the economy wide impact of pandemic influenza on the uk a computable general equilibrium CORD-Papers-2022-06-02 (Version 1)

Title: The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment
Abstract: Objectives To estimate the potential economic impact of pandemic influenza associated behavioural responses school closures and vaccination on the United Kingdom. Design A computable general equilibrium model of the UK economy was specified for various combinations of mortality and morbidity from pandemic influenza vaccine efficacy school closures and prophylactic absenteeism using published data. Setting The 2004 UK economy (the most up to date available with suitable economic data). Main outcome measures The economic impact of various scenarios with different pandemic severity vaccination school closure and prophylactic absenteeism specified in terms of gross domestic product output from different economic sectors and equivalent variation. Results The costs related to illness alone ranged between 0.5% and 1.0% of gross domestic product (8.4bn to 16.8bn) for low fatality scenarios 3.3% and 4.3% (55.5bn to 72.3bn) for high fatality scenarios and larger still for an extreme pandemic. School closure increases the economic impact particularly for mild pandemics. If widespread behavioural change takes place and there is large scale prophylactic absence from work the economic impact would be notably increased with few health benefits. Vaccination with a pre-pandemic vaccine could save 0.13% to 2.3% of gross domestic product (2.2bn to 38.6bn); a single dose of a matched vaccine could save 0.3% to 4.3% (5.0bn to 72.3bn); and two doses of a matched vaccine could limit the overall economic impact to about 1% of gross domestic product for all disease scenarios. Conclusion Balancing school closure against business as usual and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself. Prophylactic absence from work in response to fear of infection can add considerably to the economic impact.
Published: 2009-11-19
Journal: BMJ
DOI: 10.1136/bmj.b4571
DOI_URL: http://doi.org/10.1136/bmj.b4571
Author Name: Smith Richard D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/smith_richard_d
Author Name: Keogh Brown Marcus R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/keogh_brown_marcus_r
Author Name: Barnett Tony
Author link: https://covid19-data.nist.gov/pid/rest/local/author/barnett_tony
Author Name: Tait Joyce
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tait_joyce
sha: 61d619975b1d560811f05b5aad82fbeed380f2d8
license: cc-by-nc
license_url: https://creativecommons.org/licenses/by-nc/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 19926697
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/19926697
pmcid: PMC2779854
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779854
url: https://doi.org/10.1136/bmj.b4571 https://www.ncbi.nlm.nih.gov/pubmed/19926697/
has_full_text: TRUE
Keywords Extracted from Text Content: www.bloomberg.com/apps/ H5N1 £235bn individuals Vaccines friends acquaintances Competing Vaccine Facebook livestock £301.1bn 1968-9 people H1N1 flu economy-wide £6 matrix--A matrix GSK Ferguson's body women £85.8bn respondents £792m vaccine Fear × labour www.statistics.gov.uk/instantfi gures.asp Cauchemez men forestry UK 5 UK Labour Force Survey influenza A virus meat H1N1 influenza H1N1 leaves £ US swine children matrix Baxter £161.5bn small-up pandemic-specific vaccine appendix grandparents £2.2bn networks"-that UK
Extracted Text Content in Record: First 5000 Characters:In the past century there were three major influenza pandemics (1918, 1957, and 1968-9) . 1 This century has seen an outbreak of severe acute respiratory syndrome (2003) , H1N1 subtype of the influenza A virus (2009), and sporadic outbreaks of H5N1 influenza subtype. 2 In addition to the direct health impacts of a serious outbreak, we should be concerned about the economic impact; especially at a time of global recession. 3 Preparedness planning for a pandemic must therefore balance two key policy strands-maintaining "business as usual" to minimise the economic impact of a pandemic, and encouraging "social distancing" to minimise the health related impact of a pandemic 4 -as well as using resources such as antivirals and vaccinations. This paper considers the tension inherent in these two policy strands. It provides evidence of the economy-wide impact of each approach, as well as the impact that vaccine development may have in reconciling the two objectives of minimising both the health and economic effects of a pandemic. A key consideration in this analysis is the role of public perception and confidence, expressed by "prophylactic absenteeism," where