Ecoandsocialimpactofemerginginfectiousdisease 111208 PDF

The Economic and Social Impact of Emerging
Infectious Disease:
Mitigation through Detection, Research, and Response
Contents
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
I. Introduction and Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
II. Qualitative and Quantitative Cost of Epidemic-Prone and
Zoonotic Emerging Infectious Disease. . . . . . . . . . . . . . . . . . . . . . 11
The Broad-Based Economic Impact of Zoonotic and
Infectious Disease in Humans and in Animals for
Consumption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Economic Impact of Recent Epidemics . . . . . . . . . . . . . . . . . . . . . 18
Quantification of the Economic Impact of Bioterrorism . . . . . . . 20
III. Global Preparedness and Response Capabilities. . . . . . . . . . . . . . 21
IV. Conclusion and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . 29
Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
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Executive Summary
Section
Executive Summary
New advances in science and medicine help us gain
ground against certain infectious diseases, yet even
in the twenty-first century other infectious diseases
continue to emerge at a rapid paceand frequently
with significant human and financial costs.
Emerging infectious disease (EID) comprises those
infectious diseases whose incidence in humans has
increased in the past two decades and threatens to
increase in the near future.1 EID includes new or
unrecognized diseases, those that are spreading to
new geographic areas and hosts, as well as those
that are re-emerging. One recent example is Severe
Acute Respiratory Syndrome (SARS), which claimed
nearly 800 lives and imposed a devastating $50
billion in global losses.
WHO (SEARO). Combating Emerging Infectious Diseases. New Delhi, 2005, pg. 1. Emerging infectious
diseases are diseases of infectious origin whose incidence in humans has increased within the
recent past or threatens to increase in the near future. These also include those infections that
appear in new geographic areas or increase abruptly. The new infectious diseases and those which
are re-emerging after a period of quiescence are also grouped under emerging infectious diseases.
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The Economic and Social Impact of Emerging Infectious Disease
Executive Summary
EID poses major risks to the health and welfare of global human and
animal populations. Human populations are directly at risk from
infection and indirectly at risk through the impact on their food supply.
The risks associated with food supply include economic losses related
to the culling of animals and the unavailability of food due to real or
suspected contamination.2 These risks have the potential to severely
disrupt global supply chains and further harm human health and
welfare.
The life sciences, food and agriculture, and health care industries
face the greatest risk from the impact of EID, but are also uniquely
positioned to mitigate human and financial losses. A global increase of
investment in mitigation strategies is not enough without cooperation
among these three industries, as well as between governments and
global organizations.
Individually and in conjunction with each other, these industries,
governmental bodies, and international organizations should focus on
the following key activities to mitigate EID:
Early detection of high-consequence pathogens responsible for
epidemic or pandemic-prone diseases, or that otherwise pose a

threat to world populations or economies;
Timely and accurate verification of the presence or absence of these
pathogens using diagnostic methods in the field, in laboratories, and

in health care settings; and
Comprehensive and rapid response to care for infected patients and
reduce exposure of the wider population to contaminated food,

infectious humans and animals, and the accidental and/or
deliberate release of high-consequence pathogens.
Vigorous, cooperative pursuit of these key activities can serve as a
bulwark against the threats that EID poses to humans and animals
and to the operational resilience of businesses, governments, and
institutions.
Moreover, living in close proximity to animals can increase the likelihood of zoonotic infection
when animals become infected.
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Introduction and Background
I. Introduction and Background
Severe economic and social disruption or disaster

can result from epidemic or pandemic-prone
infectious diseases for which there are limited or no
therapeutic interventions or when existing
therapeutic interventions are not used.
EID is not fully preventable, however mitigating its
impact on the operational integrity of critical
national infrastructure, private industry, and global
trade is possible. Mitigation requires social, political,
and economic commitment across governments and
industries, as well as through unique public-private
partnerships.
If planning, surveillance, research, and response at
the local level are lacking or inadequate, EID can
result in far reaching and severe global
consequences.
Three industrieslife sciences, food and
agriculture, and health careare at the forefront of
exposure to epidemic-prone pathogens. They are
also uniquely positioned to mitigate the impact of
EID on society through enhanced detection,
verification, and response capabilities.
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Introduction
New or emerging infectious diseases with the potential to cause severe
epidemics or pandemics are increasingly prevalent. What previously
passed for acceptable planning and response has been re-evaluated
in light of the recent SARS experience and in anticipation of an avian
influenza pandemic or other infectious disease event. Preventing EID
from gaining a foothold in new environments is a formidable challenge,
but measures to mitigate its impact on human and animal populations
are possible.
EID is largely a product of societal-based decisions and demographic
changes that are generally considered to be a hidden cost of human
economic development.3 Social, political, and economic factors force
a continual stream of decisions upon governments and relevant
non-governmental authorities. Regardless of whether the need for
decisions is adequately addressed or ignored, unintended consequences
can promote the emergence of infectious diseases, some of which
are referenced in Table 1. The threat of naturally occurring EID is
compounded by other factors including the increased mobility of
humans, the increased import and export of food products, and the
potential deliberate use of pathogenic micro-organisms or toxins for
hostile purposes. These factors have short, medium, and long-term
impacts on populations and economies around the globe.
Infectious disease epidemics may last a few weeks or a few months and
can overwhelm the everyday course of society. For this reason, planning
to manage the numerous, complex, and connected impacts of an
infectious disease disruption or disaster has motivated multidisciplinary
strategies across sectors, professions, and functional roles. These
multidisciplinary strategies, when supported by information technology,
bioinformatics, and communications technology, assist in reducing the
lag time between detection of high-consequence pathogens, laboratory
verification, and response.
Such strategies were implemented more widely at the turn of
the twenty-first century with regard to the handling, storing, and
transporting of high-consequence pathogens for research and
development. These steps were taken to preserve the safety and security
of researchers and the general public and to ensure the integrity of
the surrounding environment. Where implemented, multidisciplinary
strategies have increased the effectiveness of biosafety and biosecurity
best practices.
3
Jones, Kate E. et al, Global trends in emerging infectious diseases. Nature, Volume 451, Issue 21,
February 2008, pgs. 990-994.
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Table 1: Origin of Infectious Disease Threats
Naturally
Occurring
Diseases
Table
1:4 5
6 7
Can be endemic (the persistent presence of a pathogen in a host in a

particular geography)
Can be emerging (the presence of a pathogen in a new host or new
geography)
Can be new (pathogen previously unknown)
Can be re-emerging (the presence of a pathogen in hosts or geographies,
previously responsive to preventive or therapeutic interventions, previously
eradicated, but has re-emerged in response to drug, insecticide, or
pesticide resistance)
Accidentally
Occurring
Diseases
Can emerge as a consequence of negligence 4 (opportunistic pathogens,

such as MRSA) or poor infection control
Can emerge as a consequence of ineffective or non-existent biosafety 5
practices and/or biosecurity practices 6, 7
Can emerge as a consequence of poor quality control in food handling
and production
Can emerge as a consequence of accidents arising from transporting
pathogenic micro-organisms and toxins
Deliberately
Occurring
Diseases
Anti-personnel or anti-food and agriculture (livestock or crops) biological

