Estimating the Potential Economic Impact of the Next

Influenza Pandemic upon Belize

Paul Edwards – MOH BelizeRony Maza – PAHO/WHO Belize

San Jose, Costa RicaDecember 16, 2005

Age Group Population

0-14 yrs 115,795

15-59 yrs 150,250

+ 60 yrs 16,555

Belize’s Population, by Age

Country Information

Country Information-Cont.

Source: CSO mid-year estimates, Belize 2004.

Total licensed non-ICU beds: 418

% licensed non-ICU beds staffed: 100%

Total staffed non-ICU beds: 418

Total licensed ICU beds: 12

% licensed ICU beds staffed: 100%

Total Staffed ICU beds: 12

Total number of ventilators: 4

% ventilators available: 100%

Total number of ventilators available: 4

Basic Hospital Resources

Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s Scenario

Population: Numbers and distribution by age and risk group

Risk groups0-14 yrs 15-59 yrs 60+ yrs

Totals % total

Non-high risk* 108,385 128,614 9,933 246,932 87%

High risk* 7,410 21,636 6,622 35,668 13%

Totals 115,795 150,250 16,555 282,600 100%

Note: High risk refers to pre-existing medical conditions (e.g., asthma, diabetes, heart and lung conditions) that increase risk of influenza-related adverse health outcome

Deaths: By age group

Gross attack rate Distribution of deaths by risk group

Age groups15% 25% 35% % high risk

% all deaths

0-14 yrs most likely 2 3 4 0-14 yrs 1% 3%

min 1 2 2 15-59 yrs 54% 62%

max 25 42 59 60+ yrs 29% 36%

15-59 yrs most likely 47 78 110 Totals 84% 100%

min 7 11 16

max 88 147 206

60+ yrs most likely 27 45 63

min 26 44 61

max 34 56 79

TOTALS most likely 76 126 177

min 34 57 79

max 147 245 344

Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s Scenario –

Cont’d

Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s scenario –

Cont’d

Hospitalizations: By age groupDistribution of hospitalizations by

risk groupGross attack rate

Age groups 15% 25% 35%

% high risk

% all hospital

0-14 yrs most likely 32 54 76 0-14 yrs 2% 8%

Min 16 27 3715-59 yrs

11% 73%

Max 136 227 318 60+ yrs 12% 19%

15-59 yrs most likely 278 463 648 Totals 25% 100%

Min 51 86 120

Max 303 505 707

60+ yrs most likely 72 121 169

Min 52 86 121

Max 91 152 213

TOTAL most likely 382 638 893

Min 119 199 278

Max 530 884 1,238

Results: Potential Impact on Belize of the Next Influenza Pandemic: 1960s/70s Scenario –

Cont’dOutpatients: By age group

Gross attack rate Distribution of outpatients by risk group

Age group 15% 25% 35% % high risk% all

outpatient

0-14 yrs most likely 10,273 17,121 23,970 0-14 yrs 5% 44%

Min 8,582 14,304 20,025 15-59 yrs 7% 50%

Max 11,963 19,939 27,915 60+ yrs 2% 6%

15- 59yrs most likely 11,593 19,322 27,050 Totals 14% 100%

Min 8,324 13,873 19,422

max 17,695 29,492 41,288

60+ yrs most likely 1,285 2,142 2,999

min 1,213 2,021 2,830

max 1,995 3,325 4,655

TOTAL most likely 23,151 38,585 54,019

min 18,119 30,198 42,277

max 31,653 52,756 73,858

Total Estimates, per Health Outcome, from two Scenarios of Potential Impact of Next Influenza

Pandemic in Belize: Most likely (min, max)

Health Outcome

Scenario 1960s/70s † Scenario tipo-1918 ‡

Gross attack rate 35%* Gross attack rate 35%*

Deaths177

(79-344)1,456

(657-2,820)

Hospitalization893

(278-1,238)7,336

(7,280-10,181)

Outpatient54,019

(42,277-73,858)49,565

(47,250-50,035)

