Interview by: James Nelson
Dr. Sherry Cooper is Global Economic Strategist and Executive Vice-President of the Toronto-based BMO Financial Group. A former economist at the U.S. Federal Reserve Board in Washington, D.C., she served there as a special assistant to then U.S. Federal Reserve Chairman, Paul Volcker.
A frequent speaker and TV commentator, Dr. Cooper is known for her ability to de-mystify the murky waters of economics and finance, and she ranks among the most influential women in her adopted Canada. In 2002 she was named by Bloomberg News as the top gross domestic product forecaster for the U.S. economy.
Over recent months Dr.Cooper and her BMO colleagues have undertaken an intensive research project on the potential human and economic consequences of a global influenza pandemic evolving from the bird flu virus. She talks here about her research findings and her call for action.
The media has been full of claims and counter-claims on the likelihood of a global influenza pandemic evolving from the H5N1 avian virus (Bird Flu). You’ve researched this danger extensively. How do you read the situation?
Sherry Cooper:
The evidence suggests that virtually all countries are unprepared. The SARS outbreak was controlled relatively quickly, within months. If global governments could decrease exposure to infected animals, strengthen an early-warning system, and contain the spread of disease at the source, they could likely avert a potential avian-flu pandemic. But most experts, including the World Health Organization (WHO), believe that the epidemic of avian flu among birds is too far gone to be eradicated, and that in some parts of Asia, it is nearly impossible to eliminate human and mammalian exposure to infected birds. Many birds are asymptomatic and still carry the disease, mostly wild migratory birds.
Quick detection, early treatment, containment, and preventative medications and vaccines are essential. This requires immediate global sharing of information and collaboration. Even now, these have significant economic implications. In the event of a pandemic, the economic effects could be colossal, affecting virtually all sectors and regions.
I don’t claim expertise in the science of pandemics, but my research included discussions with many of the world’s leading virologists, epidemiologists, and public health leaders, as well as representatives of the WHO, the U.S. National Institutes of Science, the Department of Health and Human Services, the Centers for Disease Control and Prevention and Health Canada. I have also met with medical officers and crisis-management leaders of many global financial institutions. The conclusion is that an influenza pandemic is likely, but no one knows when and where, or whether it will be a strain of H5N1, the avian flu. However, H5N1 is showing many characteristics consistent with the deadly 1918 Spanish flu virus that killed 50 to 100 million people, and that on a world population base of 1.75 billion.
Dr. Michael Osterholm, Director of the Centre for Infectious Disease Research and Policy (CIDRAP) and Associate Director of the National Centre for Food Protection and Defense, is a noted authority on bioterrorism and pandemics. He has stated to me directly that he believes there is a 100 per cent probability of a global influenza-A pandemic. But he does not know when or where. While uncertain, he believes the next influenza-A pandemic will evolve from the bird virus H5N1. This is not good news.
How deadly is the H5N1 virus?
Sherry Cooper:
The virus has mutated since the first bird cases were detected in southern China in 1996/1997, and has become far more virulent and deadly. It can kill infected chickens in less than one day, ducks in one to two days, and it has a very high death rate in humans, currently around 50 per cent in the affected regions. This is 10 times the case fatality rate of the horrific 1918 pandemic, although others might have recovered from the disease without ever being reported.
In the past four months, many thousands of wild migratory birds of multiple species have died. Before this, infected wild birds did not get sick en masse. So, the virus is continuing to evolve as a lethal pathogen and appears to be spreading globally. The more the virus extends its range, the greater the chance of mutation to allow easier human transmissibility
Have any governments made reliable estimates of the number of human deaths a pandemic would cause in their countries?
Sherry Cooper:
Michael Leavitt, the US Secretary of Health & Human Services (HHS) has warned that an outbreak of pandemic flu could cause 100,000 to 2 million deaths and as many as 10 million hospitalizations in the United States with costs exceeding $450 billion as a worst-case scenario. These estimates seemed to rattle both Congress and the White House. Of course, the numbers for the whole world could exceed this by many, many times.
How bad does an epidemic have to become before it’s classified as a pandemic?