and toxin weapons have an extensive history
Are banned by an international treaty (Biological and Toxin Weapons
Convention)
Can be sophisticated (weaponized) or simplistic (homemade)
Can be engineered to withstand known preventive or therapeutic
interventions
Can mimic naturally occurring disease outbreaks
Effective preparedness and response also hinges on establishing

cooperative relationships prior to an event, regardless of the origin or
type of the potential infectious disease threat. Unique alliances and
public-private partnerships are becoming more common, and help
mitigate the multi-faceted impact of a severe epidemic or pandemic.
As evidenced in the past, outbreaks begin as local events and go on
4
While infectious diseases can emerge as a consequence of a host of convergent factors, we have
chosen to define those diseases that occur accidentally as arising directly from unintentional
events, including negligence.
5
Biosafety Levels (BSL) 1-4 are designations provided by the US CDCs BMBL (Biosafety in Microbiological and Biomedical Laboratories) and the WHOs LBM (Laboratory Biosafety Manual). Nomenclature can vary, e.g., pgs. 1-4. Richmond, Jonathan Y. and McKinney, Robert W., ed et al. Biosafety in
Microbiological and Biomedical Laboratories, Fourth Edition. Centers for Disease Control and Prevention
and the National Institutes of Health, 1999. http://www.cdc.gov/od/ohs/pdffiles/4th%20BMBL.pdf.
World Health Organization. Laboratory biosafety manual, Third Edition. World Health Organization,
2004. http://www.who.int/csr/resources/publications/biosafety/Biosafety7.pdf
6
Biosecurity has multiple connotations, and outside of arms control and non-proliferation, biosecurity often refers to food security in terms of access to food, food free from GMOs, and freedom
from disease in the food chain. Biosecurity can also refer to preventive and protective measures
taken against the deliberate acquisition of high consequence pathogenic micro-organisms and
toxins for intentional misuse, and can also broadly include control and response. Trapp, Ralf. Implementing biosafety and biosecurity who, what, why & how. Biological and Toxin Weapons Convention,
2008. http://www.bwpp.org/MX2008Training/documents/TrappMX2008Implementingbiosafetyandbiosecurity.pdf
7
World Health Organization. Biorisk management: Laboratory biosecurity guidance., September 2006.
http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_EPR_2006_6.pdf
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to have global consequences if they are not stopped. To improve the

ability to detect and respond quickly, national programs for detection,
verification, and response can be supplemented and complemented by
private industry.
Three industries at the forefront of exposure to high-risk, epidemicprone pathogens are life sciences, food and agriculture, and health
care. These industries are also best equipped to mitigate the social
and economic impacts associated with the spread of infectious
diseases. Experts have urged greater cooperation and coordination of
preparedness and response efforts across these industries to prevent or
mitigate high-consequence pathogen exposures.
Gaps in current planning and response capabilities pose a challenge
for effective EID prevention and recovery. These gaps include unequal
geographic distribution of research and development capacity and
funding, excessive lag times between the detection of new pathogens
and the creation of therapeutic interventions, inadequate supply of
prophylaxis or countermeasures, and an incomplete understanding of
pathogenesis for EID, particularly zoonotic pathogens.8 Additionally,
there are gaps in the use of effective isolation and infection control
measures in health care and a lack of surge capacity to adequately
respond to events.
Background
In the first decade of the twenty-first century, the dynamic and often
unpredictable relationship of host-pathogen interactions continues to
challenge researchers and health care professionals.9 The infectious
disease paradigm is shifting as our understanding of the relationship
between host, infection-causing pathogens, and chronic diseases
becomes more nuanced and complex.10 Simultaneously, human
encroachment upon previously uninhabited environments, and the rate
at which people, animals, and cargo traverse the world, has reduced the
time it takes for a highly infectious disease to spread.
WHO. A zoonosis is any disease or infection that is naturally transmissible from vertebrate
animals to humans. Animals thus play an essential role in maintaining zoonotic infections in
nature. Zoonoses may be bacterial, viral, or parasitic, or may involve unconventional agents. As
well as being a public health problem, many of the major zoonotic diseases prevent the efficient
production of food of animal origin and create obstacles to international trade in animal products. http://www.who.int/topics/zoonoses/en/
9
Forum on Microbial Threats. Ending the War Metaphor: The Future Agenda for Unraveling the HostMicrobe Relationship. Board on Global Health, Institute of Medicine of the National Academies,
March 2005. http://www.iom.edu/?id=24454
10
Knobler, Stacey L. ed. et al. Obstacles and Opportunities for Framing Future Research. The National
Academies Press, 2005. http://books.nap.edu/openbook.php?record_id=11026&page=135
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Factors Behind Emerging Infectious Disease

EID is the result of a convergence of social, political, and economic
factors, whether the diseases are new, re-emerging, or becoming
endemic.
Societal decisions and actions, or lack thereof, can have unintended
consequences that cause EID to flourish, harming local populations and
potentially the global community.
Social factors include behavioral activities such as increased trade
and travel, sexual practices, food consumption patterns, new medical
practices, mass migrations of people, human conflict, and the deliberate
use of pathogens for hostile purposes.
Political factors govern public health access and allocation of resources,
including access to prevention programs, prophylaxis, and post-exposure
treatment interventions. Additionally, international political factors
can have an impact, including limited or non-existent educational
programs to support detection, identification and verification, and
response, as well as limited or non-existent information technology and
telecommunications infrastructure to establish surveillance links with
high-risk areas of the globe.
Economic factors arise from insufficient financial investment in
research and development to produce interventions, procedures,
processes, technology, and training. Additionally, economic factors
include insufficient support for a large number of beneficial programs
including public-private partnerships, market incentives to develop
interventions for neglected diseases such as malaria, research into
disease pathogenesis,11 notification of outbreaks, infection control
programs and technology, and training of health care professionals and
laboratory and field researchers.
EID Events Are Dominated By Zoonoses

More than 60 percent of EID has zoonotic origins, as shown in Figure
1. Yet scientists acknowledge a deficit in high-consequence zoonotic
pathogen research and a misallocation of surveillance resources.12
Taken together, these factors demonstrate an increased potential for
negative social and economic impacts of EID.
11
Pathogenesis comprises the origin of a disease and its progression in a host

Jones, Kate E. et al. Global trends in emerging infectious diseases. Nature, Volume 451, Issue 21,
February 2008.
12
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Figure 1: Convergent Factors Contributing to Emerging Infectious

