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Sources OIE World Animal Health 2006, 7, 8, 9FAO faostat.fao.org - 2006-9 data176 countries -- 71 diseases, of which 30 zoonosesAnnual average in 2006-09Under-reporting
relative proportions vary by diseaseCosts incurred by different sectors Indirect costs and those due to ‘avoidance behaviors’ are the largest but are often not calculated. FAO and OIE should work with national statistical offices to capture the direct and indirect impacts and to report on them – an annual cost of disease publication would over time lead to more attention to disease prevention and control.On the human health side, the calculation of costs in monetary terms (rather than just DALYs) would also be helpful.
Period Disease (Country) Start Estimate 1986-2009 Bovine Spongiform Encephalopathy (UK) 1986 15,500,000,000 6.1 billion in 1997-2009 1994 Plague (India) 1994 2,000,000,000 Sept. 1998-April 1999 Nipah virus (Malaysia) 1998 671,000,000 January 1999-Dec. 2008 West Nile fever (USA) 1999 400,000,000 Nov. 2002-July 2003 Severe Acute Respiratory Syndrome (CD, China, ROW)2002 41,500,000,000 January 2004-January 2009Highly Pathogenic Avian Influenza (Asia) 2004 20,000,000,000 2003-2007 Bovine Spongiform Encephalopathy (USA) 2004 11,000,000,000 Oct. 2005-Jan. 2009 Highly Pathogenic Avian Influenza (Europe) 2005 500,000,000 Nov. 2005-January 2009 Highly Pathogenic Avian Influenza (Africa) 2005 Nov. 2006-May 2007 Rift Valley Fever (Tanzania, Kenya, Somalia) 2006 30,000,000There appears to be a trend over time of increasing frequency and increasing costs – but these are just selected major outbreaks. It would be interesting to add persistent, endemic zoonoses and to try to obtain the costs of all outbreaks…In the first year of the crisis, the total economic loss from BSE to the U.K. was estimated at [pound]740-[pound]980 million (Atkinson, 1999) (US$1.07-$1.4 billion assuming [pound]=US$1.444). The cumulative gross budgetary cost of BSE to the U.K. between March 1996 and March 31, 2000 stands at roughly [pound]3.5 billion (US$5.05 billion), and was expected to reach [pound]4 billion (US$5.8 billion) by March 31, 2001.The export ban was lifted in 2000, so I expect that from then on, we can just take the cost of testing. Over the period 2001-2006, the cost amounted to Pound 214 million (or US $ 300 million, so we can add this to the US $ 5.8 billion, coming to a total of US $ 6.1 billion over the period 1997-2006. See http://www.publications.parliament.uk/pa/ld200607/ldhansrd/text/70416w0001.htm#07041619000002
Tourist arrivals in China and Thailand plummeted when SARS was spreading.
Period Disease (Country) Start Estimate 1986-2009 Bovine Spongiform Encephalopathy (UK) 1986 15,500,000,000 6.1 billion in 1997-2009 1994 Plague (India) 1994 2,000,000,000 Sept. 1998-April 1999 Nipah virus (Malaysia) 1998 671,000,000 January 1999-Dec. 2008 West Nile fever (USA) 1999 400,000,000 Nov. 2002-July 2003 Severe Acute Respiratory Syndrome (CD, China, ROW)2002 41,500,000,000 January 2004-January 2009Highly Pathogenic Avian Influenza (Asia) 2004 20,000,000,000 2003-2007 Bovine Spongiform Encephalopathy (USA) 2004 11,000,000,000 Oct. 2005-Jan. 2009 Highly Pathogenic Avian Influenza (Europe) 2005 500,000,000 Nov. 2005-January 2009 Highly Pathogenic Avian Influenza (Africa) 2005 Nov. 2006-May 2007 Rift Valley Fever (Tanzania, Kenya, Somalia) 2006 30,000,000 per year without SARS 48,329,000,000 2,301,380,952 SARS 41,500,000,000 1,976,190,476 Total in 1986-2006 89,829,000,000 4,277,571,429 Total in 1998-2009 only 80,201,000,0006,683,416,667 without SARS 38,701,000,000 3,225,083,333 SARS 41,500,000,000 3,458,333,333 Annual avg (12 yrs) for 7 outbreaks is $3.2 bIf SARS is once in 12-yrs event, the annual cost is $3.5 bMoreover, there are other zoonotic diseases that are not included in this calculation. For instance HIV/AIDs which imposes heavy human, social and economic costs. At present, programs to control the disease are spending on the order of $10 billion per year – if we had included this, the total costs would be even more staggering.Costs of a flu pandemic would range from about 5x the impact of these 8 outbreaks in a mild flu scenario (455 billion) to about 40 x in a severe flu scenario ($3.1 trillion). Most of these costs would be indirect.
Initial Assessment of the Impact of Poultry Sales and Production Bans on Household Incomes in VietnamD. Roland-Holst, J. Otte, D. Pfeiffer, FAO, 2006; study of data on 600 households.1.Income declines up to 20% for poorest householdsThe poorer the household (left side) the greater the decline in incomeImpact on food security, nutrition
One Health is results-oriented, across sectors and disciplines.
