Flu Pandemic Would Hurt Developing Countries Most

Washington, D.C., May 26, 2006 (PAHO)—The impact of an influenza pandemic would be greatest in developing countries, particularly those with weak public health systems and vulnerable economies, experts warned at a conference on "Responding to an Influenza Pandemic in the Americas," hosted this week by the Pan American Health Organization (PAHO) and the Center for Strategic and International Studies (CSIS) in Washington, D.C.

A moderate influenza pandemic-one that infected 25 percent of the population-would quickly overwhelm health systems in most countries of Latin America and the Caribbean. "In the first week, you would run out of ventilators and intensive care unit capacity," explained Dr. Marlo Libel, PAHO advisor on communicable diseases. "By week four, you would be using more than 80 percent of hospital beds."

In all, a moderate pandemic would put nearly 1.5 million of the region's inhabitants in the hospital, would sicken an additional 76 million, and would kill an estimated 300,000, according to Libel.

In addition to its health impact, a pandemic would have serious economic and social consequences. "You would see disruption of trade and commerce, increased demand for law enforcement and security, interruptions in public services, and a deterioration of social support mechanisms," said Libel.

Sandy Mackenzie, assistant director of research at the International Monetary Fund, noted that the major economic impact of a pandemic would result from worker absenteeism due to illness, having to care for ill family members, and efforts to avoid exposure. This widespread absenteeism would affect production, distribution, and demand, contributing to negative economic growth as low as -1 percent (estimate for Canada) and as high as -12.6 percent (globally, according to a worst-case scenario.)

The burden of absenteeism would be heaviest on poorer economies and small businesses, which are also the least capable of planning and preparing for a pandemic, Mackenzie noted. A pandemic would also increase risk aversion in financial markets, sparking capital flight away from smaller, more vulnerable economies.

Concerns about a potential influenza pandemic have grown in recent months as the H5N1 avian influenza virus has spread from Asia to Europe, Africa and the Middle East. Experts fear the virus could reach the Americas as early as the next few months. This would represent a serious threat to poultry producers as well as to humans who come into contact with sick birds. However, the greater threat is that the H5N1 virus could mutate into a form that is easily transmissible among humans, sparking a human pandemic.

This week, the World Health Organization (WHO) announced that it suspected human-to-human transmission in a family cluster of H5N1 cases in Indonesia. The cluster is the largest group of related H5N1 cases to date, but it is not that first time human-to-human transmission is believed to have occurred. WHO emphasized that there is no evidence of spread beyond the family involved or that the virus has mutated to become more transmissible. This means the level of threat of a future pandemic remains the same.

Difficult to predict

Experts say it is impossible to predict how severe the next influenza pandemic will be. The most severe pandemic in modern history was the so-called "Spanish Flu" of 1918-19, which killed between 40 million and 100 million worldwide. Less severe flu pandemics occurred in 1957 and 1968, causing between 1 million and 4 million deaths each.

It is equally difficult to estimate the social and economic impacts. These will depend primarily on how much worker absenteeism results, said Mackenzie of the IMF, and this in turn will be a function of how many people get sick and how severe their illness is.

How well businesses handle absenteeism will depend on a number of factors. "If a firm practices a policy of social distancing [telling workers to stay at home], the risk will depend on whether exceptions can be made for key personnel," he explained. "Working at home may be feasible, depending on the functions that are performed, but it may not be an option for many developing economies."

Overall, said Mackenzie, some economies will be more vulnerable to a worldwide pandemic than others. These include, in particular, tourism-dependent economies, countries that export durable goods, and "economies that were already vulnerable to external shocks." Also especially vulnerable are countries where the health of the population is already poor to begin with.

Mackenzie added that planning for a pandemic-by governments but also by individual businesses-is critical to help mitigate the economic and social effects of a possible pandemic. In the end, these effects will only be temporary, he noted. "Both supply and demand will be affected, but if the pandemic is not prolonged, and there is no breakdown in law and order, both production and demand should rebound."

"What we must do is continue to mobilize all sectors to the possibility of an influenza pandemic in the Americas and be prepared," said Dr. Carissa Etienne, PAHO's assistant director. "As with all great challenges, we can minimize and mitigate the impact of a pandemic if we all work together in the region of the Americas, as well as elsewhere."

See also:

• PAHO Avian Influenza website
• Strategic and Operational Plan for Responding to Pandemic Influenza (Draft, Sept. 23, 2005)
• United Nations Medical Services Staff Contingency Plan Guidelines for an Influenza Pandemic

PAHO press releases on avian and pandemic flu:

• "Americas Make Progress on Pandemic Preparedness" (May 24)
• PAHO Calls for North-South Cooperation to Prepare for Pandemic (Mar. 9)
• International Agencies Plan Joint Action against Bird Flu in the Americas (Mar. 7)
• PAHO Assists Bahamas in Investigation of Bird Deaths (Mar. 3)
• Avian vs. Pandemic Flu: Understanding the Threat (Dec. 20)

PAHO was established in 1902 and is the world's oldest public health organization. It serves as the Regional Office for the Americas of the World Health Organization and works with its member countries to improve the health and quality of life of all the people of the Americas.