Pathogens With a Focus on Zoonoses 13
Increasing demand for

animal protein,
leading to changes in:
farming practices (e.g. large
open poultry production
units in Asia)
animal markets
bush meat consumption
global trade
natural animal habitats (e.g.
encroachment on forests)
Factors associated with the

disease-causing agent:
adaptation to new vectors
and hosts
mutation and
recombination/
reassortment in humans
and other animals after
exposure to multiple
pathogens (e.g. food borne
viruses, influenza viruses)
development of increased
virulence or drug resistance
ZOONOSES
Human behavioral changes,

including changes in:
extent of ownership and
movement of pets
extent of ecotourism, boating,
camping, etc.
food preferences (e.g. wild
animals and raw milk)
demographics (e.g. producing
older, more susceptible
populations)
level of compliance with
recommended prevention
measures
Shortfalls in public health

infrastructures and policy,
resulting from the lack of:
integration with animal health
surveillance
funding to the public health
sector
sustained funding of scientific
studies to answer public
health questions and build
expertise
13
Data found to support this diagram can be found on the WHO, CDC, FAO, OIE, and other websites. See also: WHO (in collaboration with the Health Council of the Netherlands). Report of the
WHO/FAO/OIE joint consultation on emerging zoonotic diseases. May 2004. http://whqlibdoc.who.int/
hq/2004/WHO_CDS_CPE_ZFK_2004.9.pdf
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New analysis of socio-economic influences and environmental

conditions identify emerging disease hotspots in lower latitudes,
including tropical Africa, Latin America, and Asia. The location of these
hotspots reveals a need for a geographical re-allocation of surveillance
resources, investment in further surveillance, verification, and response
capabilities, and continued vigilance given the ever-increasing mobility
of people and goods.14
Zoonotic pathogens pose a compounded risk in many locations around
the world where humans and animals live in close proximity. In
these instances, the threat of acquiring a zoonotic infectious disease
is compounded by the direct economic threat associated with the
culling of infected animals or healthy animals suspected of being
infected. Such events can destroy the livelihood of a population and
impact its food supply, which makes zoonosis an imperative risk for all
governments and several key industries, especially life sciences, food
and agriculture, and health care.
Characterizing the Infectious Disease Risk

Infectious disease-causing pathogens pose varying degrees of risk
to humans and animals. In many countries, infectious agents are
categorized into four risk groups. Pathogens included in the highest risk
group are those that are easy to transmit and that have no effective
treatment or cure, while those in the lowest risk group are unlikely to
cause disease in humans or animals.
Infectious diseasecausing pathogens pose

varying degrees of risk to
humans and animals.
While pathogen risk groups are generally accepted to be universal,

which pathogens belong to a particular group can vary by geographic
location. International and national health agencies, such as the World
Health Organization (WHO) and the U.S. Centers for Disease Control and
Prevention (CDC), maintain and publish these risk group classifications.
Of most significance to this paper are the disease-causing pathogens in
groups 3 and 4 as characterized in Table 2.
14
Ibid., pg. 992.
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Table 2: Pathogen Risk Groups15, 16
Risk Group 1: A micro-organism that is unlikely to cause human

disease or animal disease.
Risk Group 2: A pathogen that can cause human or animal disease,
but is unlikely to be a serious hazard to laboratory workers, the
community, or the environment.
Risk Group 3: A pathogen that usually causes serious human or
animal diseases, but does not ordinarily spread from one infected
individual to another. Effective treatment and preventive measures
are available.
Risk Group 4: A pathogen that usually causes serious human
or animal disease and that can be readily transmitted from one
individual to another, directly or indirectly. Effective treatment and
preventive measures are not usually available.
15
WHO. Laboratory Biosafety Manual (LBM), Third Edition, 2004. http://www.who.int/csr/

resources/publications/biosafety/Biosafety7.pdf
16
U.S. HHS, CDC and NIH. Biosafety in Microbiological and Biomedical Laboratories, Fifth
Edition, January 2007. http://www.cdc.gov/OD/ohs/biosfty/bmbl5/BMBL_5th_Edition.
pdf.
10
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Qualitative and Quantitative Cost of Epidemic-Prone

and Zoonotic Emerging Infectious Disease
II. Qualitative and

Quantitative Cost of EpidemicProne and Zoonotic Emerging
Infectious Disease
Up-front costs associated with preparing for and

responding to epidemic-prone infectious diseases
must be factored into planning. Ignoring epidemicprone infectious diseases or failing to adequately
prepare and respond carries other costs.
The majority of EID is the consequence of zoonotic
pathogens. The impact of zoonotic epidemics from
1995 to 2008, many of them preventable, exceeded
$120 billion globally.
The economic consequences of EID are experienced
by many areas of industry including employment,
trade, travel, tourism, transport, social gatherings,
and health care.
The Broad-Based Economic Impact of

Zoonotic and Infectious Disease in
Humans and in Animals for Consumption
Independent of its origin, EID has many costs related to prevention and
response. There is also significantand likely greatercost associated
with failing to develop and implement prevention and response
capabilities. Even when plans and capabilities exist, the more insidious
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11

costs of failure to follow known prevention methods may be incurred

in research facilities, food production and processing, and health
care facilities. The former increases the likelihood of contamination
from handling, storing, and transporting high-risk pathogens. The
latter manifests as hospital acquired infection (HAI). Across all of
these industries, the potential impact on operational, financial, and
reputational integrity can be extremely severe. In addition, negligence
in high-containment laboratory settings can compromise public
confidence, potentially delaying development of the therapeutic
interventions and countermeasures needed to prevent or mitigate the
effects of severe epidemics or pandemics.
Animals removed from the food supply through infection or suspected
infection can significantly damage the global economy. The recent
Foot and Mouth Disease (FMD), Bovine Spongiform Encephalopathy
(BSE) and avian influenza outbreaks are striking examples of the cost
of these outbreaks. These diseases have generated billions of dollars in
losses globally in the past decade, as illustrated in Figures 2-6. Based
on the enormous financial, trade, and social impact of these types of
events, research and development into preventive and therapeutic
interventions have become an essential strategy.
Figure 2: Economic Impact of Recent Epidemics (Zoonotic) 17
SARS
China, Hong Kong,
Singapore, Canada
$50bn+
$50bn
$40bn
Foot & Mouth Disease

UK
$30bn
$30bn
$20bn
BSE, UK
$10 -13bn
$10bn
Lyme disease
US, $2.5bn
Swine Flu,
Netherlands
Foot & Mount Disease
$2.3bn
Taiwan, $5-8bn
Nipah, Malaysia
$350- 400m
$0
BSE, Canada
$1.5bn
Avian Flu
Asia, US, Canada
$10bn
Avian Flu, EU
BSE,
Japan $500m
$1.5bn
BSE, US
$3.5bn
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
17
Permission to reprint image granted by Bio Economic Research Associates, LLC ., 12 August
2008. SARS and the New Economics of Biosecurity, 2003.
12
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The economic impact of zoonotic disease can be extensive

reaching from the local farmers market to global trade agreements.
Understanding these impacts is the first step in designing plans for
preventing the spread of EID as well as the resumption of trade and the
continued operation of services after an outbreak.
While exposure to naturally occurring, highly transmissible infectious
diseases poses a global risk, certain industries have higher susceptibility
to infectious diseases exposure and therefore may be more vigilant
about planning to mitigate the social and economic outcomes. On
the front line are life sciences, food and agriculture, and health care.
Certain other industries may indirectly suffer severe economic losses
due to a decrease in public gatherings, travel, and tourism. These
industries include retail, wholesale, consumer packaged goods, aviation,
hospitality, gaming, sports, media, entertainment, financial institutions,
professional services, transportation, and logistics.
Impact on Employment
EID can affect global employment in several ways. Companies may
experience reduced attendance due to infection, fear of infection, or
absenteeism of workers caring for their families. Broader economic
problems caused by reduced workforces may then initiate economic
downturn and further unemployment.
Impact on Economy and Global Trade
Disease outbreaks among livestock are a major risk for the farming
sector. Previous crises or fear associated with perceived contamination
of the food supply have reduced consumer confidence, causing
sudden and drastic cuts in consumption of the affected products and
reductions in its price. In addition, losses can result from culling of
infected livestock, reduced animal value due to control measures such
as compulsory emergency vaccination, and business interruption costs.
The loss of access to regional and international markets tends to have
much more important economic implications than local production
losses alone. The extent of the economic damage is contingent upon
the volume of exports from the affected area. Naturally, the impact can
be severe for those areas that had an important and established export
market before the outbreak.
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13

