Tag Archives: pandemic disease

A Coup Against Flu?

Recent articles from two separate research groups published in Science and Nature Medicine report major breakthroughs in flu vaccine research. The advances could ultimately lead to the holy grail of influenza prevention–a universal flu vaccine.

By conferring immunity against large numbers of flu strains, the new vaccines have the potential to reduce the severity of seasonal flu outbreaks and vastly reduce the risk of novel pandemics.  Using the RMS Infectious Disease Model, we calculated that if such vaccines were able to confer immunity to 50% of people globally, the risk of a novel flu pandemic outbreak could be reduced by as much as 75%.

This would be a huge success in reducing the risk of excess mortality events and improving global health. Though I should emphasise that while Edward Jenner invented the smallpox vaccine in 1796, it took until 1980 for smallpox to be eradicated from the wild. Beyond development of effective broad-spectrum vaccines, there is a lot of work to do to make the world safe from flu.

A high proportion of flu victims are the elderly. Significantly reducing deaths from flu would disproportionately reduce old-age mortality. This is particularly interesting; not only is it an important milestone in improving old-age public health, it is also relevant to old-age care and budgeting for retirement too.

Influenza Is The Most Likely Source of Future Pandemic Sickness and Mortality. 

In the U.S., in a single flu season, the average number of flu-related deaths is 30-40,000, peaking at 47,000 deaths in previous seasons. This does not take account of the viruses that can cause major pandemics: death tolls in the 1918 “Spanish Flu” event reached as high 50-100 million people worldwide. 

Widespread use of a universal vaccine conferring lifelong immunity could eliminate these deaths, making a meaningful contribution to reducing infectious disease mortality.

Structure of influenza, showing hemagglutinin as HA. Source

The marvel of the new vaccines under development is their potential to confer immunity against many strains, including ones that have not yet emerged. They work by using cutting-edge molecular machinery to target the stem of the haemagglutinin protein on the virus’ surface. The vaccines have only been tested on animal models and only on a small scale so far, but have worked well in reducing viral loads and mortality in these tests.

If this breakthrough translates into future vaccines that prove efficacious in clinical trials, these could become immensely powerful in combatting both seasonal flu cases and reducing the likelihood of new flu pandemics.

Today, beyond seasonal flu, there are no vaccines capable of preventing novel flu pandemics. However, the production pipeline for the current seasonal flu vaccine can be put to use in pandemics, with current capacity of pipelines estimated to produce decisive quantities of vaccine within three months of a pandemic outbreak.

As quantified in the RMS Infectious Disease Model, while this current technology has the potential to substantially reduce the total caseload of a pandemic, it is not a panacea. Three months is a relatively long time for highly transmissible viruses, so very large numbers of people could be infected in this interval. Even more infections would happen during the roll-out period before the vaccine has successfully been given to sufficient people to halt the spread. Furthermore, complications could emerge during the production that either mean it takes longer than three months, or that such a vaccine only confers partial immunity.

RMS created the world’s first probabilistic model of pandemic influenza and the first probabilistic model of vaccine development, delivery, and efficacy. The recent breakthroughs in flu vaccine research are welcome news and RMS scientists are closely monitoring the developments.

Fighting Emerging Pandemics With Catastrophe Bonds

By Dr. Gordon Woo, catastrophe risk expert

When a fire breaks out in a city, there needs to be a prompt firefighting response to contain the fire and prevent it from spreading. The outbreak of a major fire is the wrong time to hold discussions on the pay of firefighters, to raise money for the fire service, or to consider fire insurance. It is too late.

Like fire, infectious disease spreads at an exponential rate. On March 21, 2014, an outbreak of Ebola was confirmed in Guinea. In April, it would have cost a modest sum of $5 million to control the disease, according to the World Health Organization (WHO). In July, the cost of control had reached $100 million; by October, it had ballooned to $1 billion. Ebola acts both as a serial killer and loan shark. If money is not made available rapidly to deal with an outbreak, many more will suffer and die, and yet more money will be extorted from reluctant donors.

Photo credits: Flickr/©afreecom/Idrissa Soumaré

An Australian nurse, Brett Adamson, working for Médecins Sans Frontières (MSF), summed up the frustration of medical aid workers in West Africa, “Seeing the continued failure of the world to respond fast enough to the current situation I can only assume I will see worse. And this I truly dread”

One of the greatest financial investments that can be made is for the control of emerging pandemic disease. The return can be enormous: one dollar spent early can save twenty dollars or more later. Yet the Ebola crisis of 2014 was marked by unseemly haggling by governments over the failure of others to contribute their fair share to the Ebola effort. The World Bank has learned the crucial risk management lesson: finance needs to be put in place now for a future emerging pandemic.

At the World Economic Forum held in Davos between January 21-24, 2015, the World Bank president, Jim Yong Kim, himself a physician, outlined a plan to create a global fund that would issue bonds to finance important pandemic-fighting measures, such as training healthcare workers in advance. The involvement of the private sector is a key element in this strategy. Capital markets can force governments and NGOs to be more effective in pandemic preparedness. Already, RMS has had discussions with the START network of NGOs over the issuance of emerging pandemic bonds to fund preparedness. One of their brave volunteers, Pauline Cafferkey, has just recovered from contracting Ebola in Sierra Leone.

The market potential for pandemic bonds is considerable; there is a large volume of socially responsible capital to be invested in these bonds, as well as many companies wishing to hedge pandemic risks.

RMS has unique experience is this area. Our LifeRisks models are the only stochastic excess mortality models to have been used in a 144A transaction, and we have undertaken the risk analyses for all 144A excess mortality capital markets transactions issued since the 2009 (swine) flu pandemic.

Excess mortality (XSM) bonds modeled by RMS  
Vita Capital IV Ltd 2010
Kortis Capital Ltd 2010
Vita Capital IV Ltd. (Series V and VI) 2011
Vita Capital V 2012
Mythen Re Ltd. (Series 2012-2)XSM modeled by RMS 2012
Atlas IX Capital Limited (Series 2013-1) 2013

With this unique experience, RMS is best placed to undertake the risk analysis for this new developing market, which some insiders believe has the potential to grow bigger than the natural catastrophe bond market.