Economics of One Health
Presentation to the One Health Summit 2012
Davos, February 19-23, 2012
Olga Jonas, Economic Adviser, World Bank
Report by Jimmy Smith, Cornelis de Haan and Sarah Stephenson
OUTLINE
• Impact on livestock, people, economies
• How can One Health approaches help
reduce these costs?
– Effectiveness gains
– Efficiency gains (within increased
investments and recurrent expenditures, esp.
in developing countries)
• Return on investment in One Health
systems
2
Zoonotic diseases account for half of
livestock losses due to diseases
50%
50%
Total loss:
762‘212 LSUs
Non-zoonoses
Zoonoses
Source: SAFOSO
3
IMPACT ON HUMANS - SELECT ZOONOTIC DISEASES
Reported
cases
Reported
fatalities
DISEASE
PERIOD
SARS
2002-3
7,918
761
HPAI
2004-present
584
345
1999-2008
28,975
1,124
2006-7
1,062
315
2009
2.6 m/year
West Nile
Rift Valley
Fever
HIV/AIDS
1.8 m/year
(25m since 1981)
Flu Pandemic of 1918/19: 50 million to 100 million died
What is the burden (total cost) of diseases
and what are its components?
• Only partial information, but better data are
increasingly needed (and will become even more
necessary)
• To assess total cost, useful to look at components of
costs of outbreaks in animals and in humans
• Costs of selected major outbreaks in 1986-2009
5
Components of economic costs due to
zoonotic disease outbreaks
100%
80%
70%
60%
50%
Indirect impact
90%
Spill-over effects in other
sectors (tourism, transport,
retail, etc)
30%
Consequential on-farm
losses
20%
10%
0%
Direct impact
40%
Ripple effects:
-- Reduced demand
-- Complementary products
Lower Productivity
Deaths from disease
& control measures
Control measures
Outbreak in animals
Avoidance behaviors
Illness and absenteeism
Mortality
Medical costs
Outbreak in humans
6
Costs of selected zoonotic disease outbreaks
SARS (Asia, Canada, rest
of the world), 2002
50
45
40
35
US $ billion
30
HPAI (Asia), 2004
25
BSE (UK), 1986
20
15
BSE (USA), 2004
10
Plague (India),
1994
5
0
1980
1985
1990
1995
Nipah virus
(Malaysia),
HPAI (Europe), 2005
1998
RVF (Kenya, Somalia,
WNV, 1999
Tanzania), 2006
2000
2005
2010
7
Example of “indirect” economic costs:
Tourist arrivals in China and Thailand
8
Adding it up: costs of zoonotic diseases
(select outbreaks, US$ billion)
Period
Costs (conservative
estimates)
1998-2009
38.7
2002-2004
41.5
Annual
average
6 outbreaks other than SARS
-Nipah virus (Malaysia),
-West Nile fever (USA),
-HPAI (Asia, Europe),
-BSE (US),
-Rift Valley Fever (Tanzania, Kenya, Somalia)
- BSE (UK) costs in 1997-09 only
SARS
Total in 12 year
period (1998-2009)
80.2
6.7
9
Poor households hardest hit – household
income effect of backyard poultry sales ban
• Significant negative impacts …. but only
partially monitored and documented
• What could One Health approaches
contribute to reduce negative impacts?
11
One Health approach – an integrated
response to “what needs to be done?” - as opposed to the classical approach
based on “what can I do?”
12
One Health approaches can increase:
• EFFECTIVENESS
– doing the right thing, getting the
desired results: prevention, accurate
and timely diagnostics, effective
control measures
• EFFICIENCY
– doing the thing right, achieving
results at least cost
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Delays increase costs
Exposure
in animals
Clinical
signs in
animals
Exposure
in humans
Clinical
signs in
humans
Cost of
control
outbreak
Humans
seek
medical
care
Adapted from IOM (2009)
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Funding requirements for “One Health”
efficient prevention and control system
• Total for 139 low- and middle-income countries
–$ 1.9 b – 3.4 b per year
» Note: actual losses in 1998-2008 were >US$ 6.7b/year (i.e., double)
– About 7x more than current effort, which is waning
due to “flu fatigue”
– Equivalent to $1.90 - $3.40 per person per year in
OECD countries (low price to pay for greater health
security and protection of incomes)
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Annual costs of prevention vs
Annual expected benefits of
40 prevention of pandemic and nonpandemic outbreaks 6.7b
35
$ billion per year
30
25
20
6.7 b
15
10
5
0
Costs of prevention
(investments in animal
and human health
systems)
Benefits from averted
mild pandemic
Benefits from averted
severe pandemic
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Case 1 : Mild Influenza Pandemic*
Annual Expected Rate of Return on Investments in Prevention
low preventive
effort
Reduction in
expected disease
outbreak impact
high
preventive
effort
20%
31%
14%
50%
65%
44%
100%
97%
71%
* Impact $600 b (1% of GDP), probability 2.5%, expected benefit of prevention $15 b/year
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Case 2: Severe Influenza Pandemic
Annual Expected Rate of Return on Investments in Prevention
Reduction in
expected disease
outbreak impact
low
preventive
effort
high preventive
effort
20%
49%
25%
50%
88%
57%
100%
123%
86%
* Impact $3 trillion (4.8% of GDP), probability 1%, expected benefit of prevention $30 b/year
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Avian & Pandemic Influenzas - Donor Interest Has Vanished
2,000
36
35
1,800
32
28
Loans
1,400
24
$ million
1,200
20
1,000
17
16
800
12
600
9
400
8
Grants
200
8
4
4
0
0
Beijing
(Jan '06)
Bamako
(Dec '06)
Financing gap
Delhi
(Dec '07)
Pledges
Sharm El
Sheikh
(Oct '08)
-
After SES,
2009
Number of donors pledging
Number of donors pledging
1,600
19
Characteristics of financing for One Health
systems
• Constant over time, medium- to long-term, and
reliably assured (not emergency response financing)
• Reach countries with greatest gaps in veterinary and
human health systems
• Should be on grant basis (global public good) … and
also include contribution from sector/livestock
product consumers
• Encourage prompt and complete reporting of
outbreaks at national, regional and international
levels
20
Some options for mobilizing resources
for One Health systems
• Official Development Assistance -- insufficient and unreliable,
prevention typically not a priority.
• World Bank, AsDB, AfDB etc – time-bound loans (good in
emergencies, as last resort). Could “blend” with grants for
leverage.
• Dedicated funding from donors (with fair burdensharing) plus a
levy on livestock products and/or contributions from consumers
wishing to lower their pandemic risk. Governance of fund could
include livestock producer associations, official and scientific
representatives, civil society.
• Private sector – international and domestic
21
Value Added of One Health Approaches
1.
2.
3.
4.
support poverty alleviation and economic growth in developing countries
reduce pandemic risk globally
improve public health globally
help build effective animal and human health systems without weak
links; “effective” means early detection and rapid response; delays result
in less effective disease control and higher risks at the animal-humanenvironment interface
5. help build efficient animal and human health systems; “efficient”
because of shared capacities and information, reduction of duplication,
economies of scope, economies of scale
6. net expected annual benefit between $4 billion (no pandemic threat)
and $35 billion (1 severe pandemic/100 years); with higher probability of
pandemics, benefits even greater.
22
Thank you.
www.worldbank.org/flu
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