Impact on Transport, Travel, Tourism, and Social Gatherings

With modern communications, news of even a small outbreak in a
country can spread rapidly throughout the global community. Travelers
intending to visit that country may perceive a threat and have concern
for their personal safety. Economies in the affected countries can
be severely impacted as commuters and vacationers cancel trips or
immediately leave the affected country. Social gatherings such as
symposia or conventions may be cancelled for public health reasons.
Impact on Delivery of Health Care
Concern continues to mount that a pandemic, or serious epidemic like
SARS, will have an enormous and potentially incapacitating impact
on the health care industry. Health care providers are considering and
planning for how to deal with unprecedented numbers of patients
in emergency rooms and hospitals, while coping with severe supply
constraints. Quality of health care might further be compromised as
employees on the front line of infectious exposure must deal with
large numbers of patients and uninfected people seeking medical
reassurance. These same workers must also bear the mental burden
of the risk they may pose in spreading the disease to their families.
Furthermore, if fears of contamination drive health care professionals,
staff, and elective patients away from health care facilities, for-profit
ones in particular which rely on patient flow and professional delivery
of services on a daily basis, may find themselves unable to maintain
operations.
These planning and response considerations raise a host of ethical,
legal, commercial, and policy questions as to how to balance the duty
of care with the occupational health and safety of employees and the
financial needs of facilities. If unanswered prior to the occurrence of
EID, the social and economic impacts could be catastrophic.
14
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Figure 3: Economic Impact of Infectious Disease in South East Asia18, 19, 20
Plague in India:
The 1994 plague outbreak
in Surat, India and
resulting panic brought
about a sudden exodus of
0.5 million people from the
region and led to abrupt
shutdowns of entire
industries, including
aviation and tourism.
Several countries froze
trade, banned travel from
India, and sent some
Indian migrants home.
The WHO estimated the
outbreak cost India some
$2 billion.
Avian flu in Hong Kong:

The avian influenza
outbreak in 1997 cost
hundreds of millions of
dollars in lost poultry
production, commerce,
and tourism. Airport
arrivals in November of
that year alone were down
by 22 percent from the
preceding year.
Nipah (zoonotic disease)
in Malaysia: In 1999, the
Nipah virus caused the
shutdown of over half of the
countrys pig farms and an
embargo against pork
exports.
18
Fielding R, et al. Avian influenza risk perception, Hong Kong. Emerg Infect, May 2005.
http://www.cdc.gov/ncidod/EID/vol11no05/04-1225.htm
19
Avian Flu Diary: The Return Of The Nipah Virus EMERGING DISEASES: Malaysian Researchers Trace
Nipah Virus. www.sciencemag.org/cgi/content/full/sci;289/5479/518
20
Campbell G L and Hughes JM. Plague in India: A New Warning from an Old Nemesis. Editorial.
Annals of Internal Medicine, 15 January 1995. Volume 122, Issue 2, Pages 151-153. http://www.annals.
org/cgi/content/full/122/2/151 See also: WHO, SEARO. Plague Surveillance and Outbreak Response.
Report of an Informal Intercountry Consultation. Bangalore, India, 15-17 July 2002. New Delhi.
http://whqlibdoc.who.int/searo/2002/SEA_PLAGUE_20.pdf
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15

Figure 4: Economic Impact of Infectious Disease in the Americas 21, 22, 23
Pandemic flu in the

US (projected):
The estimated
economic impact of
Pandemic Influenza
would be US$71.3 to
$166.5 billion, excluding
disruptions to
commerce and society.
SARS in Canada:
Research suggests a loss in
national economic activity in
2003 of roughly $1.5 billion,
representing 0.15 percent of
Canadas real GDP. Real GDP
in the City of Toronto itself was
lowered by $950 million, or 0.5
percent, with about $570 million
of this total concentrated in the
travel and tourism sector.
Cholera in Peru:
The outbreak of cholera
in 1991 cost the
Peruvian fishing
industry an estimated
$775 million
in lost tourism and trade
because of a temporary
ban on seafood exports.
21
The Economic Impact of SARS, www.dfait-maeci.gc.ca/mexico-city/economic/may/sarsbriefMay03.

pdf.
22
A wicked strain: the projected number of U.S. deaths as a result of an influenza pandemic is
more than 1.7 million over an 18-month period. Nearly half of those victims will be between the
ages of 15 and 44. The Centers for Disease Control and Prevention estimate the economic impact to the
United States at $71.3 billion to $166.5 billion.
Osterholm, Michael Tand Erik Rasmussen, The Centers for Disease Control and Prevention estimate the
economic impact to the United States at $71.3 billion to $166.5 billion. Risk & Insurance, April 15, 2005.
http://findarticles.com/p/articles/mi_m0BJK/is_5_16/ai_n1365057
23
World Health Organization, Global infectious disease surveillance, Fact Sheet No. 200. Revised 1998.
www.who.int/mediacentre/factsheets/fs200/en/index.html
16
Marsh

Figure 5: Economic Impact of Infectious Disease in the United

Kingdom24 and Sub-Saharan Africa25
Bovine spongiform encephalopathy

(BSE) in Britain: The outbreak of BSE
disease in the United Kingdom in 1995
resulted in a mass slaughter of cattle,
drastically cut beef consumption, and
led to the imposition of an EU embargo
against British beef of several years
duration. The losses to the British
economy were estimated by the WHO
at $5.75 billion, including $2 billion in
lost beef exports.
TB and Multi-drug resistant TB

(projected globally):
Recent Sub-Saharan Africa data
indicates that there were
approximately 8.8 million new
cases and 1.6 million deaths were
attributed to the disease in 2005.
The economic cost of TB-related
deaths (including HIV co-infection)
in this region from 2006 to 2015
is projected to be US $519 billion
when there is no effective
TB treatment.
24
Debarati Guha-Sapir, Willem G. van Panhuis, World Health Organization Collaborating Centre
for Research on the Epidemiology of Disasters, Armed Conflict and Public Health, 2002,
http://www1.cedat.be/Documents/Publications/rocpressweb.pd
25
WHO. Global tuberculosis control surveillance, planning, financing. Global TB report 2008.
http://www.who.int/tb/publications/global_report/en/index.html
Marsh
17

