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

At a Glance:

A pandemic of H1N1 flu was declared in June 2009 as the disease spread from North America to Europe and then to countries of the Southern Hemisphere during the summer. The pandemic is expected to continue for two years. About 30-50 percent of the populations of countries of the Northern hemisphere may be infected during the coming fall and winter. The H1N1 flu is mild to date, and no mutations indicating greater severity have been detected. Historically, influenza pandemics have encircled the globe in two, sometimes three, waves, as evidenced during the 1918, 1957 and 1968 pandemic outbreaks.

So far, most severe cases and deaths have occurred in adults under the age of 50 years, with mortality among the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where some 90 percent of severe and fatal cases occur in people 65 years of age or older. Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. The toll of the disease in terms of deaths, illness, and economic impact is expected to be particularly severe in developing countries.

Avian Influenza H5N1

At the same time, the spread of H5N1 continues. To date, H5N1 has resulted in 262 human deaths and has affected wild birds and poultry populations in 61 countries throughout Asia, Europe, the Middle East and Africa. Poultry deaths due to culling and disease stand at more than 300 million, causing substantial losses for poor farmers. The disease is believed to be present in most East Asian countries, as well as in parts of Bangladesh, Egypt, India, and Nigeria. While there are definitely seasonal peaks and troughs in human infections, there have been cases recorded every month since November 2004. Human infections with H5N1 continue to be extremely rare, and the number of officially reported cases has declined in 2007 and 2008. To date, the World Health Organization (WHO) has confirmed that 440 people in 15 countries have been infected with H5N1, including 262 fatalities, representing a case fatality ratio of more than 60 percent.

Economic Impact 

Experience with previous outbreaks such as SARS (2003) indicates that there are two major types of socio-economic impacts.

First, service sectors such as tourism, retail trade, transport, and entertainment register initial impact. During the SARS outbreak, these costswere estimated to have reduced GDP by 1.5-2.5 percent in the second quarter of the year (i.e., 0.3-0.5 percent of annual GDP) in affected economies such China, Hong Kong (China), Singapore, and Taiwan (China).

Second, if preventive actions fail to stop an influenza pandemic, the costs of illness can include medication and hospitalization, and indirect costs, which include losses to economic production as a result of the illness or death of workers. In a moderate pandemic flu scenario, studies have suggested that the economic losses from illness and death in the first year of the pandemic could amount to 1.3 percent of world GDP or more. Combined with preventive costs of close to 2 percent of GDP, total costs could exceed 3 percent of world GDP in a moderate pandemic scenario.

Focus on Health Systems Strengthening

The H1N1 outbreak has reinforced the need for health systems strengthening, which is bedrock of the World Bank’s Health, Nutrition and Population (HNP) Strategy. The health system is vital at all stages in the response to the pandemic: from detection and confirmation of cases to providing care, treatment, and advice to those affected. Though disease surveillance and response capacity have improved in many developing countries (especially those that have already suffered avian flu outbreaks), their human and animal health systems are not sufficiently strong enough at the moment to ward off future outbreaks.

Bank Support in the Global Fight against Avian and Human Influenzas (AHI)

The Bank is well-positioned to help countries and other partners with technical, social, economic, political, policy, and regulatory issues in dealing with influenza prevention, care, and treatment. The Bank has been quick to help in similar global or regional emergency situations, such as SARS, post-disaster reconstruction, and HIV/AIDS.

Support for Integrated Country Programs

In January 2006, the Bank’s Board of Executive Directors endorsed a Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI), with a ceiling of US$500 million from the International Bank for Reconstruction and Development (IBRD) and International Development Association (IDA), in response to the disastrous impact of the highly pathogenic avian influenza (HPAI) virus H5N1 on poultry farmers, especially in the poorest countries, and the serious concerns over the potential emergence of a human pandemic caused by the H5N1 virus. In response to the global health emergency presented by the outbreak of H1N1, the Bank’s Board approved extension of the closing date of the GPAI from June 2009 to June 2010, and an increase in the ceiling of the GPAI from US$500 million to US$1 billion.

By end-June 2009, US$453 million has been approved for 64 projects in 62 countries (Table 2). Most of this financing was from IBRD/IDA (US$350 million), supporting fully developed integrated country programs in 26 countries. Significant funding came from Bank-administered trust funds, including the Policy and Human Resources Development Fund (PHRD) provided by Japan, and the multi-donor Avian and Human Influenza Facility (AHIF). AHIF received pledges of US$125 million from nine donors, of which the European Commission is the largest. The primary focus of these operations has been the strengthening of country veterinary services, animal and human disease surveillance, and human health systems. These operations have proved extremely useful in laying additional groundwork to support overall pandemic preparedness in general, and H1N1 prevention and control in particular.

For H1N1, beginning with its immediate support to several hard-hit countries (including Argentina, Brazil, Costa Rica, and Mexico), the Bank has taken steps to ensure that governments, communities, and individuals are well-prepared to deal with H1N1. For example, Bank teams have responded to client requests for assistance by reallocating existing GPAI, HNP, and agriculture and rural development operations, and providing new lending and technical support. In this category, more than 20 clients have requested or are exploring Bank support, for human and animal health systems strengthening, communications, and implementation of pandemic preparedness plans.

The Bank’s engagement has been critical in ensuring a well-coordinated cross-sectoral response by bringing together the relevant ministries, government agencies, and the donor community, and in facilitating high-level political coordination. For many affected countries, rapid Bank support has been essential to enabling them to respond immediately to the crisis, to mitigate economic impacts if possible, and ensure that social stability is maintained.

Working with Partners

The Bank is working closely with developing countries, donors, the UN System Influenza Coordinator, and the international technical agencies—WHO, FAO, OIE—in providing an integrated approach at the national, regional, and international levels to the fight against H5N1 and in responding to the ongoing flu pandemic. The Bank has supported UNSIC, WHO and the UN Office for the Coordination of Humanitarian Affairs’ gap assessment exercise and report, Urgent Support for Developing Countries' Responses to the H1N1 Influenza Pandemic, prepared on the basis of an urgent needs identification and prioritization exercise undertaken with national authorities in 77 countries since mid July 2009. The purpose is to identify interventions that can be completed within the next 6-12 months that would strengthen the capacity of the most vulnerable countries to deal with H1N1, particularly in terms of preventing pandemic-related illness and death.

The Bank has also supported a series of ministerial conferences on avian and pandemic influenza by providing analytical inputs (such as work on financing needs and gaps, poultry sector biosecurity, and compensation schemes to foster disease control) and global progress reports (together with UNSIC). The government of Vietnam will host the next ministerial conference in Hanoi in April 2010 on the international response to avian and pandemic influenza threats.

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

Media Contact:
Phil Hay, (202) 473-1796
Email: phay@worldbank.org

Updated September 2009