Economics of a Flu Pandemic: Part II

Republication of this article from 2010

I just finished reading the Nesbitt Burns Investors Guide to Avian Flu. It’s a good report, but the advice to investors is limited (basically, expect a flight to safety such as gold and US treasuries and keep money on the side to buy up distressed properties after the pandemic.) They do a very good job of detailing the history of flu pandemics, the current state of preparedness and the likely consequences. (They’re essentially the same as the ones I discuss in my essay in the FluWiki, but Sherry Cooper and Donald Coxe run through them in much more detail and style.)

The more I look into this the more pathetic it all seems. Our society, as a whole, has no surge protection – no ability to take shocks. We have no excess beds, no excess equipment, no excess ability to produce vaccines or medicines, nothing. Everybody has worshiped at the altar of efficiency for so long that they don’t understand that if you don’t have extra capacity you have no ability to deal with unexpected events. And now some people are suing the Ontario government for their SARS handling, which I fear will perversely make the government less willing to do what needs to be done when a crisis hits.

Public healthcare in a pandemic or epidemic is a triage operation. You isolate people and you shut things down deliberately, and people are going to die because of the decisions you make. If nurses and doctors decide that their own lives are more important than those of the sick, or if ordinary citizens decide to break quarantine or travel restrictions, then there could be complete disaster. The moment of the SARS outbreak that caused me the most fear was when there were reports of people fleeing Beijing. In a real pandemic situation, all that would do is spread the disease further and kill even more people.

In a pandemic, no one should be out and doing things who doesn’t need to be. Take food – it should be delivered to each person’s door and left there, once the delivery person leaves, the occupant comes out to get the food. No interpersonal contact other than that which is unnecessary.

When I was approached to write about the economics of a pandemic, my first thought was: “Find out what happened during the Spanish Flu pandemic.” Apparently, Coxe thought the same thing and his conclusion is that because our society and economy is so much more integrated and so much more connected (for example the flu had to spread by ship back then), and so much more “just in time” that it isn’t really a model you can use. We’ll likely get hit harder, faster, and because many locations have such limited inventories, relying on getting it as they need it, the supply disruptions are likely to be much worse. I can’t find any flaw with his argument.

The lack of urgency on the part of governments is rather distressing:

It is hoped the Canadian studies will begin late next summer. February’s federal budget set aside $34 million for production of trial batches of an H5N1 vaccine. But Canada’s flu vaccine manufacturer, ID Biomedical, still has not been given the go-ahead to do the work.”We’re close to entering into a contract. Hopefully it will be done shortly,” Health Minister Ujjal Dosanjh said Monday. The company has said it would take 12 months from contract signing to vaccine delivery, because it must build and license a special high-biosecurity facility within its existing vaccine plant.

Now, I don’t know the details of what is required to set up such facilities, but I’m not getting a huge sense of urgency from the government here. The contract should be signed now and whatever is necessary to build extra facilities should be done, as well as whatever is necessary to get them up and operating faster. I do understand that biosafety is an absolute necessity, but getting these facilities up too late is as good as “never.” Let’s be frank, 34 million is peanuts. How much money did they lose trying to create the gun registry (a database no larger than many commercial databases successfully brought in for much less)?

I would suggest to politicians that if an influenza pandemic does occur, and people decide you didn’t do everything you could have to prepare for it, that, at the very least, you will no longer have a political career. At the worst, well, you won’t be alive to worry about it.

There aren’t enough respirators, there aren’t enough hospital beds, there isn’t enough vaccine production capacity or antiviral production capacity. There is so little being done to deal with those deficiencies that there might as well be nothing being done. Doubling production isn’t what is necessary, production needs to be ramped up by orders of magnitude. If it’s never used, oh well, it’s better than building a bridge to nowhere in Alaska which even Alaskans don’t want.

I don’t know when there will be an influenza pandemic. No one does. It’s an odds game. But right now, the odds aren’t so good. It’s time to spend some money and buy some insurance against the possibility. Put the facility in your riding and tell your constituents how you just got them some jobs.

But do it.

(This is a reprint, at a reader’s request. You can find part one of Economics of a Flu Pandemic here.)

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