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Expand Your Knowledge–Top Papers on Avian Bird Flu
These materials were selected to help the actuary better understand Avian Influenza. An asterisk indicates that the paper is written by an actuary or appears in an actuarial publication.
Business/Enterprise Risk
This report by the American Academy of Actuaries' Catastrophe Management Work Group discusses how property and casualty insurers manage catastrophe risks (prepared in response to a request by the Coordinating with Federal Regulators Subgroup on Financial Issues of the NAIC). This monograph addresses property catastrophe exposures that broadly impact the insurance industry and discusses the definition of catastrophes, insurer capital considerations and managing catastrophe risk – the five steps used by insurers, reinsurance and risk transfer. It also addresses public policy implications. Several appendices have been included that expand on topics outlined in the monograph.
Although this is a paper on property catastrophe management practices, the concepts and discussions presented can provide a framework for thought by life insurers and reinsurers.
- By Fitch Ratings
In this special report for Europe and the United States, Fitch notes that the economic effect of a bird flu pandemic (if it materializes) would be significant with considerable impact on life insurers and their reinsurers. While recognizing the difficulty of predicting the effect of bird flu with any accuracy, the report suggests the impact on life as well as non–life insurance (health, business interruption coverage, travel insurance and agricultural business insurance) and business continuity. The potential for widespread rating downgrades to the life, non-life or reinsurance sector is also examined in this brief paper that will be of interest to anyone working in the insurance field.
This paper includes background information on 'bird flu' depicts the United States' current and long–term levels of preparedness for a possible avian influenza pandemic and roughly estimates the economic effects of the illness. As there is uncertainty surrounding the occurrence and outcomes of a pandemic, the paper presents two scenarios based on past pandemics–a severe pandemic with more than two million deaths and a mild pandemic with approximately 100,000 deaths. Findings are that there are few options if the H5N1 virus caused a pandemic in the near term. Available options range from attempts to control the spread of the virus to careful allotment of healthcare facilities, personnel and supplies.
The two–scenario modeling of influenza–related mortality is of particular interest to life and health actuaries. All readers, however, will benefit from the constructs and messages contained in this paper, which can be applied more broadly to other types of pandemics and catastrophes.
- By D.L. Wolak
- Risk Management Matters, December 2005, and Health Watch, January 2006
The article compares the potential impacts of a pandemic influenza on the health care industry to the impacts of other catastrophic events. It discusses responses and costs to date from Hurricane Katrina and likely costs if a nuclear 'dirty bomb' were detonated in a metropolitan area. As terrible as these events are to contemplate, a pandemic would have a greater impact to health care due to the following:
- Private health insurance would unlikely be supplemented by public plans.
- Most or all of the country would be impacted.
- As it is not a one–time, one–location, dramatic event, it is less likely government and humanitarian relief efforts will come into play.
- The virus would reduce the number of available health care workers.
The article recommends actuaries participate in assessing life and health insurance carrier risks and provide information for decision making relative to market share and concentration. It provides impact numbers based on two levels of modeled pandemics.
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Clincial
This article provides detailed descriptions of the agents responsible for the spread of the avian influenza virus, as well as information on various infection control methods, clinical and treatment considerations and data regarding the outbreak of the current strain (H5N1). The article also provides travel recommendations for those who are considering travel to various parts of the world and underscores that the strain is highly pathogenic for humans and that immunity in the human population is generally lacking. This piece may be viewed as a very useful tool to gain a greater understanding of the disease, a better insight into the huge implications the spread of the disease could have on all sectors of society and more awareness of the plight on the population that could result from a worldwide influenza outbreak.
This two–page article provides an overview of: a) confirmed instances of human infection of the avian influenza viruses since 1997; b) symptoms of the viruses in humans and c) antiviral drugs for treatment and prevention of influenza. This article is part of a larger section on the CDC Web site devoted to flu information (see also the CDC's "Key Factors") and appears to be updated on a regular basis.
This brief fact sheet, developed by the Centers for Disease Control, provides a broad overview about the origins of avian influenza and the H5N1 virus, as well as general information about:
- How the H5N1 virus compares to other types of avian influenza and human influenza viruses;
- How the avian influenza virus is spread from bird to bird, bird to human, and human to human;
- Where outbreaks of H5N1 have occurred;
- Who is at risk of contracting H5N1; and
- What treatments and vaccines are available to protect humans against the H5N1 virus.
This easy–to–read overview considers important questions that underlie the preparedness issue: "How can we prepare?" "What if the next pandemic were to start tonight?" "What if an H5N1 influenza pandemic began a year from now or in 10 years?"
The author suggests obstacles to the control and prevention of morbidity and mortality associated with pandemic influenza. He explains issues associated with pandemic control, such as the slow process associated with cell–culture–based production of influenza vaccine. The article presents an understanding of the "cytokine storm", i.e. uncontrolled immune response to the virus that leads to acute respiratory distress syndrome, thereby offering a context in which to understand pandemic-related morbidity and mortality.
Keywords: preparedness, cytokine storm, morbidity
The FDA's web site offers a document containing general information about the prevention and control of influenza. The written section on antiviral drugs provides information and links on trade names, package inserts, and other material related to the four antiviral drugs currently approved by FDA to treat acute, uncomplicated influenza. The document also offers a list of web sites with additional influenza information and a list of contacts for further inquiries.