Economic Impact of Recent Epidemics

The following section provides greater details on costs attributed to real
and projected epidemics caused by pathogens belonging to Risk Groups
3 and 4 as characterized in Table 2.
The Impact of Severe Acute Respiratory Syndrome (SARS) 26
In 2002 and 2003, SARSa novel virus that causes acute respiratory
disorderis believed to have emerged in China where it is assumed to
have made a zoonotic leap. Within months, this communicable disease
spread around the world, from Asia to North and South America and
Europe. Before it was finally contained, SARS infected 8,098 people,
nearly 800 of whom died.27
Many more around the world felt the deep financial impact of SARS. It
measurably lowered the GDP of Asian countries and Canada.28, 29 The
total worldwide impact of $50 billion in losses, as shown in Figure 2, was
largely from industries such as tourism, retail, and trade,30, 31 as people
cancelled trips and business deals due to the fear and uncertainty
about transmissibility of this previously unknown pathogen. Health
care also suffered immense panic and concern about a disease that
had no known cure. A significant number of those infected were health
care workers, causing high levels of distress amongst hospital staff, 32
a situation that raises legal and ethical issues about the obligation of
health care workers to perform their duties and the protection they are
provided during such an event.
The Projected Impact of Pandemic Influenza
No other anticipated global EID scenario is causing as much concern as
pandemic influenza. In 1918, pandemic influenza was responsible for
an estimated 50 million deaths worldwide.
A new influenza pandemic is expected when the virus mutates to a
form that is readily transmitted among humans. The projected losses to
26
Order of the Centers for Disease Control and Prevention, Department of Health and Human
Services: Notice of Embargo of Civets, (Centers for Disease Control and Prevention, May 2005).
http://www.cdc.gov/ncidod/sars/civet_ban_exec_order.htm.
27
Summary of probable SARS cases with onset illness from 1 November 2002 to 31 July 2003, (Epidemic and Pandemic Alert and Response (EPR), September 2003). http://www.who.int/csr/sars/country/
table2003_09_23/en/
28
Asian Development Bank, Assessing the Impact and Cost of SARS in Developing Asia. Asian
Development Outlook 2003 Update, 2003. http://www.adb.org/documents/books/ado/2003/update/
sars.pdf
29
Darby, Paul. The Economic Impact of SARS. The Conference Board of Canada, May 2003.
30
Corporate Pandemic Preparedness: Current Challenges to and Best Practices for Building a More
Resilient Enterprise, (Marsh Inc. and The Albright Group, LLC, 2007).
31
Maunder et al. Factors Associated With the Psychological Impact of Severe Acute Respiratory
Syndrome on Nurses and Other Hospital Workers in Toronto. Journal of Psychosomatic Research,
Volume 66, pgs. 938942, 2004.
32
Styra et al. Impact on healthcare workers employed in high-risk areas during the Toronto SARS
outbreak, Journal of Psychosomatic Research, Volume 64, pgs. 177-183, 2008.
18
Marsh

global economies could top $1.25 trillion, and the pandemic could kill
as many as 150 million people worldwide. 33, 34
To date, current strains of avian influenzathe anticipated source of
pandemic influenzahave killed tens of millions of domestic birds
(poultry) and wild birds worldwide.35 This has amounted to billions
of dollars in losses for economies in Asia, which have been hit the
hardest.36 As avian flu spreads throughout the worlds poultry food
supply, it is causing import/export bans as it did in France in 2006 and
in the U.S. in 2008.37
Once the virus becomes capable of efficient human-to-human
transmission, the potential disruption to industry, services, and
government is anticipated to be enormous. Stockpiling of vaccines
and antiviral medication is happening on a global basis and massive
planning efforts are underway to mitigate the effects of the pandemic.38
The sufficiency of these measures is currently being evaluated. Access
to the existing standard of care, however, will remain a concern when a
pandemic strikes.39
Bovine Spongiform Encephalopathy (BSE)
BSE, a zoonotic neurodegenerative disease found in cattle also known
as mad cow disease, can be transmitted to humans through the
consumption of infected cattle products. In humans, it is known as
Variant Creutzfeldt-Jakob disease (vCJD), a long incubation disease
that is fatal and has killed 204 people.40
By far, the greatest impact of BSE has been economic. In the UK, more
than 4.4 million head of cattle were destroyed to stop the spread of a
BSE outbreak. The combined effects of a fall in consumer confidence
throughout the UK and Europe, and the subsequent bans and
Once the virus

becomes capable of
efficient human-to-human
transmission, the potential
disruption to industry,
service, and government
is anticipated to be
enormous.
33
Press Conference by UN System Senior Coordinator for Avian, Human Influenza, (United
Nations Department of Public Information, New York News and Media Division, September 2005).
http://www.un.org/News/briefings/docs/2005/050929_Nabarro.doc.htm
34
Frielink, A. Barend. Joint OIE-ASEAN/ADB Inception Workshop on HPAI Control and
Eradication in ASEAN. Asian Development Bank, October 2006. http://www.adb.org/documents/
speeches/2006/sp2006047.asp
35
Polet, Yvan, Avian Influenza: Impact of Outbreaks on European Poultry and Meat Markets. GAIN
Report, March 2006. www.fas.usda.gov/gainfiles/200603/146187030.doc.
36
Ibid.
37
Tyson bird flu find curbs exports to Japan, Russia. Nathan Becker. Marketwatch,
June 4, 2008 http://www.marketwatch.com/news/story/tyson-bird-flu-find-curbs/story.
aspx?guid=%7B1E8A9C17-A8D9-4A21-98B8-414EDE665032%7D&dist=msr_1
38
CDC chief says that avian flu is the biggest threat, (CIDRAP News, Center for Infectious Disease
Research and Policy, February 2005), http://www.cidrapsummit.org/cidrap/content/influenza/avianflu/news/feb2105gerberding.
39
Ability of regional hospitals to meet projected avian flu pandemic surge capacity requirements.
Prehospital Disaster Medicine. 2008 Mar-Apr;23(2):103-12.
40
Variant Creutzfeldt-Jakob Disease, Current Data (April 2008), (The National Creutzfeldt-Jakob
Disease Surveillance Unit, April 2008), http://www.cjd.ed.ac.uk/vcjdworld.htm . See also fact
sheets from WHO on BSE, http://www.who.int/mediacentre/factsheets/fs113/en/ and vCJD, http://
www.who.int/mediacentre/factsheets/fs180/en/, as well as from CDC on vCJD, http://www.cdc.
gov/ncidod/dvrd/vcjd/factsheet_nvcjd.htm and EUCDC on vCJD, http://www.cjd.ed.ac.uk/.
Marsh
19

restrictions on beef trade, caused the British cattle and beef market to
collapse, costing nearly $6 billion.41 In Canada, a single cow infected with
BSE led to the ban of Canadian beef imports in the United States, costing
an estimated $5 billion.42
Quantification of Economic Impact of

