Pandemic Prevention, Preparedness and Response

1. Pandemic Prevention, Preparedness and Response The Business Case

2. Presentation Overview • Characteristics and Costs of Outbreaks, Epidemics, Pandemics • Effects of Emerging Infectious Diseases (EIDs) on Private Sector • The EbolaExample • Impacts of Ebola on the Private Sector • Case Studies – Ebola Response • Private Sector Prevention, Preparedness and Response • Role of Private Sector in Risk Mitigation • Best Practices • Key Takeaways/P&R Tools

3. Characteristics and Costs Outbreaks, Epidemics, Pandemics

4. Macroeconomic Costs of Recent Epidemics • Past epidemics had significant economic impacts and the next outbreak is around the corner • High costs to private sector • Increased labor costs • Decreased productivity • Increased input costs • Numerous others • Following slides provide examples of pandemics affecting P&R countries in 3 regions: • West Africa • East Africa • SE Asia Adaped from: Marsh, n.d. The Economic and Social Impact of Emerging Infectious Disease: Mitigation through Detection, Research, and Response, s.l.: s.n.

5. Avian Influenza (H5N1) Distribution of H5N1 Avian Influenza cases in humans and poultry Snapshot: • Since 2003 +700 human infections • Europe, Middle East, Asia, Africa and the Pacific • Human cases have high mortality Cases: +700 (human) since 2003 Deaths: • ~420 (human) since 2003 • 2003-3004 outbreak dead/culled poultry • Vietnam: 44 mill. (17.5%) • Thailand: 29 mill. (14.5%) • 2014 Nigeria: 1.6 mill dead/culled poultry Costs (estimates): • 2004-2009 worldwide economic impact: $30 billion • 1997 Hong Kong outbreak: 100s of  millions including knock-on effects • USD 100-200 billion (2004 values) Industries affected: poultry, trade,  tourism Transmission risk: Poultry → poultry     Poultry → humans (rare, but deadly) Human → human (rare, but deadly) Epperson, S. & Bresee, J., 2015. Chapter 3 Infectious Disease Related to Travel: Influenza. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/influenza

6. Swine Flu (H1N1) Confirmed deaths reported to WHO - August 2010 Snapshot: • Emerged in 2009 • Circulates worldwide Cases: lab-confirmed in +200 countries, millions Deaths (human): +18,000 lab-confirmed; estimate: 284,500 (51% in SE Asia & Africa) Costs: Global: $330 billion (mild) to $4.4 trillion losses (severe) Industries affected: tourism, trade Transmission risk: Pigs → humans (rare) Humans→ humans (common, but mild) World Health Organization, 2010. Timeline Pandemic (H1N1) 2009 laboratory confirmed cases And number of deaths as reported to WHO. Available at: http://gamapserver.who.int/h1n1/cases-deaths/h1n1_casesdeaths.html

7. Impacts of Swine Flu (H1N1) Snapshot: • Flu kills ~.2-1.5 million per year Costs: Macro-economic impact estimates: • Mild: 1.4 million lives; $330 billion loss economic output • Ultra (not pictured): 142.2 million deaths; $4.4 trillion loss economic output Next strain: emerge from China or Far East Chakravarty, M. & Philipose, M., 2009. Economic impact of swine flu. http://www.livemint.com/Money/ALhNfoq6XIf5Vxja4fmniM/Economic-impact-of-swine-flu.html

8. Severe Acute Respiratory Syndrome (SARS) Snapshot: • Emerged in late 2002 (China) • Spread to 30 countries in < 10 months Cases: 8,096 (including fatalities) by end of 2003 Deaths: 774 (9.6% case fatality) Costs: • Int’l travel to affected areas declined 50-70% • $40-80 billion (estimated) loss in global economic activity Industries Affected: Travel (airlines, taxis, etc.), tourism/hospitality business (hotels, restaurants, retail, etc.) Transmission Risk: palm civets → humans (moderate, deadly) infected humans → humans (high, deadly) • Boulos, M. N. K., 2004. Descriptive review of geographic mapping of severe acute respiratory syndrome (SARS) on the internet. [Online] Available at: https://www.researchgate.net/publication/8898152_Descriptive_review_of_geographic_mapping_of_severe_acute_respiratory_syndrome_SARS_on_the_Internet[Accessed 21 July 2017].