Sherry Cooper:
A pandemic is an epidemic that becomes very widespread and infects a whole region, a continent or – most likely with global travel – the world. Influenza pandemics are known to attack three or four times each century. They occur when a novel influenza strain emerges with specific characteristics: it is readily transmissible between humans; it is genetically unique so that the human population lacks a pre-existing immunity; and it is highly virulent. Each pandemic is unique, so the mortality rate of the next one can’t be easily predicted.
At least 10 pandemics have been recorded in the past 300 years. The last one was in 1968, and it killed an estimated one-to-four million people worldwide. Earlier, there was also another mild episode in 1957, with roughly the same number of deaths.
The real killer-flu pandemic was in 1918, the so-called Spanish flu. It did not originate in Spain, although it did devastating damage there. In this pandemic an H1N1 strain infected 200 million to 1 billion people. According to a detailed country-by-country study published in the Bulletin of Medical History, an estimated 50 million to 100 million people died globally. Over the period from 1918 to 1920, roughly half the global population was infected in three separate waves, several months apart – the middle one being the worst. The fatality rate was about 3 per cent of those infected, killing about 500,000 people in the U.S.A. and nearly 60,000 in Canada. This makes the Canadian death toll from SARS, at 44, seem almost trivial. Moreover, in 1918, the global population was only 1.75 billion. Today, the world’s population is an estimated 6.4 billion.
The death rate was highest among young healthy adults, aged 20 to 40, and among pregnant women. The case-fatality rate among pregnant women ranged from 23 per cent to 71 per cent. If the woman survived, the foetus invariably did not.
Why was the death rate highest among young healthy adults? You’d think they would have the strongest immune systems.
Sherry Cooper:
They do, and ironically in the 1918 pandemic that was exactly the problem. The disproportionate high death rate among the young and healthy resulted from what doctors call a “ cytokine storm“, in which cytokine production causes enormous lung and other organ damage. Cytokines are regulatory proteins, such as the interleukins and lymphokines that are released by cells of the immune system and act as intercellular mediators in the generation of the immune response. People with the strongest immune systems produce the most cytokine and, hence, have the highest fatality rates. Millions experienced acute respiratory distress syndrome, an immunological condition in which disease-fighting cells overwhelm the lungs in their battle against the virus so much that the lung cells become collateral damage, and the victim suffocates. Even with our modern intensive care units, medical science is not able to handle this condition much more effectively today than we could in 1918.
Current studies of H5N1 cases in Southeast Asia, as well as the clinical picture and epidemiology of the virus, indicate a similar cytokine storm phenomenon, which would disproportionately kill the most economically productive age group
Among medical experts, what is the current consensus that the bird flu virus will mutate and thus become transmissible from person to person, and at what human cost?
Sherry Cooper:
Dr. Robert Webster of St. Jude Children’s Research Hospital in Memphis has studied flu viruses for 40 years and says he has never seen anything like this. In terms of being highly pathogenic it’s probably the worst influenza virus he has ever seen or worked with. With the known deaths so far, many public health experts fear a catastrophe. Dr. Webster and many others believe that the H5N1 virus, which isn’t yet transmissible among humans “will learn to do it”.
"Dr. David Nabarro, the newly appointed UN co-ordinator for global bird flu preparations, warned that a pandemic could kill up to 150 million people."
Estimates of potential human deaths vary widely. These estimates are highly contentious and subject to dispute. In late September, Dr. David Nabarro, the newly appointed UN co-ordinator for global bird flu preparations, warned that a pandemic could kill up to 150 million people. The deaths come in waves, extending the crisis and raising the panic level. These death toll estimates, even the conservative ones, are staggering. They demand attention, action, coordination and response plans, now. As Canadian Press medical reporter Helen Branswell has pointed out, whatever the number of deaths the situation will be extremely difficult and economically colossal.
So what can be done?
Sherry Cooper:
Dr. Klaus Stöhr, project leader of the Global Pandemic Project at the World Health Organization, says we have not been so close to a pandemic since 1968, and for the first time in history we are watching it unfold in slow motion. So detection, containment and prevention are critical.
But once a pandemic virus emerges it is too late to begin planning and collaboration. There will only be a window of 20 to 30 days between emergence and pandemic. Dr. Stöhr suggests that antiviral prophylaxis of 80 per cent of the surrounding population within 20 days would be required to slow or stem the spread of disease. It takes four or five days for the patient to become symptomatic and go to the hospital. In the interim, the virus is highly contagious and spreading fast.