healthy people avoid social contact, including going to work. This response is likely to emerge at higher case fatality rates and to be moderated by the availability of effective vaccines (the current strain of H1N1 influenza seems to be highly infectious but not very deadly, and this may explain its limited economic impact to date). The analysis is based on a computable general equilibrium model of the UK 5 over one year. The economy is specified in terms of several agents, including households, producers, and government, and based on data (in the form of a social accounting matrix, which represents income and expenditure in the economy by sector) for 2004 taken from the Global Trade Analysis Database 6 and national statistics. 7 8 Computable general equilibrium modelling is described in further detail by Dervis et al. 9 The economic impact of influenza in our model is assumed to occur through the labour supply, since illness and death cause both a reduction in the availability of labour and in its quality. Mitigation actions can also affect the labour supply by (a) reducing labour when people are kept away from the workplace to avoid infection or (b) by increasing labour supply compared with non-mitigated pandemic scenarios by reducing the number of infections and deaths 10 and reducing the extent to which people feel the need to engage in prophylactic absenteeism. Pandemic impact Pandemic planning documents 4 11 12 anticipate clinical attack rates between 25% and 35%, with a maximum of 50%. We therefore use these three values in our disease scenarios. Based on previous pandemics, predicted case fatality rates for the UK range from 0.2% to 2.5%, 4 12 13 and the summary estimate for European pandemic preparedness plans is 0.37%. 11 We used 0.4% as our base disease scenario and 2.5% for our severe scenario, with an extreme scenario of 10% based on severe acute respiratory syndrome (SARS). 13 14 We therefore have nine possible combinations of clinical attack rate and case fatality rate. While deaths permanently remove labour from the workforce, absenteeism represents temporary removal. Illness absence will result in subsequent immunity to the virus, whereas those undertaking prophylactic absenteeism will still be vulnerable to infection. The Commission of the European Communities suggests that the duration of pandemic influenza illness is five to eight working days, 11 and absence for seasonal flu is approximately five days. 15 We therefore assume five days of illness for our mild scenario, seven days for severe, and 22 days for the extreme scenario, which is based on hospitalisation rates for SARS. 16 17 All absences are estimated as a percentage of time lost from a working year of 220 days. Pandemic mitigation: vaccination Although the US recently announced that it expects to go from vaccine trial to mass vaccination within two months, 18 and the UK has signed agreements (with GSK and Baxter) to purchase 132 million doses of pandemic-specific vaccine, 19 specific vaccines are unlikely to be available for the first wave of infection. 20 During this stage, pre-pandemic vaccines, based on existing virus strains, will be the only option for protection, giving approximately 20% efficacy and, when combined with other clinical countermeasures, reducing the pandemic's impact to that of seasonal influenza. 21 Once matched vaccines become available they are likely to have 70-80% efficacy, probably requiring two doses at an interval of three weeks. Vaccine shelf life is currently about one year. 22 We assumed two vaccination strategies-a pre-pandemic vaccine with 20% efficacy and a matched vaccine with 40% efficacy (single dose) and 80% efficacy (double dose). 23 For all vaccines we assumed sufficient stocks for 60% coverage. Vaccination would have two potential impact
Keywords Extracted from PMC Text: year.22 friends men H5N1 influenza studies28 £85.8bn £ £301.1bn labour care32 " studies28 29 acquaintances weeks4 £235bn H1N1 influenza body Vaccine www.statistics.gov.uk/instantfigures.asp pandemic-specific vaccine,19 livestock colleagues.34 leaves grandparents UK Labour Force Survey appendix individuals women meat US influenza.21 3-4 forestry people GSK Cauchemez Baxter SARS.16 UK 's children influenza A virus high,4 swine Facebook H1N1 economy-wide outbreak31