9. Nipah Virus Snapshot: • Annual outbreaks in Bangladesh since 2001 • Malaysia/Singapore outbreak in 1998 Cases: • Bangladesh (196 from 2001-2012) • Malaysia/Singapore (257 in 1998) Deaths: • Bangladesh (150- 77% case fatality) • Malaysia/Singapore (105- 40% case fatality) • Costs to Malaysia: • $97 million distributed as compensation for culled pigs • $120 million lost locally due to 80% drop in pork consumption • $124 million lost as result of export market decline • Industries Affected in Malaysia: • Commercial pig farming and adjacent industries (drug/vaccine sales, transport, feed, etc.) Transmission Risk: pigs  humans (high, deadly) fruit bats/contaminated sap) humans (high, deadly)

10. Ebola Snapshot: West Africa outbreak - more deaths than all others combined • Inadequate health systems • Little or no surveillance activities • Slow response by international community • Stigma • Resistance to reporting • Burial practices Cases: 28,646 Deaths (human): + 11,323 Costs: $2.8 billion (Guinea, Sierra Leone, and Liberia) Industries affected: Mining, oil & gas, tourism, transport • Transmission risk:primates, bats, etc. → humans (rare, but deadly) • humans → humans (high, deadly) The Economist, 2016. Ebola in Africa: the end of a tragedy?. http://www.economist.com/blogs/graphicdetail/2016/01/daily-chart-12

11. Macroeconomic Impacts of Ebola Combined GDP Losses (2014 & 2015): $2.8 billion Liberia Est. Loss in GDP: $300 million 2015 Fiscal Deficit: 8.5% of GDP 2014 Rubber Exports: Down 20% Guinea Est. Loss in GDP: $600 million 2015 Fiscal Deficit: 9.4% of GDP 2014 Coffee Production: Down 50% 2014 Cocoa Production: Down 33% 2014 Palm Oil Production: Down 75% Sierra Leone Est. Loss in GDP: $1.9 billion 2015 Fiscal Deficit: 4.8% of GDP • 2015 Diamond Exports: Down 30% • 2014 Cocoa Production: Down 39% Source: World Bank Group Source: World Bank Group Source: World Bank Group

12. Effects of Emerging Infectious Diseases (EIDs) on Private Sector Outbreaks, Epidemics, Pandemics

13. Hot Spots for Emerging Infectious Diseases Hotspots Map: emerging diseases over time High Risk Areas • Risk of large-scale EIDs risk is especially high in tropical regions where land use change is rapidly occurring, biodiversity is high, and human populations are growing. Low Capacity to Prepare, Prevent, and Respond • West Africa is home to some of the poorest countries in the world, with fast growing populations, and porous borders • The region is characterized with weak institutions, under resourced public health systems and infrastructure, inadequate healthcare workers, and limited disease surveillance capacity • Cultural practices and mistrust of government authority increases the vulnerability to disease • The region remains underprepared to respond to pandemic threats quickly and effectively What Does this Mean for Business Operations? • The confluence of EID risk and low capacity increases the vulnerability of operating in hotspot areas • Companies operating in these environments cannot rely on local resources during an EID event • Key Areas of Impact • Workforce • Environment Health & Saftey (EHS)/ • Occupational Health & Safety (OHS) • Logistics Source: EcoAlliance • Procurement • Legal & Insurance • Financial

14. Costs of Large-scale Outbreak

15. Costs of Large-scale Outbreak (Cont.)

16. Bottom Line Impacts on Business Production Slow-down/Shut-down • Companies may not be able to sustain operations or maintain production levels due to loss of labor and operational challenges, directly affecting the revenue of a company • A large-scale outbreak may fundamentally undermine a company’s ability to withstand external shocks (such as commodity prices) Scaling down or postponement of investment • Increased operational costs and risks may cause companies to postpone investments. This will impact a company indirectly, vis-a-vis foregone revenue Corporate Reputation and Social License to Operate • As an outbreak gains media attention, companies operating in affected areas will be placed under scrutiny based on their response. The result could be positive or negative • Companies that evacuate expat staff and do not provide adequate protection for their local staff may face negative press and may lose their social license to operate The Bottom Line:Large-scale outbreaks can significantly impact the operational and financialhealth of a company None of Aureus Mining’s workers contracted Ebola, but the outbreak delayed their Liberian project by at least two months and cost the company $18-million in direct costs (e.g. screening procedures) and indirect costs (mostly deferred/foregone revenue). When Tawana ResourcesNL, announced it was halting non-essential field work on the Mofe Creek iron ore project, its stock fell nearly 19 percent.

