George Mason University: The Threat of Pandemics in the Asia-Pacific Region and Challenges of U.S. Preparedness

1. George Mason University: The Threat of Pandemics in the Asia-Pacific Region and Challenges of U.S. Preparedness World Bank Perspectives on Avian Flu John Underwood

2. Overview • World Bank’s Role—assist developing countries to achieve their goals of growth and poverty reduction • Avian flu and potential pandemic human influenza are threats to progress in reducing poverty • World Bank—has worked with partners at three levels on the world-wide response: • Globally, as part of the international coalition in support of developing countries • At the country level, providing financing support for integrated animal/human health programs • Within the Bank, coordination across regional staff and across central units working on animal health and human health issues (including analysis and research)

3. The World Bank • An international organization owned by its shareholders—member governments—set up in 1944 • Goal—work to reduce poverty in the world • A cooperative providing funding to developing countries and sharing technical knowledge across developing countries to help them achieve their growth and poverty reduction goals • Two financing windows—loans at market rates to mainly middle-income countries (IBRD window); subsidized credits and grants to poorer countries (IDA window) • Total commitments last year: $23.6 billion, of which $9.5 billion from IDA

4. The HPAI Threat—Already a Reality • HPAI is a zoonotic that is emerging as endemic in several developing countries, mainly in Asia, and potentially a poultry pandemic • HPAI is transboundary and spreads rapidly in poultry; the scope of control is beyond any one country or region • HPAI has a negative impact on the welfare of the poor in countries with outbreaks • HPAI has a negative impact on regional and international trade

5. The Spread of Avian Influenza

6. The Poverty Threat from Avian Influenza • Vietnam example—44 million birds culled, 17 percent of poultry population; loss of $120 million; 50 days of income of poor, small poultry producers. • Based on experience with SARS, the World Bank estimates that a human pandemic could reduce world GDP by two percent, a loss of roughly $800 billion over one year. • Threat to five years of the strongest growth and consequent poverty reduction in developing countries in half a century, especially for low-income countries (almost 4 ½ percent per year growth in per capita income) and Sub-Saharan Africa (almost 2 ½ percent per year growth in per capita income).

7. Response at the Global Level • The Protocols—coordination across technical agencies—World Health Organization on human health; Food and Agriculture Organization and OIE (the world animal health organization) on pandemic preparedness coordinated with progressive control of HPAI and minimizing its threat to humans; UNICEF on communications • The Funding—donors pledged $1.9 billion in support to developing countries—not a separate fund but money earmarked for support mainly to UN agencies, countries • Monitoring and Evaluation—following up with UN Special Influenza Coordinator on donor pledges and technical agencies on refining the protocols, based on experience (example: culling versus vaccination of poultry)

8. Response at the Country Level • Global program for Avian Influenza Control and Human Pandemic Preparedness and Response • $500 million facility from World Bank resources to help countries develop and implement integrated human/animal health programs to address the threat • Operations tailored by countries to their needs; coordinated with support from other donors • $150 million committed to 16 countries; preparation under way in 24 additional countries • Small trust fund administered by the Bank to provide additional grant financing—appropriate given the global public good nature of efforts to fight the spread of the disease

9. Response Within the World Bank • Coordination across geographic regions to draw best practice and lessons of experience • Coordination of staff working on animal health and human health issues • Work on analytical issues, like best practice on poultry culling and compensation (communicate program ahead of time; pay 75 to 90 percent of market price; pay quickly)—an important issue for timely response to an outbreak of HPAI—draws on Bank’s strength in bringing economists together with sector subject experts

10. Summary and Challenges Ahead • Countries are adopting, as recommended, integrated programs preparing for or working to stamp out HPAI while reducing the threat of HPAI to humans and preparing for a possible human flu pandemic • Progress on gradual control of HPAI but a long way to go: • Asia—most countries have moved aggressively with strong donor support (Indonesia was lagging but now moving) • Africa—a major challenge, given other disease priorities; needs more international financial support (international conference in Bamako, Mali in December) • More information at www.worldbank.org (first page under Hot Topics) including links to partner organizations

11. Have We Cried Wolf? • What if no human pandemic emerges from the current strain of avian influenza? Will there be a public backlash? Hopefully “no” • Zoonotics like HPAI—Major threat to human health (rabies, SARS, HIV/AIDSs, salmonella, unknown emerging diseases); strengthened developing country public animal health systems better linked to their human health systems will pay large dividends. • Pandemic preparedness plans in developing countries will serve them well, even in preparing for natural disasters