Then it takes time for sampling, testing, diagnosis and field investigation. This relies on the ability of health officials across the region to spot the disease and report it quickly, a huge challenge given problems with health care and reluctance to disclose information in many countries. So, the intervention period is really only 10 to 14 days.
Isn’t the best answer a vaccine?
Sherry Cooper:
Most experts assume potential vaccines and other preventative and curative measures will have little effectiveness in the early stages of the pandemic and can’t be manufactured fast enough to make a large difference. Not only would the development of a vaccine take months, but production capacity constraints would limit its distribution to enough people to slow the spread.
A host of companies around the world are at work developing a vaccine. The problems are huge, involving the type of viral strain that might attack humans, delays in the production process and the strength of the immune response. The WHO has made it clear that these vaccines are no sure-fire panacea, and has warned of shortages in production capacity of vaccines, not to mention the issues of getting the vaccine to those who need it most, especially in the emerging economies of East Asia
What contingency plans should companies be making in order to be prepared for the worst?
Sherry Cooper:
The key continuity planning steps I view as essential for businesses, both large and small to follow, would include:
- I’d first check to assure that existing contingency plans are applicable to a pandemic, in particular that core business activities can be sustained over several months.
- Anticipate interruptions of essential governmental services like sanitation, water, power, and disruptions to the food supply.
- Identify your company’s essential functions and the individuals who perform them, since the absence of these people could seriously impair business continuity. Build in the training necessary to ensure their work can be done in the event of an absentee rate of at least 25 to 30 per cent.
- Maintain a healthy work environment by ensuring adequate air circulation and posting tips on how to stop the spread of germs at work. Promote hand and respiratory hygiene, and ensure easy availability of alcohol-based hand sanitizer products.
- Determine which outside activities are critical to maintaining operations and develop alternatives in case they can’t function normally. For example, what transportation systems are needed to provide essential materials? Does the business operate on “just in time” inventory or is there usually some reserve?
- Establish or expand policies and tools that enable employees to work from home with appropriate security and network access to applications.
- Expand online and self-service options for customers and business partners.
- Be sure your workforce knows about the threat of pandemic flu and the steps the company is taking to prepare for it. In emergencies, employees are more inclined to listen to their employer, so clear and frequent communication is essential.
- Update your sick leave and family medical leave policies and communicate with your workforce about the importance of staying away from the workplace if they become ill. Concern about lost wages is the biggest deterrent to self-quarantine.
If a pandemic does strike, what other scenarios will companies need to confront?
Sherry Cooper:
In the case of a global pandemic, disruption is magnified by its pervasiveness. Supply chains are broken. People everywhere are frightened. Every business is in emergency mode. Financial markets are destabilized and some might not even operate for a period of time. Gold prices will jump as investors seek a financial haven. Central banks will add liquidity, but that only helps if bond markets are functioning, banks are making loans, and people are there to apply for those loans. While gold prices might rise, other commodity prices will fall as global growth slows, particularly in Asia. Clearly, the overall functioning of the global economy will be weak for some period of time, depending on the severity of the pandemic. Some experts suggest the pandemic could last for 12 to 18 months and hit most regions of the world.
Business would be confronted with, say, 25 per cent absenteeism, maybe more, as many workers become ill, stay at home to take care of children or refuse to go to work, especially in heavily populated office towers. Business continuity planning is essential. Companies must help to protect employees’ health, and they will need to work with health officials to minimize disruption. But leaning on government won’t be enough.
Many businesses are multi-national, under the auspices of numerous national, provincial and local governmental authorities. Already, many corporations are developing pandemic-specific emergency plans, focusing first on their Asian employees and businesses, and then on the rest of the world. Financial institutions and large corporations in the OECD are also making preparations, so bird flu is definitely now a threat on the business radar screen. Small businesses must also prepare, particularly those providing essential goods and services such as food, fuel, electricity and medical products.
But all of this is uncertain. If, when, and where still remain unknowable and, in many ways, imponderable. Putting actual numbers on the loss of life, productivity, growth and development is nothing more than a guessing game. It ranges from “dodged that bullet”, to manageable, to bad, to disastrous, to catastrophic.