17. Outbreaks, Epidemics, Pandemics The Ebola Example Impacts of Ebola on the Private Sector Case Studies - Ebola Response

18. Examples of Ebola’sImpact on the Private Sector

19. Examples of Ebola’s Impact on the Private Sector

20. Private Sector Ebola Response - Case Study ArcelorMittal in Liberia Industry: Mining (iron ore) Ebola Response: • Hired Ebola specialists to advise the company on best practices • Crafted a trigger matrix, ran scenarios (like border closures) and corresponding alert levels to guide the company • Constructed a new medical clinic, hired medical staff, and spearheaded an education campaign for employees and local community members • Installed scanners to test employees for fever, distributed personal protective equipment to on-site hospitals and providing training to health-care workers and employees “the private sector’s largest contribution during the Ebola outbreak was ‘simply’ to keep business running. This was achieved through rigorous risk-planning and through the development of health-and-safety systems which minimized the risk of employees contracting the virus.” -Alan Knight, ArcelorMittal Ebola private sector mobilisation group (EPSMG): • Founding member of EPSMG, a group established in July 2014 to facilitate a mobilised and coordinated private sector response to the Ebola virus disease in West Africa • The group developed into an advocacy organization for global response to Ebola • At the peak there were over 100 companies and almost 50 public bodies and NGOs joining the calls Bottom Line: The company was able to sustain existing operations (though the company postponed additional investment) and continued employing nearly 3,000 direct and indirect employees. These actions mitigated operational disruptions, maintained production levels, and contributed to collective private sector stability.

21. Private Sector Ebola Response - Case Study Firestone in Liberia Industry: Agriculture (rubber) Ebola Response: • Response included: services for case identification, case management, and reintegration of convalescent patients into the community • Created an isolation ward and developed a comprehensive treatment response strategy • Established an incident management system, to coordinate a comprehensive response to the outbreak using the existing organizational framework of the company in Liberia • Instituted procedures for the early recognition and isolation of Ebola patients, enforced adherence to standard Ebola infection control guidelines (including guidance from MSF) • The company also created a robust risk communication, prevention, and social mobilization campaign to boost community awareness of Ebola and how to prevent transmission ”An important result of Firestone's response is the success with which community members identified suspected Ebola cases, agreed to voluntary quarantine in dedicated facilities, and minimized stigmatization of Ebola survivors. The education, social mobilization, and reintegration programs, as well as the visibility of supervisors and leaders in the community likely contributed to these successes.” • Control of Ebola Virus Disease — Firestone District, Liberia; CDC Morbidity and Mortality Weekly Report (MMWR) Bottom Line: • The company’s agricultural operation continued to perform at close to 100%, though the rubber wood mill saw a 50% drop-off in production due in part to government imposed curfews

22. Moving forward PREVENTION, PREPAREDNESS, AND RESPONSE Role of the Private Sector Best Practices Key Takeaways

23. Role of Private Sector in Prevention, Preparedness & Response Prevention • Good Business Principles. Business risk and EHS/OHS processes, already instituted by companies, can provide a good framework to plan for pandemic risks Preparedness • Strong Partnerships.Especially in environments with limited public sector resources, the private sector is uniquely positioned to help the public sector to plan and prepare through participation in simulations, trainings, and technology transfers (e.g. health and saftey, procurement, and logistics) Response • Existing Networks & Infrastructure. The private sector has existing accommodation, communication and transportation networks, which can be repurposed quickly in order to bolster the emergency response systems The private sector has unique competencies and capabilities to prevent, prepare, and respond to EIDs. “The EPSMG was special because it helped to unlock the real contribution from the private sector which was not cash, but skills, assets and awareness. The EPSMG helped the collaboration and coordination of goodwill, skills, and physical assets.” -Alan Knight, ArcelorMittal

24. Best Practices for Private Sector Prevention • Basic Health and Safety Procedures. Institutionalizing food and health safety systems (including waste management and water safety) to limit transmission of any infectious disease on the worksite • Preparedness • Awareness and Training. Provide awareness and training to employees and communities surrounding the worksite on disease prevention • Supplier and Asset Mapping. Map suppliers and business assets (physical and human resources) to better prepare for preventative action and should feed into a system of reporting and information sharing • Response Planning and Coordination. Integrate risk management system with local health system Response • Effective Implementation. Follow-through of preparedness plans and coordination • Stability with Business Continuity. One of the most effective – if often overlooked – actions that companies can take in disaster-affected regions is to continue operations in spite of the heightened risks • IPIECA Guidelines for Infectious Disease Outbreak Management Source: IPIECA

25. USAID’s Risk Assessment/Mitigation “Tool Box”

26. Next Steps • How would your company like to work with the One Health Platform? • Participate in simulations • Provide expertise on specific topics through seminars (e.g. logistics, risk management, biosecurity) • Participate on working groups (e.g. laboratory, response logistics) • Review of relevant documents (Preparedness and Response Plans, Policies on quarantine or biosecurity) • Evaluate the company’s vulnerabilities to zoonotic diseases