Ill without medical care43,821

(23,470-56,276)40,553

(38,659-40,938)

Outpatient + ill without medical care

90,118(85,909-90,973)

Demand for Hospital-based Resources: 1960/70s Scenario: 35%

Attack Rate: 8 Weeks DurationPandemic Influenza Impact / Weeks 1 2 3 4 5 6 7 8 9 10

Hospital Admission Weekly admissions 61

102

152

193

193

152

102 61    

  Peak admissions/day       30 30          

Hospital Capacity

# of influenza patients in hospital 45 75

112

142

147

129 99 65    

 % of hospital

capacity needed 11%18%

27%

34%

35%

31%

24%

16%    

ICU Capacity# of influenza patients in ICU 9 19 30 39 43 41 33 23    

 % of ICU capacity

needed 76%162%

248%

328%

355%

345%

274%

189%    

Ventilator Capacity

# of influenza patients on ventilators 5 10 15 20 21 21 16 11    

  % usage of ventilator114%

243%

372%

492%

532%

518%

412%

284%    

Deaths# of deaths from

influenza     11 18 27 34 34 27 18 11

 # of influenza deaths

in hospital     7 12 19 24 24 19 12 7

Distribution of admissions: By day, 8 week outbreak 35% attack rate

0

10

20

30

40

50

1 8 15 22 29 36 43 50Days of outbreak

Da

ily #

of

ad

mis

sio

ns

Most likely Minimum scenario Maximum scenario

Hospital Admissions by Week: 1960/70s Scenario: Hospital Admissions (most likely, min,

max weekly admissions): 8 weeks duration

Pandemic Influenza Impact / Weeks 1 2 3 4 5 6 7 8 9 10

Hospital Admission Weekly admissions 501 836 1,253 1,587 1,587 1,253 836 501    

  Peak admissions/day       247 247          

Hospital Capacity

# of influenza patients in hospital 368 614 921 1,167 1,208 1,062 814 534    

 % of hospital capacity

needed 88% 147% 220% 279%289% 254% 195% 128%    

ICU Capacity# of influenza patients in

ICU 75 159 245 323 350 341 271 187    

 % of ICU capacity

needed 627%1329

%2041

%2696

%2917

%2838

%2255

%1557

%    

Ventilator Capacity

# of influenza patients on ventilators 38 80 122 162 175 170 135 93    

  % usage of ventilator 940%1993

%3061

%4043

%4376

%4257

%3383

%2336

%    

Deaths# of deaths from

influenza     11 18 27 34 34 27 18 11

 # of influenza deaths in

hospital     7 12 19 24 24 19 12 7

Demand for Hospital-based Resources: 1918-type scenario: 35% attack rate: 8

weeks duration

Distribution of admissions: By day, 8 week outbreak 35% attack rate

050

100150200

250300

350400

1 8 15 22 29 36 43 50Days of outbreak

Da

ily #

of

ad

mis

sio

ns

Most likely Minimum scenario Maximum scenario

Hospital admissions by week: 1918-type scenario: 35% attack rate (most likely, min,

max weekly admissions): 8 wks duration

Workdays Lost due to an Influenza Pandemic: Two scenarios, 8 weeks duration, 35% attack rate †

Workdays lost

1960s/70s scenario

% all workdays full time*

1918-type scenario**

% all workdays full time**

Most Likely 416,099 12.3 561,734 16.6

Minimum 382,739 11.3 516,698 15.3

Maximum 466,249 13.8 629,436 18.6

* Percent of annual workdays, calculated as 132,821 fulltime equivalents employed of those aged 15-59 years age (88.4% of 150,250), multiplied by 250 workdays per year.† See Appendix III for details of methods and assumptions** Estimated based on other studies which demonstrate a 30-40% increase for the 1918-type scenario as compared to the 1960/1970 scenario therefore an average of 35% was utilized

Distribution of days lost from work, 8 week outbreak, 35% attack rate

0

2

4

6

8

10

12

14

16

1 8 15 22 29 36 43 50

Days of outbreak

# of

day

s lo

st f

rom

wor

k (in

1,0

00s)