The Economics of One Health: Extraordinarily High Returns on Investments in One Health Approaches
Economics of One Health Presentation to the One Health Summit 2012 Davos, February 19-23, 2012 Olga Jonas, Economic Adviser, World BankReport by Jimmy Smith, Cornelis de Haan and Sarah Stephenson
OUTLINE• Impact on livestock, people, economies• How can One Health approaches help reduce these costs? – Effectiveness gains – Efficiency gains (within increased investments and recurrent expenditures, esp. in developing countries)• Return on investment in One Health systems 2
Zoonotic diseases account for half oflivestock losses due to diseases Non-zoonoses 50% 50% Zoonoses Total loss: Source: SAFOSO 762‘212 LSUs 3
IMPACT ON HUMANS - SELECT ZOONOTIC DISEASES DISEASE PERIOD Reported Reported cases fatalities SARS 2002-3 7,918 761 HPAI 2004-present 584 345 West Nile 1999-2008 28,975 1,124 Rift Valley 2006-7 1,062 315 Fever HIV/AIDS 2009 2.6 m/year 1.8 m/year (25m since 1981) Flu Pandemic of 1918/19: 50 million to 100 million died
What is the burden (total cost) of diseasesand what are its components?• Only partial information, but better data are increasingly needed (and will become even more necessary)• To assess total cost, useful to look at components of costs of outbreaks in animals and in humans• Costs of selected major outbreaks in 1986-2009 5
Components of economic costs due to zoonotic disease outbreaks100%90% Spill-over effects in other Indirect impact80% sectors (tourism, transport,70% retail, etc) Avoidance behaviors60%50% Ripple effects:40% -- Reduced demand -- Complementary products Consequential on-farm losses -30% Illness and absenteeism Direct impact Lower Productivity20% Deaths from disease10% & control measures Mortality Control measures Medical costs 0% Outbreak in animals Outbreak in humans 6
“Indirect” economic costs: Tourist arrivalsin China and Thailand 8
Adding it up: costs of zoonotic diseases (select outbreaks, US$ billion) Costs (conservative Annual Period estimates) average6 outbreaks other than SARS-Nipah virus (Malaysia),-West Nile fever (USA),-HPAI (Asia, Europe), 1998-2009 38.7-BSE (US),-Rift Valley Fever (Tanzania, Kenya, Somalia)- BSE (UK) costs in 1997-09 onlySARS 2002-2004 41.5Total in 12 year 80.2period (1998-2009) 6.7 9
Poor households hardest hit – householdincome effect of backyard poultry sales ban
• Significant negative impacts …. (but only partially monitored and documented)• What could One Health approaches contribute to reduce negative impacts? 11
One Health approach – an integratedresponse to “what needs to be done?” -- as opposed to the classical approachbased on “what can I do?” 12
One Health approaches can increase: • EFFECTIVENESS – doing the right thing, getting the desired results: prevention, accurate and timely diagnostics, effective control measures • EFFICIENCY – doing the thing right, achieving results at least cost 13
Delays increase costs Cost of Exposure control Exposure in humans Clinical outbreak Clinical in animals signs in signs in animals humans Humans seek medical care Adapted from IOM (2009) 14
Funding requirements for “One Health” efficient prevention and control system• Total for 139 low- and middle-income countries –$ 1.9 b – 3.4 b per year » Note: actual losses in 1998-2008 were >US$ 6.7b/year (i.e., double) – About 7x more than current effort, which is waning due to “flu fatigue” – Equivalent to $1.90 - $3.40 per person per year in OECD countries (the price of greater health security and protection of incomes) 15
Annual costs of prevention vs Annual expected benefits of 40 prevention of pandemic and non- 35 pandemic outbreaks 6.7b 30 25$ billion per year 20 6.7 b 15 10 5 0 Costs of prevention Benefits from averted Benefits from averted (investments in animal mild pandemic severe pandemic and human health systems) 16
Case 1 : Mild Influenza Pandemic* Annual Expected Rate of Return on Investments in Prevention high low preventive preventive effort effort 20% 31% 14% Reduction in expected disease 50% 65% 44% outbreak impact 100% 97% 71%* Impact $600 b (1% of GDP), probability 2.5%, expected benefit of prevention $15 b/year 17
Case 2: Severe Influenza Pandemic Annual Expected Rate of Return on Investments in Prevention low preventive high preventive effort effort 20% 49% 25% Reduction in expected disease 50% 88% 57% outbreak impact 100% 123% 86%* Impact $3 trillion (4.8% of GDP), probability 1%, expected benefit of prevention $30 b/year 18
Avian & Pandemic Influenzas - Donor Interest Has Vanished 2,000 36 35 1,800 32 Number of donors pledging 1,600 28 1,400 Loans 24 1,200$ million 20 1,000 17 16 800 12 600 9 8 400 Grants 8 200 4 4 0 0 Beijing Bamako Delhi Sharm El - After SES, (Jan 06) (Dec 06) (Dec 07) Sheikh 2009 (Oct 08) Financing gap Pledges Number of donors pledging 19
Characteristics of financing for One Health systems• Constant over time, medium- to long-term, and reliably assured (not emergency response financing)• Reach countries with greatest gaps in veterinary and human health systems• Should be on grant basis (global public good) … and also include contribution from sector/livestock product consumers• Encourage prompt and complete reporting of outbreaks at national, regional and international levels 20
Some options for mobilizing resources for One Health systems• Official Development Assistance -- insufficient and unreliable, prevention typically not a priority.• World Bank, AsDB, AfDB etc – time-bound loans (good in emergencies, as last resort). Could “blend” with grants for leverage.• Dedicated funding from donors (with fair burdensharing) plus a levy on livestock products and/or contributions from consumers wishing to lower their pandemic risk. Governance of fund could include livestock producer associations, official and scientific representatives, civil society.• Private sector – international and domestic 21
Value Added of One Health Approaches1. support poverty alleviation and economic growth in developing countries2. reduce pandemic risk globally3. improve public health globally4. help build effective animal and human health systems without weak links; “effective” means early detection and rapid response; delays result in less effective disease control and higher risks at the animal-human- environment interface5. help build efficient animal and human health systems; “efficient” because of shared capacities and information, reduction of duplication, economies of scope, economies of scale6. Net expected annual benefit between $3.8 billion (no pandemics) and $33.8 billion (1 pandemic/100 years) 22