Extracted PMC Text Content in Record: First 5000 Characters:In the past century there were three major influenza pandemics (1918, 1957, and 1968-9).1 This century has seen an outbreak of severe acute respiratory syndrome (2003), H1N1 subtype of the influenza A virus (2009), and sporadic outbreaks of H5N1 influenza subtype.2 In addition to the direct health impacts of a serious outbreak, we should be concerned about the economic impact; especially at a time of global recession.3 Preparedness planning for a pandemic must therefore balance two key policy strands—maintaining "business as usual" to minimise the economic impact of a pandemic, and encouraging "social distancing" to minimise the health related impact of a pandemic4—as well using resources such as antivirals and vaccinations. This paper considers the tension inherent in these two policy strands. It provides evidence of the economy-wide impact of each approach, as well as the impact that vaccine development may have in reconciling the two objectives of minimising both the health and economic effects of a pandemic. A key consideration in this analysis is the role of public perception and confidence, expressed by "prophylactic absenteeism," where healthy people avoid social contact, including going to work. This response is likely to emerge at higher case fatality rates and to be moderated by the availability of effective vaccines (the current strain of H1N1 influenza seems to be highly infectious but not very deadly, and this may explain its limited economic impact to date). Pandemic planning documents4 11 12 anticipate clinical attack rates between 25% and 35%, with a maximum of 50%. We therefore use these three values in our disease scenarios. Based on previous pandemics, predicted case fatality rates for the UK range from 0.2% to 2.5%,4 12 13 and the summary estimate for European pandemic preparedness plans is 0.37%.11 We used 0.4% as our base disease scenario and 2.5% for our severe scenario, with an extreme scenario of 10% based on severe acute respiratory syndrome (SARS).13 14 We therefore have nine possible combinations of clinical attack rate and case fatality rate. While deaths permanently remove labour from the workforce, absenteeism represents temporary removal. Illness absence will result in subsequent immunity to the virus, whereas those undertaking prophylactic absenteeism will still be vulnerable to infection. The Commission of the European Communities suggests that the duration of pandemic influenza illness is five to eight working days,11 and absence for seasonal flu is approximately five days.15 We therefore assume five days of illness for our mild scenario, seven days for severe, and 22 days for the extreme scenario, which is based on hospitalisation rates for SARS.16 17 All absences are estimated as a percentage of time lost from a working year of 220 days. Although the US recently announced that it expects to go from vaccine trial to mass vaccination within two months,18 and the UK has signed agreements (with GSK and Baxter) to purchase 132 million doses of pandemic-specific vaccine,19 specific vaccines are unlikely to be available for the first wave of infection.20 During this stage, pre-pandemic vaccines, based on existing virus strains, will be the only option for protection, giving approximately 20% efficacy and, when combined with other clinical countermeasures, reducing the pandemic's impact to that of seasonal influenza.21 Once matched vaccines become available they are likely to have 70-80% efficacy, probably requiring two doses at an interval of three weeks. Vaccine shelf life is currently about one year.22 We assumed two vaccination strategies—a pre-pandemic vaccine with 20% efficacy and a matched vaccine with 40% efficacy (single dose) and 80% efficacy (double dose).23 For all vaccines we assumed sufficient stocks for 60% coverage. Vaccination would have two potential impacts on a pandemic, reducing the number of infected individuals and moderating the extent of prophylactic absenteeism because people feel protected from infection. School closures are believed to reduce the impact of the pandemic, since infection rates among children are high,4 and this is mentioned in many pandemic planning documents.12 24 25 26 Although we witnessed closure at the early stages of the H1N1 influenza pandemic, it has been suggested that closure later, when the epidemic is better established, will be more effective in delaying spread, but also inevitable if large sectors of the population adopt prophylactic absenteeism in the face of increasing reports of deaths.27 It is therefore important to distinguish between school closure as a reactive policy to a pandemic and school closure associated with prophylactic absenteeism. Ferguson et al10 suggest that reactive school closure will result in closure for 95% of the 15 weeks of the pandemic, regardless of how often they reopen (duration of school closure associated with prophylactic absenteeism cannot, of course, be known). Previous studies28 29 have
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