Bioterrorism
As with naturally occurring zoonotic EID, bio-terrorism is a threat to
human health and to our food supplies and supply chain. Following
the deliberate use of anthrax in the United States in 2001, there was a
substantial increase in funding to counter the threat of bioterrorism
against national assets at home and abroad. Other nations have
committed to the G8s Global Partnership Against the Spread of Weapons
of Mass Destruction (which includes bio-terrorism agents),43 including:
Canada ($730 million); Sweden ($12 million); France ($910 million);
Germany ($1.8 billion); Italy ($1.2 billion); Norway ($121 million); Japan
($200 million); UK ($750 million); EU ($1.2 billion); Switzerland ($13
million); Netherlands ($29 million); Czech Republic ($75,000); Finland ($12
million); and Russia ($2 billion).44 The U.S. government alone has budgeted
nearly $50 billion between FY2001 and FY2009.45
While many countries have constructed models for identifying the social
and economic impact of anti-personnel and anti-livestock bioterrorist
scenarios, the frequency of such attacks remains exceedingly low. The
small-scale 2001 anthrax attack in the United States resulted in a cost of
over $200 million to decontaminate anthrax-infected facilities. This raises
the question of the economic ramifications of a large-scale bioterrorist
attack. A study by the CDC estimates that the economic impact of a
bioterrorist attack could range from an estimated $477.7 million per
100,000 persons exposed (brucellosis scenario) to $26.2 billion per 100,000
persons exposed (anthrax scenario).46
41
Buzby Jean C and Detwiler Linda R. BSE Anatomy of A Crisis - bovine spongiform encephalopathy
- Statistical Data Included Choices: The Magazine of Food, Farm and Resource Issues, Spring, 2001.
42
Beef ban cost producers up to $5B: BMO economist, CBC News, November 29, 2004. http://www.
cbc.ca/money/story/2004/11/29/beefbancost-041129.html.
43
Roffey, R. G8 Global Partnership: State of play of efforts against CB-weapons. Swedish Defense Research
Agency, June 2005. http://www.delegfrance-cd-geneve.org/declarations/declafrancaises/armes%20
bio/Roffey%2080th%20GenevaProtocol%20G8GPCBW%2010June2005.pdf
44
As of 2004 the original G8 partners have pledged $17 billion to the effort Center for Strategic
and International Studies. Global Partnership Scorecard, May/June 2004. Strengthening the Global
Partnership, 2004. http://www.sgpproject.org/GP%20Scorecard.pdf.
45
Since the 2001 terrorist attacks on the United States, the U.S. government has spent or allocated
nearly $50 billion among 11 federal departments and agencies to address the threat of biological
weapons. For Fiscal Year 2009 (FY2009), the Bush Administration proposes an additional $9 billion in
bioweapons-related spending, approximately $2.5 billion (39%) more than the amount that Congress
appropriated for FY2008. The Center for Arms Control and Non-Proliferation. Federal Funding for
Biological Weapons Prevention and Defense, Fiscal Years 2001 to 2009. Brief published on 15 April
2008. http://www.armscontrolcenter.org/media/fy2009_bw_budget.pdf
46
Kaufmann AF, Meltzer MI and Schmid GP. CDC. The Economic Impact of a Bioterrorist Attack:
Are Prevention and Postattack Intervention Programs Justifiable? Emerging Infectious Diseases, Vol 3,
No 2. April-June 1997. http://www.cdc.gov/ncidod/EID/vol3no2/kaufman.htm.
20
Marsh
Global Preparedness and Response Capabilities
III. Global Preparedness and

Response Capabilities
Three key industrieslife sciences, food and agriculture,
and health careare crucial to managing EID and its

negative social and economic impacts.
Detection, identification and verification, and response to
severe epidemic or pandemic prone disease causing

pathogens hinge on cooperation and coordination,
necessitating further investment and increased capacity.
Cooperation among industries and organizations is
necessary because activities carried out in isolation often

have unforeseen consequences. Examples of these
consequences include the accidental fostering of drug
resistance in pathogens, continued emergence of infectious
diseases, as well as other opportunities for disruption and
long-term costs.
The life sciences, food and agriculture, and health care industries
play an important role in detection, identification and verification,
and response, which are the key pillars of effective infectious diseases
management. These industries are at the forefront of exposure to high
risk and epidemic-prone pathogens and, if properly prepared, are also
in a strategic position to prevent or mitigate the spread of infectious
diseases.
Marsh
21
Pillars of Infectious Disease Management

Detection
Effective disease detection includes ongoing surveillance, reporting, and analysis
of a given population over time.
Disease surveillance is the gathering and generation of data on disease
incidence and prevalence within a population, and is the cornerstone
of effective response.47 It is used to assist in prioritizing decisions with
respect to human, zoonotic, and animal infectious disease prevention
and control methods. Activities developed to detect high-consequence
pathogens leverage technical and organizational processes and skills, as
shown in Table 3.
Table 3: Overview of Cross-Sector Industry Roles in Detection

Microbiological laboratory tools, technologies,
equipment, and materials (e.g., reagents, cell culture,

etc.)
Life Sciences
Trained technicians and scientists

Pathogen reference databases/bioinformatics
Development of diagnostic tools for the field and
clinical settings
Networked communication within local and regional
geographies for sharing disease intelligence
Food and
Agriculture
Training of livestock owners

Use of rapid hand-held diagnostics
Implementing and integrating quality assurance and
sampling into food manufacturing and distribution
Trained health care professionals and technologists

In-house laboratory
Health Care
Infection control sampling

Pathology
Use of diagnostic and clinical tools and equipment
(e.g. microbiology, medical imaging)
47
Burroughs, Tom, Knobler, Stacey, Lederberg, Joshua. The Emergence of Zoonotic Diseases:
Understanding the Impact on Animal and Human Health. The National Academies Press, 2002.
22
Marsh
The presence of robust and sensitive detection capabilities across life

sciences, food and agriculture, and health care are mutually reinforcing.
Early detection of infectious disease in animals is vital for prevention
of the disease in humans. It is also critical for fast development of
prevention and control interventions. Further, if adequate surveillance
capabilities are not in place, the downstream public health prevention
efforts will be less effective. Sharing disease intelligence is also
beneficial for preventing or rapidly controlling infectious disease
emergencies of international concern and can contribute to the early
warning of potentially significant outbreaks.
The implications for trade and travel can be significant if pathogen or
disease presence is detected. Consequently, verification plays a crucial
role in the management of infectious diseases.
Identification/Verification
Effective identification and verification of the presence or absence of pathogens
using field, laboratory, and clinical diagnostic tools and equipment.
Following the detection of a pathogen, confirmatory tests are needed
to demonstrate the presence or absence of disease during an outbreak.
This requires access to diagnostic equipment and professionals trained
to use and interpret the results of these diagnostic tests. These tests
include rapid hand-held diagnostic tools, such as those used in the
field or in clinical settings on the host suspected of being infected,
confirmatory microbiological laboratory tests, and accepted clinical
procedures that help confirm the presence of a disease (e.g., medical
imaging, laboratory-based tests).48
Following the
detection of a pathogen,
confirmatory tests are
needed to demonstrate
the presence or absence
of disease during an
outbreak.
Laboratory capability to verify pathogens is essential to execute a

response during an outbreak. Characterization of novel and emerging
infectious diseases is also essential to better recognize, detect, and
achieve verification in the event of a future outbreak. In this way,
detection can be improved through the identification and verification
process. For example, laboratory identification of new pathogens can
help to develop more sensitive detection tools for use in field and
clinical environments.
48
Smolinski, Mark S., ed. et al. Microbial Threats to Health: Emergence, Detection, and Response. The
National Academies Press, 2003.
Marsh
23
Table 4: Overview of Cross-Sector Industry Roles in Identification/

