-- Related Links -- Pandemic Flu Influenza A (H1N1): Questions and Answers

At a Glance
The 2009 H1N1 flu pandemic was the first such event in more than 40 years. It was not as severe as had been feared. Had it been more severe, it would have set back progress in reaching the Millennium Development Goals (MDGs), especially since pregnant women and children were particularly hard-hit. The World Bank has made available $1 billion in fast-track approval credits from the International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA) to help developing countries tackle the 2009 H1N1 flu, avian flu (H5N1), and other animal-borne or “zoonotic” diseases. Early detection and prevention of disease spread are important, as is preparedness for future disease outbreaks.

H5N1
The highly pathogenic avian influenza virus H5N1 has affected 61 countries to date (Figure 1). Poultry deaths due to culling and disease are estimated at one billion, causing substantial losses to, and reducing the nutritional options of, the poor. The virus persists in China, Indonesia and other countries. In the first seven months of 2011, Bangladesh, Cambodia, Egypt, China Hong Kong (SAR), India, Israel, Japan, Korea, Mongolia, Myanmar, Vietnam, and West Bank and Gaza reported outbreaks. Human infections continue to be extremely rare; reported cases have declined in 2007-8, but increased again in 2009-10. As of June 22, 2011, the laboratory-confirmed human toll stood at 562 cases, including 329 fatalities, representing a case fatality ratio of 60 percent. In 2011 Bangladesh, Cambodia, Egypt, and Indonesia reported human cases.

Economic Impact of Pandemic Influenza
Episodes such as SARS (2003) point to two types of impact. First, demand for services (tourism, retail trade, transport, entertainment, etc.) contracts as people take preventive actions. Second, there will be costs of illness (medication, hospitalization, etc.) and production losses as a result of reduced labor supply due to illness and death. In a moderate scenario, the labor supply shock in the first year of the pandemic could amount to 1.3 percent of GDP or more. Combined with preventive costs of close to 2 percent of GDP, total costs could exceed 3 percent of GDP. In a severe scenario, costs could reach 4.8 percent of world GDP, or $3 trillion.

Health Systems Strengthening in the Global Fight against Avian and Pandemic Influenzas
The H1N1 pandemic has reinforced the need for health systems strengthening, which is central to the Bank’s 2007 Health, Nutrition, and Population Strategy. Health systems are vital in the response to a pandemic. Disease surveillance and response capacity have improved in many developing countries, but their human and animal health systems are not sufficiently strong to ward off future outbreaks. Donor financing for surveillance and control of infectious diseases at their animal source expanded substantially in 2006-9, when combating avian flu was a priority. But it has since declined as media and policymakers’ attention has shifted from pandemic prevention to other issues.

Though it cannot provide grant funding that would be most effective to encourage disease prevention, the Bank is well-positioned to help countries with the multisector (“One Health”) approach that is needed to ward off infectious diseases. In January 2006, the Bank’s Board endorsed a fast-track program of $500 million from IBRD and IDA and subsequently enlarged it to $1 billion in June 2009. To date, $1.3 billion has been approved, from IBRD/IDA and trust funds, for projects in 60 countries (Table 1). The Bank-administered multidonor Avian and Human Influenza Facility (AHIF) received pledges of $127 million from 10 donors, of which the European Commission is the largest. The program supports integrated programs that use “One Health” approaches to strengthen veterinary services (critical for disease prevention), animal and human disease surveillance (critical for timely diagnosis), and human health systems. It also supports pandemic preparedness and H1N1 responses. IBRD-eligible countries that are interested may obtain Catastrophic Draw-Down Option loans that can make substantial resources available immediately to respond to a pandemic or other catastrophic disaster.

Working with Partners and Support to Ministerial Conferences to Improve Coordination
The Bank is working closely with developing countries, donors, the United Nations (UN) System Influenza Coordinator, WHO, Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE), and other partners. The Bank has supported a series of ministerial conferences on avian and pandemic influenza, starting in 2006, by analyzing for the international community the status of financing needs and gaps, poultry sector “bio-security,” and compensation schemes. The Bank and the UN have prepared five global progress reports for ministers. A key theme of the most recent meeting (April 2010) was the need for “One Health” approaches. Mexico has proposed to host a ministerial summit in 2012 to promote further international cooperation in the fight against global disease threats. Since financing for prevention and disease control at the animal source has diminished, the conference will also be a good opportunity to highlight the need to provide, in the interest of the whole world, more adequate resources to “One Health” systems in developing countries.

For more the Bank and avian and pandemic flu, please visit: www.worldbank.org/flu.

Contacts: Phil Hay, (202) 473-1796, phay@worldbank.org 
Melanie Mayhew, (202) 458-7891, mmayhew1@worldbank.org

Updated August 2011