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Epidemiological
This fact page explores the origin of avian flu, its effects on some animals, its capacity to mutate, its transmissibility to humans and the use of antiviral drugs. In addition, it covers the history of influenza pandemics and more specific, non-pandemic episodes of avian influenza around the world. The page lists countries where avian flu has been transmitted to humans through close contact with animals, lines of defense to contain the transmittal rate between farms and markets of live birds, destruction of live animals, and vaccination of workers and some of the population.
Keywords: avian flu, pandemic, control, virus, H5N1
Authored by the chief of the CDC's Influenza Branch, this authoritative overview discusses the epidemiological, ecological, virological and evolutionary aspects of influenza in general. Influenza–related mortality patterns change dramatically during a pandemic. In the 1968–69 pandemic, half of U.S. influenza–related mortality occurred in those under 65 years of age. Younger persons were at a 20–fold risk of influenza-related mortality during the prior three pandemics although the risk for those 65 years and older remains the same as in non–pandemic years. The paper briefly discusses the H5Ni bird flu virus and also notes that another avian virus, H9N2 infected humans in the late 1990s.
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Historical
Based on a presentation for the 2004 Enterprise Risk Management Symposium, Rudolph uses a case study of the 1918 influenza pandemic to talk about the dangers specifically posed by influenza as a pandemic source. Ninety percent of the article is on the particulars of an influenza epidemic, including how influenza is spread, why it's hard to treat/prevent, an analysis of conditions in 1918 that worked to exacerbate or quiet the spread, why influenza still poses a threat and what might differ today. Ten percent focuses on the actuarial implications, variability in mortality changes, how one might model mortality in a pandemic, and what strains might be put on the system (e.g. will reinsurers be able to satisfy their obligations?). Very interesting, big–picture overview of one pandemic that can stimulate thought about the unpredictability of the course of a pandemic and how that changes the risk.
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- By J. Luk, P. Gross and W.W. Thompson
- "Clinical Infectious Diseases" 2001; 33: 1375–1378
The article explains the unusual mortality rates observed among individuals aged 20 to 40 years during the 1918 Influenza Pandemic. An unusual W–shaped mortality curve was associated with those individuals in this age group, rather than the characteristic U–shaped, age–specific epidemic curve. While mortality rates were higher among those individuals aged 20 to 40 during the 1918 pandemic, these rates were not as high among elderly individuals. It was noted that the W–shaped curve became non–existent when total mortality was plotted against age. The decline in the peak of the excess rates suggested most of the susceptible young adults were infected in 1918 during the greater portion of the epidemic. One reason to explain the negative excess mortality among the elderly is that they had been previously exposed to an influenza strain similar to the 1918 strain, and thus became immune during the pandemic of 1918. The comparisons made by this article between two groups could serve those analyzing the implications pandemic influenza could have on today's population.
This article presents an exploration of the potential impact on the health and life insurance industry of an avian flu pandemic. Starting with a review of recent historical flu pandemics including the Spanish flu in 1918 and Hong Kong flu in 1968, the article delves into the expected cost drivers for the insurance industry. The article points out that a major problem for the North America could be inadequate capacity for manufacturing flu vaccine. Resulting delays in flu vaccine dissemination would be a factor in increasing costs to the insurance industry. The article also summarizes the limitations of pandemic cost models because of little historical experience and the medical complexities of an emerging outbreak. In conclusion, the article provides some broad cost estimates and examines the impact on morbidity, mortality and asset bases.
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Statistics and Modeling
Influenza pandemic planning is a complex, multifactorial process, which involves public health authorities, regulatory authorities, academia and industry. It is further complicated by the unpredictability of the time of emergence and severity of the next pandemic and the effectiveness of influenza epidemic interventions. The complexity and uncertainties surrounding pandemic preparedness have so far kept the various stakeholders from joining forces and tackling the problem from its roots. This mathematical model shows the tangible consequences of conceptual plans by linking possible pandemic scenarios to health economic outcomes of possible intervention strategies. This model helps to structure the discussion on pandemic preparedness and facilitates the translation of pandemic planning concepts to concrete plans. The case study for which the model has been used shows the July 2004 level of global pandemic preparedness in an assumed pandemic scenario, the health economic implications of enhanced pandemic vaccine supply and the importance of cell culture-based influenza vaccine manufacturing technologies as a tool for pandemic control.
The purpose of this paper is to forecast the financial impacts of the occurrence of a pandemic on the American population. The paper analyzes the consequences of different scenarios of a pandemic on the death rate, the hospitalization rate, the outpatient rate and the use of drugs. The study analyzes the financial impacts of each category of outcomes, both directly and indirectly, to society.
The financial analysis is well detailed; different sources of financial information are presented, which can be relevant to actuaries. Also, the study analyzes the hedging strategy of vaccinating some groups in the population and its net effect for each of the previously mentioned outcomes. In addition, different scenarios are also discussed. The study also analyzes the costs to society to prepare on an annual basis for a pandemic, which is labeled as the equivalent of an insurance premium.
Finally, although the study was done from the perspective of analyzing the costs and benefits of different vaccination strategies for the public and didn't include the scenario of avian flu, it still provides a valuable actuarial approach to modeling the financial consequences of a pandemic, including many references to relevant data.
Using information from a quantitative assessment of human traveling statistics, based on bank note circulation, the authors of this paper provide a unique way to think about and model the spread of human infectious disease. A two–parameter, continuous–time, random walk model indicates that human traveling behavior can be described mathematically with surprising accuracy. Actuaries may find the results of this work useful as a starting point when modeling to the spread of infectious disease pandemics.
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