Verification
Development of field kits to rapidly determine
presence of pathogen
Life Sciences
Designate high-containment reference facilities to
rapidly test dangerous samples to evaluate presence

of pathogens in large numbers of possible patients for
human and zoonotic pathogens
Pre-production random laboratory-based verification
of detection samples in livestock, feed, soil, and

ground water
Random sampling built into food production
Food and
Agriculture
processes
Trained personnel to read samples and determine
safety
Use of microbiology laboratory (on site or shared
outsourced facility) to confirm presence or absence of

pathogens on equipment, employees, or in products
Health Care
Detection of infectious disease in patients
Response
Effective measures to mitigate or prevent spread of a disease in the field using
a mixture of practices including patient isolation, quarantine, therapeutic
interventions, prophylaxis, culling of animals, and food recall practices.
While it is not possible to fully anticipate infectious disease incidents
of international public health concern, it is possible to prepare for
response and recovery, whatever the origin of the outbreak. Initial
efforts taken to control the spread of infectious diseases, prior to
pathogen verification, will follow a similar set of practices aimed at
isolation, quarantine, and travel controls.49
If an event is determined to be an act of bioterrorism or sabotage, there
are particular implications for which agency (e.g. law enforcement,
49
24
WHO. International Health Regulations (2005). http://www.who.int/csr/ihr/travel/en/index.html
Marsh
public health, etc.) will assume the lead in the disease investigation.
Regardless of origin, the ultimate goalcontrolling the spread of
diseaseremains the same. In the event that prior intelligence
or prior verification was received, appropriate prophylaxis can be
provided to prevent further exposure of employees and the general
public. Preparing to recover from an infectious biological event
necessitates that preparedness and response procedures are tested
and evaluated for their applicability and potential efficacy. No singular
set of characteristics exists for an infectious biological incident or
contamination. Managers may use a combination of pathogen-specific
plans as well as more flexible approaches for isolation and quarantine
in the case of unidentified or unverified diseases. Planning for
prevention and planning for response are parallel efforts.
Table 5: Overview of Cross-Sector Industry Roles in Response

Principally responsible for developing therapeutic
interventions for EID
Life Sciences
Drive laboratory research and findings into clinical
applications and interventions (translational

research) 50
Culling of infected animals or animals suspected to be
Food and
Agriculture
infected
Product recall of suspected or known contaminated
food products and animal by-products

Provide care in hospitals or alternate locations
Health Care
Administer preventive or post-exposure interventions

Provide preventive or post-exposure public health
solutions such as isolation and quarantine
* 50
Managing the Infectious Disease Risk: Research Facilities
Because modern epidemic-prone infectious diseases can be novel (e.g.
SARS) or constantly evolving (e.g. seasonal influenza), research
50
The U.S. National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA)
have both recently initiated programs to encourage the use of modern research tools as part
of a focus on translational research, the goal of which is to accelerate the transfer of medical
discoveries to the clinical environment. Examples of these tools include genomics and proteomics,
imaging, and bioinformatics. See the FDAs Critical Path initiative http://www.fda.gov/oc/initiatives/
criticalpath/initiative.html. See also, The NIHs New Pathways to Discovery initiative http://
nihroadmap.nih.gov/newpathways/.
Marsh
25
facilities are essential for understanding pathogenesis 51 and developing

therapeutic interventions. To counter a potential epidemic, research on
infectious diseases must be conducted years in advance. Efforts aimed
at shortening this development cycle include translational research
methods, which encourage the use of technologies enabling bench-tobedside solutions. Once interventions have been developed, production
can begin for stockpiling in preparation for an epidemic or a pandemic.
The devastating potential of an epidemic resulting from EID, in
conjunction with the paucity of facilities dedicated to this research, has
spurred an increase of labs, with the majority in the United States.
Lab-based infectious disease research inevitably entails the handling
of pathogens and carries parallel requirements to ensure safety and
security. It is imperative that research laboratories employ appropriate
and effective security measures and equipment, upgrading both as
needed, in order to prevent release of pathogens and to ensure the
occupational health and safety of researchers as well as the integrity
of the surrounding environment. In order to reduce the exposure to
and mitigate the spread of highly pathogenic micro-organisms and
toxins in the laboratory environment, new and unique engineering
and equipment solutions are being developed to preserve operational
integrity of laboratories, preserve occupational health and safety, and to
expedite development of countermeasures.52
Dedicated biomedical research facilities are designed to handle high
risk pathogens and infected specimens and animals. Health care
facilities, however, due to their open, care-oriented design, face greater
challenges in reducing exposure to pathogens, whether through personto-person contact or through exposure to the hospital environment.
Managing the Infectious Disease Risk: Health Care Facilities
Health care facilities are an integral component in the immediate
response to a spreading infectious disease.
Hospitals and clinics are prepared to care for infected patients, and
they play a pivotal role in early warning and detection of an emerging
epidemic. Because they are a locus for infected patients, however,
51
Government Accountability Office. High-Containment Biosafety Laboratories: Preliminary

Observations on the Oversight of the Proliferation of BSL-3 and BSL-4 Laboratories in the United States. U.S.
Government Accountability Office, 2008. http://www.gao.gov/docsearch/abstract.php?rptno=GAO08-108T
52
The Integrated Research Facility at Fort Detrick is a high containment facility for the
Biodefense initiative of the National Institute of Allergy and Infectious Diseases (NIAID) in
Frederick, MD. It features BSL2, 3, and 4 level laboratories with unique aerobiology and BSL 4
imaging. BSL 4 imaging allows for more limited movement of animal specimens and contributes
research throughput. Integrated Research Facility Ft. Detrick. (Office of Research Facilities,
National Institutes of Health, February 2006), http://orf.od.nih.gov/Construction/CurrentProjects/
IRFFtDetrick.htm. (website accessed September 4, 2008).
26
Marsh
they also provide an opportunistic location for a disease to spread.

In the event that diagnostic tests confirm the presence of a highly
transmissible disease, emergency operating procedures (EOPs) will be
triggered to protect exposed health care professionals, other patients,
and the public from further exposure. Infection control procedures are
grouped by the mode of disease transmission. These procedures can
range from timely contact tracing of cases and interactions, screening at
ports of embarkation and departure, social distancing, expanded prehospital emergency preparedness and response, to the use of airborne
infection isolation rooms within health care facilities.53
Developing the resilience needed to manage a disruptive infectious
biological event includes advanced supply chain planning and the
implementation of human capital plans to ensure the continued
delivery of services within a health care setting. Operational resilience
planning includes consideration of the use of hospital infrastructure in
the delivery of care during a patient surge. Continuity of services relies
upon coordinated plans for managing triage, patient admission, alternate
care sites, and partnerships with community resources that can extend
care to the less critically ill without over-burdening the hospital (e.g.,
mobile response capabilities). Moreover, stockpiling critical consumables
(e.g., pharmaceuticals, blood products, sterilants, decontaminants and
disinfectants) as well as respirators, personal protective equipment (PPE),
and other equipment, sometimes procured using just-in-time inventory
management, is also a key operational strategy. 54
Managing the Infectious Disease Risk: Food Production Facilities
Rapid globalization of food production and trade has increased the
likelihood of international incidents involving contaminated food. Wellestablished best practice standards exist within private industry.
However, the degree to which programs are implemented and enforced
globally remains inconsistent. To rectify these gaps, there has been a
shift to more holistically integrate industry processes into national and
international food safety programs.55
Government regulators are responsible for developing national
policies and standards that support the implementation of risk-based
production and control programs, monitoring and surveillance of these
programs and enforcement of legal standards. Shifting some of
53
History of Quarantine, (Centers for Disease Control and Prevention, February 2007),
http://www.cdc.gov/ncidod/dq/history.htm.
54
Marsh Inc. and The Albright Group, LLC. Corporate Pandemic Preparedness: Current Challenges to
and Best Practices for Building a More Resilient Enterprise. Marsh Inc. and The Albright Group, LLC, 2007.
55
WHO with the cooperation of FAO. The International Food Safety Authorities (INFOSAN) Users Guide.
October 2006. http://www.who.int/foodsafety/publications/fs_management/INFOSAN_User_
Guide_Final.pdf.
Marsh
27
the responsibility onto industry participants, and assigning them a

