The Economic and Social Impact of Emerging ... - Philips Healthcare

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 

This report sets forth the information required by the terms of the assignment and is prepared in the 

form expressly required thereby . This report is intended to be read and used as a whole and not in parts . 

Separation or alteration of any section or page from the main body of this report is expressly forbidden and 

invalidates this report . 

The independent development and publication of this document by Marsh Inc . was funded through an 

educational grant from Philips Healthcare .

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 pace—and 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 . 

1 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” . 


Section 

Marsh The Economic and Social Impact of Emerging Infectious Disease 1


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 . 

2 Moreover, living in close proximity to animals can increase the likelihood of zoonotic infection 

when animals become infected . 

2 The Economic and Social Impact of Emerging Infectious Disease Marsh

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 industries—life sciences, food and 

agriculture, and health care—are 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 . 

Introduction and Background 



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 . 


Table 1: Origin of Infectious Disease Threats 

Naturally 

Occurring 

Table Diseases 1: 

4 5 6 7 

Accidentally 

Occurring 

Diseases 

Deliberately 

Occurring 

Diseases 

• 

• 

• 

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) 

• 

• 

• 

• 

• 

• 

• 

• 

• 

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

such as MRSA) or poor infection control 

Can emerge as a consequence of ineffective or non-existent biosafety 

6, 7 

practices and/or biosecurity practices 

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 

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 CDC’s BMBL (Biosafety in Microbiological 

and Biomedical Laboratories) and the WHO’s 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 


Marsh The Economic and Social Impact of Emerging Infectious Disease 5 

5


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 . 

8 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 Host- 

Microbe 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 


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 

12 Jones, Kate E . et al . Global trends in emerging infectious diseases . Nature, Volume 451, Issue 21, 

February 2008 . 




Figure 1: Convergent Factors Contributing to Emerging Infectious 

Pathogens With a Focus on Zoonoses 13 

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 

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) 

ZOONOSES 

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 

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 

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 


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 . 

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 . 


Infectious diseasecausing 

pathogens pose 

varying degrees of risk to 

humans and animals. 



15, 16 

Table 2: Pathogen Risk Groups 

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 . 


II. Qualitative and 

Quantitative Cost of Epidemic- 

Prone 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 . 

Qualitative and Quantitative Cost of Epidemic-Prone 

and Zoonotic Emerging Infectious Disease 

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 significant—and likely greater—cost associated 

with failing to develop and implement prevention and response 

capabilities . Even when plans and capabilities exist, the more insidious 




$50bn 

$40bn 

$30bn 

$20bn 

$10bn 

$0 

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 

BSE, UK 

$10 -13bn Foot & Mount Disease 

Taiwan, $5-8bn 

Lyme disease 

US, $2.5bn 

Swine Flu, 

Netherlands 

$2.3bn 

SARS 

China, Hong Kong, 

Singapore, Canada 

$50bn+ 

Foot & Mouth Disease 

UK 

$30bn 

Nipah, Malaysia 

$350- 400m 

BSE, Canada 

$1.5bn 

Avian Flu, EU 

BSE, 

Japan 

$500m 

$1.5bn 

Avian Flu 

Asia, US, Canada 

$10bn 

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 

12 The Economic and Social Impact of Emerging Infectious Disease Marsh 

BSE, US 

$3.5bn 

17 Permission to reprint image granted by Bio Economic Research Associates, LLC © ., 12 August 

2008 . SARS and the New Economics of Biosecurity, 2003 .

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 . 






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 . 


18, 19, 20 

Figure 3: Economic Impact of Infectious Disease in South East Asia 

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. 

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 



Nipah (zoonotic disease) 

in Malaysia: In 1999, the 

Nipah virus caused the 

shutdown of over half of the 

country’s pig farms and an 

embargo against pork 

exports. 

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. 




Figure 4: Economic Impact of Infectious Disease in the Americas 

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. 

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. 

SARS in Canada: 

Research suggests a loss in 

national economic activity in 

2003 of roughly $1.5 billion, 

representing 0.15 percent of 

Canada’s 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. 

21, 22, 23 

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 


Figure 5: Economic Impact of Infectious Disease in the United 

Kingdom 24 and Sub-Saharan Africa 25 

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 



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. 




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, SARS—a novel virus that causes acute respiratory 

disorder—is 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 . 938–942, 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 . 


global economies could top $1 .25 trillion, and the pandemic could kill 

33, 34 

as many as 150 million people worldwide . 

To date, current strains of avian influenza—the anticipated source of 

pandemic influenza—have 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 world’s 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 

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/ . 



Once the virus 

becomes capable of 

efficient human-to-human 

transmission, the potential 

disruption to industry, 

service, and government 

is anticipated to be 

enormous. 




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 G8’s 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 . 


III. Global Preparedness and 

Response Capabilities 

Three key industries—life sciences, food and agriculture, 

and health care—are 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 . 

Global Preparedness and Response Capabilities 



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 

Life Sciences 

Food and 

Agriculture 

Health Care 

Microbiological laboratory tools, technologies, 

equipment, and materials (e.g., reagents, cell culture, 

etc.) 

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 

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 

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 . 


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 

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 . 


Following the 

detection of a pathogen, 

confirmatory tests are 

needed to demonstrate 

the presence or absence 

of disease during an 

outbreak. 



Table 4: Overview of Cross-Sector Industry Roles in Identification/ 

Verification 

Life Sciences 


Agriculture 

Development of field kits to rapidly determine 

presence of pathogen 

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 

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 WHO . International Health Regulations (2005). http://www .who .int/csr/ihr/travel/en/index .html 


public health, etc .) will assume the lead in the disease investigation . 

Regardless of origin, the ultimate goal—controlling the spread of 

disease—remains 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 

Life Sciences 


Agriculture 

Health Care 

* 50 

Principally responsible for developing therapeutic 

interventions for EID 

Drive laboratory research and findings into clinical 

applications and interventions (translational 

research) 50 

Culling of infected animals or animals suspected to be 

infected 

Product recall of suspected or known contaminated 

food products and animal by-products 

Provide care in hospitals or alternate locations 

Administer preventive or post-exposure interventions 

Provide preventive or post-exposure public health 

solutions such as isolation and quarantine 

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 FDA’s Critical Path initiative http://www .fda .gov/oc/initiatives/ 

criticalpath/initiative .html . See also, The NIH’s New Pathways to Discovery initiative http:// 

nihroadmap .nih .gov/newpathways/ . 




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=GAO- 

08-108T 

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) . 


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 . 




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 . 


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, 

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 . 

Conclusions and Recommendations 

Failure to jointly 

pursue these goals in 

a balanced approach 

will only contribute to 

new, re-emerging, and 

therapeutically resistant 

pathogens. 


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 precautions—when indicated—and 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 . 


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Notes 


Notes 


Notes 



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