Assessing economic vulnerability to emerging infectious disease outbreaks: Ebola versus Zika

Transcription

1 Assessing economic vulnerability to emerging infectious disease outbreaks: Ebola versus Zika Dr Anas El Turabi National Academy of Medicine Forum on Antimicrobial Threats June 12, 2018

2 The ultimate goal of economic analysis (?) Question Prediction Resource allocation decision

3 The 2 methods of economic analysis

4 Simplified model of infectious disease economic impacts Transmission dynamics model Reservoir Other vectors Primary vector Humans Social responses Biological responses Individuals Government Illness C S C P Organisations Death P s Recovery C I E R Disability C L P L P L C S P E C L P L Economic impact model Disease dynamic model

5 Simplified model of infectious disease economic impacts Transmission dynamics model Reservoir Other vectors Primary vector Humans Social responses Biological responses Individuals Government Illness C S C P Organisations Death P s Recovery C I E R Disability C L P L P L C S P E C L P L Economic impact model Disease dynamic model

6 Economic vulnerability to outbreaks is an intersectoral issue Intrinsic vulnerability Pandemic preparedness and response Industry sector vulnerability Overall assessment

7 Comparing Ebola and Zika

8 Ebola and Zika disease dynamics Ebola Zika PHEIC dates Aug Mar 2016 Feb Nov 2016 Months PHEIC active WHO regions affected during PHEIC period Countries reporting during PHEIC period 3 Estimated cases during PHEIC period (+18 with active transmission pre-2015) 28, ,000 Deaths attributed 11, Indirect deaths from healthcare diversion ~10,000 additional malaria deaths None estimated Status at end of PHEIC Quiescent Active

9 Ebola and Zika disease dynamics Ebola 1 Zika 2 PHEIC dates Aug Mar 2016 Feb Nov 2016 Months PHEIC active WHO regions affected during PHEIC period Countries reporting during PHEIC period 3 Estimated cases during PHEIC period (+18 with active transmission pre-2015) 28, ,000 Deaths attributed 11, Indirect deaths from healthcare diversion ~10,000 additional malaria deaths None estimated Status at end of PHEIC Quiescent Active

10 Ebola and Zika economic impacts Ebola 1 Zika 2 Short term costs (3yr) ~ $3 billion ~ $7-18 billion Long term costs Not calculated $11 billion lifetime care microcephaly Principal sectors affected Agriculture Mining Informal Trade, tourism & mobility Agriculture Trade, tourism & mobility Informal West Africa Ebola Crisis: Impact Update. World Bank (May 2016). 2. A Socio-economic Impact Assessment of the Zika Virus in Latin America and the Caribbean: with a focus on Brazil, Colombia and Suriname. UNDP (April 2017).

11 Conclusions and recommendations Economic impacts decoupling from direct health impacts Economic impacts outlast epidemiological events Post hoc analysis we are doing better but local capacity constraints remain Need to address model dependence

12 The 2 methods of economic analysis

13

14 Better understanding of sectoral sensitivity can help inform economic models of impact Feb 1: WHO declares PHEIC S&P 500 Carnival Corporation Carnival UK Royal Caribbean Cruises Ltd

15 Short run GDP effects of Ebola were substantial

16 The 2 questions of economic analysis How bad will it be? How bad was it? Causal inference

17 Vulnerability The susceptibility of an economic system to disruption by a specified hazard. Implies causal relationship between threat/system interaction and outcome (disruption). Two components: Likelihood: risk of threat occurring Impact: likely effect conditional on occurrence

18 Assessing economic vulnerability to infectious disease crises requires assessment across multiple domains Intrinsic vulnerability Risk of disease emergence Social and behavioral impact modifiers Healthcare system strength Pandemic preparedness and response Capability across JEE domains: Prevention Detection Response Industry sector vulnerability Sectoral composition of economy Sectoral sensitivity to outrbeaks Trade and labor dependencies Overall assessment Overall assessment of economic vulnerability and policy effectiveness to incorporate into broader economic analysis

19 Economic analysis is No omnibus goal Advocacy vs. learning Normative vs. positive No single best tool No ground truth(?) At best, one input into decision making processes

20 Drivers of outbreak risk are multisectoral Eradication Endemic Disease Risk Pool Increased rate of new EIDs Intensive agricultural practices Animal-human densification Climate and ecological change Emerging Infectious Disease Outbreak Epidemic Pandemic Increased susceptibility of immunocompromised populations (HIV/AIDS, malnutrition) Inadequate country-level surveillance and control systems Global trends in migration, trade & transport Failures of global health coordination Inadequate resources for pandemic responsiveness by IGOs Limited ability to detect outbreaks early Underinvestment in R&D for EID diagnostic and vaccine platforms Antimicrobial resistance