Maureen Lewis, a CGD senior fellow who specializes in health economics and has recently studied the economics of epidemics, recently returned two weeks in East Asia gathering information about the region’s response to the threat of avian flu. She spoke on the topic at Beijing University in China and participated in a meeting organized by the World Bank in Jakarta, where donor countries reviewed Indonesia’s response and sought to identify ways in which the international community could further support Indonesian efforts. On her return, Maureen discussed the key conclusions from her trip.
Q: What’s the single most important thing that rich countries should do now to prevent a global avian flu epidemic among humans?
A: The good news is that the international community has responded very well under the circumstances. Countries have agreed on coordination under the World Health Organization to provide international surveillance, to alert the international community and to intervene jointly if and when the avian flu emerges. Research into the pathogen, its likely mutations, and possible vaccines and treatment is being funded and undertaken in the rich countries. All these first steps are being put in place.
The main problem now is that developing countries, especially the poorest countries in East Asia where the threat is the greatest, lack the capacity to put in place sophisticate surveillance systems quickly. Moreover, countries like Indonesia and China are so vast that it is difficult to cover the entire country in any case. Rich countries should offer both technical help and funding to find alternatives.
For example, it may be that rewards need to be offered to farmers who voluntarily report their sick and dying chickens, or volunteers can be recruited to do something similar within a defined area. Again, some form of compensation will be needed or surveillance will fail.
Q: What happens then? What can be done to strengthen the global response if there is a rapidly spreading epidemic among humans?
A: In a sense much of the ongoing effort is merely buying time, time to better understand the virus and put in place the arrangements needed to cope with a new epidemic. The specific virus that could emerge and spark a pandemic is not yet known, so vaccinations and treatment must rely on more generic vaccines and medicines that may or may not help. Scientific advances on related viruses will help the process and prepare the world.
Once the Avian Flu reaches a human-to-human transmission either we have the treatment and preventive tools in hand to immunize and cure the disease, or we fall back on isolation and quarantine. The problem, of course, is that movement of birds simply cannot be controlled, and controlling the movements of humans is almost as difficult.
Q: Your paper, The Economic Implications of Epidemics Old and New, looks at the short-run and long-run economic implications of four epidemics: Plague in the 14th century, the 1918–19 flu epidemic, HIV/AIDS and SARS. What does this historical experience tell us about the likely economic impact of an avian flu epidemic?
A: Avian flu has more in common with the Plague, the 1918 “Spanish Flu” and SARS than the slower-moving HIV/AIDS epidemic. In the 1918 pandemic the new pathogen was overlooked in the early stages. Infected troops in the US mobilizing for World War I were put in barracks and on ships, spreading the disease. Although SARS was not a particularly lethal virus, it offers important lessons because it occurred in today’s globalized world, where rapid travel and instant communications tie the fates of all countries.
Although only 8,422 cases of SARS were reported, reactions to the news of the disease shut down economic activity not only in Guangdong Province, where the disease originated, but in Hong Kong, and other Asian cities as well. Travel bans affected tourism, hotels and restaurants, as well as factories serving the international market. The total cost to the region was $15 billion or 0.5 percent of GDP. But the true cost was in expectations and faltering business confidence.
China’s rapid response to the Avian Flu problem no doubt stems from a realization of the consequences of inaction. China has been aggressive in dealing with surveillance and culling of infected birds. Thailand too has internalized the need to contain a potentially lethal communicable disease. Other at risk countries have not acted as quickly, although most of these countries are poorer and have less capacity to act.