An Economic and Policy Framework for Pandemic Control and Prevention

An Economic and Policy Framework for Pandemic Control and Prevention Peter Daszak Executive Vice President of EcoHealth Alliance November 2016 A Significant Address Presented at the Scowcroft Institute’s Global Pandemic Policy Program Texas A&M University, College Station, Texas on Sept. 15-17, 2015 For more information: bush.tamu.edu/scowcroft/ An Economic and Policy Framework for Pandemic Control and Prevention By Peter Daszak President of EcoHealth Alliance Human Activity is at the Root of Pandemic butchering of bushmeat. This virus Diseases replicated in that person and evolved the capacity for person-to-person spread so that Pandemics have a long history in our global the epidemic smoldered within the human population, from the Justinian Plague of population for decades as the virus evolved AD541-2 through the Black Death of the into HIV-1. New patterns of human middle ages to the 1918 flu and a series of demography and movement in 1950s and recent infections such as HIV/AIDS, SARS, 1960s were then exploited by HIV/AIDS as and Ebola. Pandemics are diseases with it invaded African cities, then spread global spread, meaning they typically affect globally with the rise of international air more than one continent. Historical reviews travel in the 1970s-80s. Not all EIDs are of the natural history of pandemics suggest able to make the transition to pandemic, some common themes: 1) in the majority of however. Some infect people, but are cases, they are caused by diseases that were unable to spread from one person to previously unknown; 2) they often exploit another, either never achieving this, or only new travel and trade networks; and 3) they causing small, localized outbreaks. frequently originate in wildlife species in remote regions. With the growing interface Understanding what brings a disease into a between human populations and wildlife population and causes it to evolve the ability species, and increases in globalization and for sustained human-to-human transmission air travel, it is likely that pandemic can provide a potential policy framework for incidences will only become more frequent. preventing pandemics because intervention strategies can be tailored to reduce the threat Many pandemics have their roots in at its origin. However, before we can enact emerging infectious disease (EID) events. policies, we need to understand when and These pandemic EIDs are essentially where to act and how much they will cost. diseases on the move, increasing in case numbers, expanding their geographical Most pandemics begin with an initial footprint, changing their nature to become ‘spillover’ event, when people are infected more virulent to people, or making the by a disease typically exclusive to an animal jump from animal hosts to people for the reservoir (Stage 1). Some spillover events first time. The different scales of impact die out rapidly when pathogens can’t be can be viewed as representing different transmitted among people, but, in other stages of emergence, often with different cases, pathogens do evolve the capacity for underlying causal drivers (Fig. 1). For human-to-human transmission. These example, HIV-1 emerged from emerging pathogens often undergo repeated Chimpanzees in Central Africa in the early cycles of spillover (Stage 2) followed by 20th Century when a person was small-scale spread (green in Fig. 1) and in contaminated by chimpanzee retrovirus some cases larger outbreaks (orange in Fig. (SIVCPZ) probably during hunting or 1). A Significant Address Presented at the Scowcroft Institute’s Global Pandemic Policy Program Texas A&M University, College Station, Texas on Sept. 15-17, 2015 An Economic and Policy Framework for Pandemic Control and Prevention population density, land use change, wildlife trade, and agricultural intensification. Secondly, the proportion of EID events that become pandemic is likely to increase because the number of people traveling by air, road and sea is exponentially rising. Thirdly, the economic impact of emerging diseases is likely to increase in the future because trade and travel patterns are often disrupted by pandemics, causing significant financial losses. Finally, statistical analysis of correlates of EID origins show that there are distinct geographic regions from which future EIDs and pandemics will most likely originate. These emerging disease hotspots tend to be tropical regions rich in wildlife biodiversity with large and growing human populations (Fig. 2). As human populations increase and the human footprint expands, bringing us into closer Fig. 1: The Process of pandemic Emergence and some policies and approaches used to counter each stage contact with wildlife, livestock and each other, the incidence of EIDs has also begun Occasionally, pathogens that are to increase. transmissible between people enter globalized travel and trade networks to become pandemic (Stage 3). True pandemics are rare events, but extremely damaging when measured in morbidity, mortality, or economic damages. The Increasing Frequency and Cost of Pandemics Analysis of global databases of EID events provides important insights into recent and future trends in disease emergence, the underlying drivers of emergence, and potential strategies for control and prevention. Firstly, EIDs are increasing in Fig. 2: Global emerging infectious disease hotspots (red) frequency, even after correcting for are regions that contain the right mixture of dense human 1 populations, high wildlife biodiversity, and rapid land use increasing surveillance over time. The change. This map highlights the Southeast Asian region, cause of this trend is likely attributed to and hotspots include places where SARS emerged (Southern China), and Nipah virus continues to spillover decreasing boundaries between wildlife 2 and human populations. Additional and (Bangladesh, Northern India). related factors include, increasing human 2 An Economic and Policy Framework for Pandemic Control and Prevention These analyses provide us with a strategic feasible, possible, or necessary? The framework to develop policies to better geographical hotspots of pandemic control pandemics, and to prevent them emergence are critical to this challenge. from emerging in the first place. They also Our analysis shows that diseases emerge provide a way to allocate our global predominantly in tropical, developing resources efficiently by targeting regions countries that have significant challenges where pandemics are most likely to with healthcare and prevention of existing emerge, the people most likely to be the diseases. Economic development often patient zero of the next pandemic, and the drives pandemic origins, with pressure to human-wildlife interface from which it is alter land use, expand cities, and build road most likely to emerge. networks. These economic actions put human populations into closer contact with The cost of pandemics is often out of wildlife that harbor novel, potentially proportion to the morbidity and mortality zoonotic, pathogens. Once an emerging rates. In 2002-3, the first pandemic of the disease is able to spread person-to-person, 21st Century began in a small group of it will naturally gravitate to the countries people trading wildlife in Guangdong which have the highest rates of air travel, province, China. SARS eventually spread meaning that EID pandemics will likely to 37 countries within a few months and have a large human and financial impact led to a large impact on international travel on developed countries as well as and trade (between $10 and 50 Billion) developing countries. Pandemics should despite the relatively small number thus be viewed as global commons infected (8,096 infections and 774 problem that intrinsically requires fatalities). In West Africa during 2013-15, international cooperation to solve. Ebola virus spread from an initial focus in Guinea to cause the largest known The rising frequency of emerging diseases is outbreak of this virus, infecting over critical to considerations of the necessity, 28,000 people and causing mortality in feasibility and cost of a global pandemic more than 11,000. It spread to seven other strategy. The relative frequency of EID countries, leading to disruption of air events (Stage 1 of pandemic emergence) has travel, controversial quarantine measures, been measured for the past five decades and and social unrest. The estimated cost of the corrected for underlying reporting biases. outbreak is between $10 and $30 billion. Based on this data, we can predict that Policies to prevent or control pandemics around five new EID events will occur each earlier in the chain of emergence are likely year, and about three of these will originate to be substantially cheaper and more cost- in animals.3 Additionally, the rise in EID effective than the, often long term, societal frequency is exponential. This creates an changes needed to reduce their impact once interesting economic policy conundrum: As they have spread globally. the frequency and economic impact of EIDs rise, our ability to prevent their initial How rapidly should we enact a Global spillover is reduced as it becomes too Strategy to thwart Pandemics? difficult or too costly. Given the global nature of pandemics, The dynamics of pandemics can be modeled could there be a global, coordinated in economic terms to deduce how rapidly an strategy to thwart them, and is this 3 An Economic and Policy Framework for Pandemic Control and Prevention effective global strategy will need to be so that the waiting time is effectively

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