Q&A with Keith Hansen, Bank Health Expert for the Region - September 23, 2009

How has H1N1 behaved in Latin America?

Most Latin American countries have had their first encounter with H1N1 this flu season. As has happened in Mexico and seems to be happening elsewhere in the world, the virus is spreading rapidly. It’s rapidly displacing other flus and affecting a somewhat unusual segment of the population.

What do you mean by ‘unusual segment?’

A typical flu mostly sickens the very old and the very young. This one seems to be having a stronger effect among young adults, and not so much among senior citizens, suggesting older people may have immunity from a long ago exposure to the flu. This is consistent with any new strain of the flu, so it’s not surprising, but it is a challenge for any health system. The countries have all had to confront this one way or another, and I think a few lessons are emerging.

What are those lessons?

One is that early, aggressive, honest public communication is essential. This is what Mexico pioneered in April, when they came forward as quickly as they had information and made a virtual daily habit of putting it out to the public through various media, being as clear and reassuring but honest as they could with the information. And most other countries have done the same thing.

Another lesson is that surveillance is critical, and having a good public health surveillance program is an essential element to being able to mount an effective response. This is not about counting people – flu is such a common event, and in any country it’s no longer useful to be counting how many people get infected. But the issue is to track the progress of the epidemic as a whole , see where the waves are moving, what kind of people are getting infected, how quickly, how long they stay sick, getting a sense of how long they’re infectious, if the disease is changing, and of course, most important, where is it having the most severe impact? And, being ready to treat those who are most severely affected.

Is the World Bank working with other international organizations and countries on this surveillance and preparations for future outbreaks?

Yes, there is a big global partnership involving many organizations, led by the World Health Organization and its regional bodies in Latin America – that’s PAHO. The World Bank is very much a partner in this undertaking. WHO takes the lead on all the clinical, technical and medical aspects of this and the Bank is trying to contribute financial and programmatic aid through our different forms of support.

What kinds of things has the World Bank done to help countries in the region?

We’ve provided almost every kind of support the Bank offers. In some countries this has taken the form of financial support. In other countries, we’ve put together new projects or new parts of projects that are going to enable them to prepare for the continuance of the flu. In others, it’s taken the form of technical assistance or knowledge sharing – talking to other countries that have gone through this or experienced SARS several years ago to see what the lessons are of effective epidemic management and control. And in others it’s just helping countries do a bit of forward planning, costing of potential response, and making sure they’re considering all the aspects before moving forward.

How many countries of the region is the Bank currently working with?

Probably upwards of a dozen. We’ve been in touch with all of them from the beginning. Ten to 12 have decided to use direct Bank support in one form or another, including finance. We’ve had dialogue with virtually all the clients.

Now that there’s a vaccine on the horizon, are there any plans to assist countries with purchasing vaccine?

Yes. The Bank stands ready to help any country with support, whether financial or technical or programmatic. We have a couple of projects that will be funding vaccines directly. Vaccines, of course, are only one small part of the overall puzzle. It’s very important to strengthen laboratory networks and surveillance systems in general. The Bank is ready to work on all those things, and we are in several countries.

How has the virus affected people and the economy in the region?

People often ask, what is the overall impact of an epidemic like this? The first answer is it sickens and kills people. That remains the most important answer to the question, but it’s obvious to everybody that it does have effects beyond that. We saw that the schools in Mexico, the government and most other public facilities were shut for a couple of weeks. The same thing happened in countries in the Southern Cone. Travel dropped dramatically to some of these countries. Tourism fell as people engaged in what’s called ‘social distancing’—they stay away from crowded places and markets, football matches are cancelled or go ahead in empty stadiums. Obviously this has an impact on the economy, but the important point to bear in mind is this has an impact because people are doing the right thing. This isn’t one of those instances where countries take an ill-advised action which also ends up costing them. Here, doing the right thing costs money and hurts the economy, and to some extent this is unavoidable because staying home if you’re sick is one of the main recommendations. We want people to continue doing this. What we want, of course, is for the epidemic to be as mild and as quick as possible. Therefore we want to do everything we can to support surveillance and controls so countries can minimize impact. We don’t want to get into the trap of saying, well it costs this amount of money, therefore maybe people should have continued to go to work and to school. That simply would have made things worse.

Epidemics can be very costly for the economy, for business, and this is why it’s worth investing a great deal to strengthen and maintain good surveillance and public health control measures. Also, the economy is not the measure of all things. The fundamental issue is that people’s lives, health, productivity and happiness are all at stake. Epidemics aren’t entirely preventable but they can be minimized, and that’s the role of a good public health system, and partners, such as the Bank, can support this.

What is the Bank doing to help strengthen health systems in Latin America?

In both Argentina and Brazil, we have public health projects set up explicitly to improve the countries’ readiness and preparedness, both for regular health challenges and also for emergencies and epidemics. In both of those countries, we were able to allocate money instantly, in a day or two, to meet the most urgent immediate needs of the countries. For all the countries to which we’re providing support, we’re taking the view this support should be investments that can help countries be ready immediately and also pay off in the long run.

So let’s say this epidemic turns out to be very mild or miraculously just vanishes overnight, it would still be worth undertaking all these measures because this is the right thing to do—to strengthen surveillance, public health response, laboratory networks, readiness, strategic reserves of the necessary drugs, not just vaccines for this virus, but the kind of drugs that a good health system needs. So the goal here is not to just chase the disease du jour but to really be prepared for what else might be coming down the pike and strengthening countries overall in their readiness.