major role in secondary prevention indicates an increasing reliance on
enhanced detection, verification, and recall capabilities. For example,
food companies are best situated to deploy capabilities for rapidly
detecting contaminated food products and preventing them from
reaching consumer markets.
Zoonotic EID in livestock poses a risk to farmers and others in the
agricultural production supply chain. Pushing the identification of
risk up the supply chain to the source itself is becoming integral to
managing zoonoses (e.g. avian influenza, BSE). Increased detection
capabilities on the farm complement random sampling in food
production facilities. The earlier pathogens are detected the sooner
interventions can be made available. Many countries have begun
to incentivize and endorse research to protect animals raised for
consumption, thereby protecting their major exports related to
livestock and food products. 56, 57 Additionally, some governments are
compensating farmers for complying with guidelines and regulations
related to the reporting of infectious outbreaks and the culling of herds.58
Twenty-first century public and veterinary health have a sophisticated
understanding of how to detect, identify and verify, and respond to most
known infectious diseases, but the extent to which these capabilities
are present across the globe varies. Individual efforts at the industry
or national level are paramount to achieving global health security.
Without cooperation, however, collective health security benefits will
not be fully realized.
56
Asian Development Bank Economic and Research Department, Potential Economic Impact of an
Avian Flu Pandemic on Asia. November 2005. http://www.adb.org/Documents/EDRC/Policy_Briefs/
PB042.pdf.
57
Avian and pandemic influenza: developments, response and follow up, and applications of
International Health Regulations (2005), (World Health Organization, January 2007), http://www.
who.int/gb/ebwha/pdf_files/EB120/b120_id3-en.pdf.
58
FAO and OIE (in collaboration with WHO), A Global Strategy for the Progressive Control of Highly
Pathogenic Avian Influenza (HPAI), FAO and OIE, May 2005. http://www.fao.org/ag/againfo/resources/
documents/empres/AI_globalstrategy.pdf.
28
Marsh
Conclusions and Recommendations
IV. Conclusions and

Recommendations
Through a convergence of social, political, and
environmental factors, EID hot spots are causing
governments and industry to face the significant
challenge of mitigating outbreaks while
simultaneously attempting to plan for and prevent
epidemics and pandemics. Global efforts to expand
joint planning, information sharing, and financial
support of a range of global efforts aimed at
detection, verification, and response are increasingly
important. Failure to jointly pursue these goals in a
balanced approach will only contribute to new,
Failure to jointly
pursue these goals in
a balanced approach
will only contribute to
new, re-emerging, and
therapeutically resistant
pathogens.
re-emerging, and therapeutically resistant

pathogens.
The life sciences, food and agriculture, and health care industries are
at the forefront of exposure to highly infectious pathogens and are
also uniquely positioned to mitigate their impact. They are involved in
efforts to safeguard:
human and animal populations through therapeutic and other
interventions;
the global food supply chain; and
the operational resilience of the delivery of health care services.
Marsh
29
Conclusions and Recommendations
Gaps identified across geographies and competencies indicate a

deficiency in prevention and response capabilities. In the area of EID
research, these gaps underscore the need for improved tools and
facilities for detection and verification, as well as the need to speed up
development and production of interventions and therapeutics through
translational research, which by its nature can contribute to faster
clinical implementation of interventions.
In food production and trade, cooperation between government and
industry is critical in preventing contaminated food products from
reaching consumers. It is necessary to include producers in the effort
to detect EID in farm products at the source, which speeds up response
and lowers the cost of recovery.
In health care environments, there is an ongoing need for improved
planning and investment in the capacity to manage disruptive
infectious biological events. Hospitals can be both a site for healing and
a locus for infection. Therefore, implementation of accepted infection
control practices, isolation precautionswhen indicatedand solutions
that allow for the uninterrupted delivery of vital diagnostic and
treatment services is required. Adherence to these practices, plus the
creation of adequate surge capacity, will allow hospitals to carry out the
mission of delivering care during an event without contributing to the
spread of EID.
Fortunately, many sectors recognize that when it comes to upstream
planning and prevention efforts, the benefits outweigh the costs.
History has shown, however, that opportunistic pathogens can and
do exploit gaps in these efforts. Timely development of interventions
and therapeutics, improved coordination between participants, and
increased vigilance in food safety and enhanced response capacity in
health care delivery will improve our ability to successfully address the
increasing threat from EID.
30
Marsh
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41
Notes
42
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Notes
Marsh
43
Notes
44
Marsh
Marsh
45
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The Economic and Social Impact of Emerging

The Economic and Social Impact of Emerging Infectious Disease

epidemic or pandemic-prone diseases, or that otherwise pose a

pathogens using diagnostic methods in the field, in laboratories, and

reduce exposure of the wider population to contaminated food,

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

I. Introduction and Background

Severe economic and social disruption or disaster

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

Table 1: Origin of Infectious Disease Threats

Can be endemic (the persistent presence of a pathogen in a host in a

Can emerge as a consequence of negligence 4 (opportunistic pathogens,

Anti-personnel or anti-food and agriculture (livestock or crops) biological

Effective preparedness and response also hinges on establishing

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

to have global consequences if they are not stopped. To improve the

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

Factors Behind Emerging Infectious Disease

EID Events Are Dominated By Zoonoses

Pathogenesis comprises the origin of a disease and its progression in a host

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

Figure 1: Convergent Factors Contributing to Emerging Infectious

Increasing demand for

Factors associated with the

Human behavioral changes,

Shortfalls in public health

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

New analysis of socio-economic influences and environmental

Characterizing the Infectious Disease Risk

Infectious diseasecausing pathogens pose

While pathogen risk groups are generally accepted to be universal,

Ibid., pg. 992.

The Economic and Social Impact of Emerging Infectious Disease

Introduction and Background

Table 2: Pathogen Risk Groups15, 16

Risk Group 1: A micro-organism that is unlikely to cause human

WHO. Laboratory Biosafety Manual (LBM), Third Edition, 2004. http://www.who.int/csr/

The Economic and Social Impact of Emerging Infectious Disease

Qualitative and Quantitative Cost of Epidemic-Prone

II. Qualitative and

Up-front costs associated with preparing for and

The Broad-Based Economic Impact of

The Economic and Social Impact of Emerging Infectious Disease

Qualitative and Quantitative Cost of Epidemic-Prone

costs of failure to follow known prevention methods may be incurred

Figure 2: Economic Impact of Recent Epidemics (Zoonotic) 17

Foot & Mouth Disease

The Economic and Social Impact of Emerging Infectious Disease

Qualitative and Quantitative Cost of Epidemic-Prone

The economic impact of zoonotic disease can be extensive

The Economic and Social Impact of Emerging Infectious Disease

Qualitative and Quantitative Cost of Epidemic-Prone

Impact on Transport, Travel, Tourism, and Social Gatherings

The Economic and Social Impact of Emerging Infectious Disease

Qualitative and Quantitative Cost of Epidemic-Prone