economic-and-social-impact-of-epidemic-and-pandemc

Vaccine24(2006)6776–6778EconomicandsocialimpactofepidemicandpandemicinfluenzaAvailableonline14July2006AbstractAmidstthehumansufferingcausedaninfluenzaepidemicitisalltooeasytooverlookthedisease’swidersocialandeconomicimpact.Notonlydoesinfluenzaimposehugeinfrastructuredemandsonhealthcaresystems,butitexactssubstantialeconomiccostsintermsofsickness-relatedabsenteeism,disruptedworkschedulesandlostproductivitytosocietyatlarge.Influenzaaccountsforaround10%ofsickness-relatedabsencefromworkinEuropewherethelikelycostoflostproductivityinFranceandGermany,forexample,rangesfrom£5.6billionto£8.5billionperyear,accordingtoESWIestimates.Buthowtoassessthefulleconomicimpactofinfluenza?Thedirectcostsareeasilyenoughidentified,butwhatabouttheindirectcosts?Howshouldthesebemeasured?Howforexample,doesoneassessthecostoflostopportunities,andwhataretheeconomicgainsofvaccinationregardingavoidedcosts?Finally,whichtargetgroupsforvaccinationwouldgeneratethegreatestavoidedcosts?Leavingasidethemoralimplicationsofsuchaquestion,thefactremainsthatpoliticiansandhealthpolicymakersneedthecoldhardfigurestooptimallyallocatethecostsofvaccinationandpreventativehealthcampaigns.Theseissuesandmorewereclearlydelineatedduringthissession,co-chairedbyDrs.T.SzucsoftheUniversityofZurichandK.NicholoftheUniversityofMinnesota.ReportontheconferencesessionEconomicandsocialimpactofepidemicandpandemicinfluenzaChairmen:•Dr.T.D.Szucs,UniversityofZurich,Switzer-land•Dr.K.Nichol,UniversityofMinnesota,Min-neapolis,USASpeakers:•Dr.M.Meltzer,CenterforDiseaseControlandPrevention(CDC),Atlanta•Dr.E.Hak,UMCUtrecht,TheNetherlands•Dr.J.Chancelor,Consultant,InnovusResearchLtd,UK•Mrs.C.Ammon,BusinessGroupInfluenza,Geneva,Switzerland“Inthe21stcenturythedeathratesaregoingtovaryhugelyintermsofwhatyoucanpredict.Andwewillnotbeabletotellitsscale.”DrM.Meltzer,SeniorHealthEconomist,CDC,Atlanta“Ithinkthenextpandemicwillleadtoanuncon-trollablesituation:averyhighdeathrateandhugecosts.”Dr.E.Hak,UMCUtrecht,TheNetherlands“BasedonouranalysisacrossfourEuropeancountries,offeringvaccinationtoallpeoplebetween50and64yearsofagewouldbecost-effective.”Mr.J.Chancellor,Consultant,InnovusResearchLtd.,UKOpeningthesession,Dr.E.HakofUtrechtUniversity’sMedicalCentre,pointedtoresearchshowingthatifapan-demicweretohittheUnitedStates,forexample,thehumanandeconomiccostswouldbeastronomical.0264-410X/$–seefrontmatterdoi:10.1016/j.vaccine.2006.06.072Miscellaneous/Vaccine24(2006)6776–67786777“Deathswouldrangefrom89,000to207,000andthecosttotheUSeconomycouldrunashighas$167billion,”hesaid.“Buttheseareconservativeestimatesbecausetheydonotincludelossofproductivitycosts,”hetoldparticipants.Basedonarecentstudy1byhisinstitutiontoestimatemorbidity,mortalityanddirectmedicalcosts,HakandteampredictedthatthenextinfluenzapandemicinTheNetherlandswouldinfectone-thirdoftheDutchpopulation,Hakconcludedthathigh-risksub-groupsandtheadultpopulationaged20–64yearsshouldbethefocusofvaccinetreatmentandprevention.Buthealsonotedthat“Ithinkthenextpandemicwillleadtoanuncontrollablesituation:averyhighdeathrateandhugecosts”.TheabilityofsciencetocircumscribeeconomicimpactThefollowingspeakeralsohadasoberingviewoftheabilityofsciencetocircumscribetheeconomicimpactofapandemic.“Fluisadiseasethatvisitsuseveryyearandwereallydonotknowwhatitscostsaretosociety.Foranygivengrossattackrate,there’sawiderangeofpotentialdeaths.Inthe21stcentury,thedeathratesaregoingtovaryhugelyintermsofwhatyoucanpredict,andwewillnotbeabletotellitsscale,”saidDr.M.Meltzer,seniorhealtheconomistattheUSCenterforDiseaseControlinAtlanta.MeltzersaidtheCDChasexaminedtheeconomicsofvaccinationintheUnitedStatesbasedontheprior-ityofsavinghigh-risklivesversusdecisionslinkedtomacro-economiccostsavoided.Notingthatthevastnum-berofpandemicvictims“whoaregoingtoclogupdoc-tors’officesandthemedicalsystem”willbeunder65yearsofage,MeltzersaidpolicymakersfaceaSalomonicchoice.“Ifyouchooserisk-of-deathasthecriterium,thenprioritygoestothoseover65:Grandmagetsthefirstavailablesup-plies.Butifitistomaintainsocietyandkeepitrunning,thenfromapurelyeconomicviewpointyouhavetoprotectthe20–65workingagegroupandthenthe0–19year-olds.ButthissendsGrandmatothebottomofthelist,”hesaid.“Ifyou’retheministerofhealthofcountryX,whichofthesedoyouchoose?Theeconomicsofapandemicsuggestthatyouvaccinatethehigh-riskpopulationsofadultsandchildrenfirst—andtheelderlylast.”Healsostressedthatvaccinationpolicymustprotect“thefirst-responders”sothathealthcareworkersanddoctorscantreatothers.Butthatassumeshealthcareworkersgetthem-selvesvaccinated—achallengeechoedtimeandagainduringthe4-dayESWIconference.Indeed,theproblemwasreit-eratedbysessionspeakerC.AmmonoftheGeneva-basedBusinessGroupInfluenza.1SeeChapterI,Proceedingsofthescientificsessionsforthescientificpaperbasedonthisstudy.“VaccineuptakeamongHCWsremainsverylowandabsenteeism(duetosickness)isawidespreadproblemwithinhealthcaresystems,”shesaid.“Fluisthefirstreasonforabsenteeism—about10percentofthetotal.Afterreturning,thepersonhaslost50percentofhisproductivityduringtheperiod.”Evenwiththebestofpreventivemeasures,however,Me