures. It affected tourism, retail sales, mass transportation, hotels and restaurants.

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23/07/2011 Hussein Sabit, Ph.D-MUST 19 We are not only dealing with the price of disruption, but if the avian influenza becomes a global pandemic, the amount of the world output would suffer sizeable losses due to a reduction in productivity.

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23/07/2011 Hussein Sabit, Ph.D-MUST 22 Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza virus able to cause “community-level outbreaks.” WHO Pandemic alert phase

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23/07/2011 Hussein Sabit, Ph.D-MUST 24 WHAT SHOULD BE DONE

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23/07/2011 Hussein Sabit, Ph.D-MUST 25 Discuss the most difficult topics regarding life and death medical decisions and their consequences; Reorient approach to health care delivery in the case of very limited resources; and Identify and activate fast and dependable domestic capacity to produce needed pharmaceuticals. Address and meet key medical requirements

Evaluate and update plans:

23/07/2011 Hussein Sabit, Ph.D-MUST 26 Evaluate and update plans Create a National Strategy for Pandemic Influenza. Identify and include necessary stakeholders in the evaluation and updating of the Plan. Analyze and comprehend how the National Strategies interact;


23/07/2011 Hussein Sabit, Ph.D-MUST 27 Cont . Implement an effective public awareness campaign to help citizens; and Implement a uniform global biological surveillance program to provide biological. warning of incidents and suspicious events.

Vaccine Production Capacity:

23/07/2011 Hussein Sabit, Ph.D-MUST 28 Vaccine Production Capacity At the global level: ≈900 mil 15 mcg doses/year At the USA level: ≈180 mil single doses/year

Projected Number of Deaths Due to Future Pandemic Influenza Based on the 1918-1920 Pandemic:

23/07/2011 Hussein Sabit, Ph.D-MUST 29 Projected Number of Deaths Due to Future Pandemic Influenza Based on the 1918-1920 Pandemic Area No. Deaths Twin Cities SMA 18,538 Minnesota 30,498 United States 1,763,664 Worldwide 30,000,000 - 384,000,000

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What Do We Do?:

23/07/2011 Hussein Sabit, Ph.D-MUST 31 What Do We Do? Pray, plan and practice (In that order) Not a matter of if , just when and where? Lack of international political will and support At minimum, assume we will virtually no vaccine for the first 6-8 months and then supplies will remain limited.

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23/07/2011 Hussein Sabit, Ph.D-MUST 32 To mitigate the potential impact of an influenza pandemic, control interventions include two strategies – one , a non-pharmaceutical approach such as social distancing and infection control and the other , a pharmaceutical approach such as the use of influenza vaccines and antivirals for treatment and prophylaxis.

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23/07/2011 Hussein Sabit, Ph.D-MUST 33 Tragically, such a pandemic will likely intensify the divisions between the world's rich and poor nations: While wealthier nations would have access to limited supplies of vaccines and antiviral drugs, the poor would die for lack of treatment. Splitting the world

The Wealth of Nations (GDP) per Capita — (US$ 000s : PPP-terms):

23/07/2011 Hussein Sabit, Ph.D-MUST 34 The Wealth of Nations (GDP) per Capita — (US$ 000s : PPP-terms)

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23/07/2011 Hussein Sabit, Ph.D-MUST 35 There is no magic bullet to control an influenza pandemic. A comprehensive approach to pandemic control includes a combination of non-pharmaceutical interventions, use of antiviral drugs and vaccines; this is the best way to mitigate the impact of an influenza pandemic. Will a vaccine be a magic bullet to control an influenza pandemic?

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23/07/2011 Hussein Sabit, Ph.D-MUST 36 At present, WHO has not made any recommendations to countries about the pre- pandemic purchase of potential pandemic vaccine, but consultations are ongoing to identify the most appropriate strategies. Moreover, pre-purchase of vaccine is a national decision. Should countries pre-purchase pandemic influenza vaccine?

The global cost of the next pandemic:

23/07/2011 Hussein Sabit, Ph.D-MUST 37 The global cost of the next pandemic Estimates by the World Bank have shown that the economic costs of such a pandemic could be on the order of $1.5 trillion - 2 trillion globally. About three quarters of these costs would fall on high-income countries although, as a percentage of GDP, the decline would be greatest in developing countries , with potentially huge long term socio-economic impacts.

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Insurance :

23/07/2011 Hussein Sabit, Ph.D-MUST 39 Insurance In addition, the Insurance Information Institute estimates that such a pandemic could result in $133 billion more in death claims for life insurers than would be expected in the absence of a pandemic.

Recommendations :

23/07/2011 Hussein Sabit, Ph.D-MUST 40 Recommendations Influenza pandemic is not a regional problem. Measures should be taken accordingly. International assistance is required for the surveillance and control of the pandemic in low income and developing countries. Media should promote awareness to the public through informative documentaries.


23/07/2011 Hussein Sabit, Ph.D-MUST 41 Recommendations By focusing exclusively on building a protective shield of vaccines, drugs and early warnings – we will do little to limit the emergence of newer and deadlier pathogens.


23/07/2011 Hussein Sabit, Ph.D-MUST 42 Finally What we do risk is making influenza and other zoonotic diseases a scourge inflicted on those who can’t afford or access vaccines and drugs. ….. In short, AI will be diseases of the poor – as has happened with malaria, tuberculosis and HIV/AIDS

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23/07/2011 Hussein Sabit, Ph.D-MUST 43 Thank you