Mostlikely Minimum Maximum

Economic Impact: Work-days Lost

Value of Lost Workdays

Value of lost workdays

Lost work days

1960s/70s scenario BZ$

1918-type scenario

BZ$

Most Likely 416,099days $25,964,577 $35,052,179

Minimum 382,739 $23,882,914 $32,241,933

Maximum 466,249 $29,093,938 $39,276,816

GDP 2004 = $2,071,200,000

Workday lost equivalent to % GDP: 1.25 1.69

Source: CSO: [GDP/(workforce X employment rate)]/250 work days/year= $62.4

Value of Direct Medical Care

Direct Medical Costs BZ$

Health outcomes

1960s/ 70s scenario†

1918-type scenario

Gross attack rate 35%*

Gross attack rate35%

Deaths* $263,139.00 $355,238

Hospitalized no ICU

$827,220.00 $1,116,747

Hospitalized ICU

$23,865,141.00 $32,217,940

Outpatients $34,417,666.00 $46,463,849

Ill, no medical care

$1,095,525.00 $1,478,959

Totals $60,468,691.00 $81,632,733

* Assumed 70% of deaths require medical care equivalent of 10 days ICU Source:

# Cost per

day**

# of days Total

Death 177 $212.38 7 $263,138

Hospitalizationa.No ICUb.ICU

1016

779*237*

$212.38$212.38

510

$827,220$23,865,140

Outpatient 54,019 $212.38 3 $34,417,665

Ill no medical attention

43,821 $212.38 0 $1,095,525

TOTAL $60,468,691

* Total of 1016 (893 + (70% of 177)** KHMH Budget $7M. Bed occupancy 78.5% of 115 beds (90.3). Therefore ($7M/90.3)/365=$212.38

MINISTRY OF HEALTH INFLUENZA PANDEMICPREPAREDNESS PLAN

NOVEMBER 2005BELIZE

100 nm

Planning Process

1. National Committee established with technical sub-committees

2. 3 preparatory meetings organized3. Meeting with stakeholders4. Presentation to Cabinet and

approval5. Development of guidelines and

SOPs

Background Information

Belize is free of both LPIA and HPIA

Surveillance in both poultry and wild birds

Factors Considered in Developing the Plan

Large population of migratory birds: 28% of bird species are migratory (from North and South America)

Significantly large poultry industry 3% of national population from Asian descent –

who travel to and from affected areas Importation of supplies/equipment from Asian

countries

The longest distance migrant is the Arctic Terns. They migrate from the Arctic circle to Antarctica each

year – an annual distance of approximately 25,000 miles.

Purpose and Objectives of the Plan

Purpose: To protect the Belizean population from the predicted outbreak of the avian flu

General Objective: To reduce the risk and the impact of the avian flu on the country

Specific Objectives:

•Reduce opportunities for human infection•Minimize the economic impact on the

agricultural/poultry industry•Strengthen early warning systems•Control or delay spread at the source•Reduce morbidity and mortality, and social

disruption

Periods Phases Response Actions

Pre-pandemic I.Virus confirmed in humans outside of Belize (bird to human transmission) II.Virus confirmed in humans in Belize (bird to human transmission)

Pandemic I.Human to Human transmission outside of Belize II.Human to human transmission in Belize

Post Pandemic I – The first wave of human to human transmission in Belize is controlled

Response Periods and Phases

Budget Summary

Component Prepandemic Pandemic Total

I II I II

Planning & Coordination

13,000 3,000 -- 10,000 26,000

Situation Monitoring & Assessment

22,500 6,000 29,000 5,000 62,500

Prevention & Control

143,500 57,500 120,000 -- 321,000

Multisector Response 500 40,000 --- -- 40,500

Communication 34,000 20,000 15,000 -- 69,000

213,500 126,500 164,000 15,000

340,000 179,000 519,000

66% 34%

THANK YOU GRACIAS