Second meeting of the ICSU Urban Health and Wellbeing Planning Group

An ICSU Workshop in collaboration with the International Institute for Applied Systems Analysis (IIASA) with additional support from the US National Science Foundation

17-19 June, 2008

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A Systems Analysis Approach to Health and Wellbeing in the Urban Environment

An ICSU Workshop in collaboration with the International Institute for Applied Systems Analysis (IIASA) with additional support from the US National Science Foundation

24-25 January, 2008

Workshop Summary

Agenda

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Pandemic influenza in China: challenges, responses, needs Round table workshop

22 October, 2007

The joint IIASA - Peking University Institute for Population Research roundtable "Pandemic Influenza in China -- Challenges, Responses, Needs" was held at Peking University on 22 October, 2007. In attendance were approximately 15 experts on human and animal health from IIASA, Peking University, the Chinese Centre for Disease Control, the Agriculture Academy, the Ministry of Agriculture, Chinese Centre for Animal Disease Control, and the Natural Science Foundation of China.

In her presentation on the infectious disease situation in China, Institute for Population Research director Prof. Xiao-ying Zheng pointed out that, despite declines in infectious disease incidence, case-fatality ratios remain high. This indicates that, while there have been successes in reducing the spread of infectious diseases, medical care for those who become sick has not significantly improved. Government should not be satisfied with the apparently optimistic trend of incidence statistics.

IIASA Health and Global Change Project leader Landis MacKellar's presentation on pandemic influenza largely summarized his recent review on the subject published in Population and Development Review. He reviewed the main sources of uncertainty but stressed that the issue of the next pandemic is "when" not "if." The most important unknowns are the virus's pathogenicity and age-attack profile. Citing policy fatigue and the danger of "boom-bust" policy cycles, he expressed his preference for general health sector strengthening as opposed to vertical pandemic preparedness planning.

Dr. Wu of the Institute for Population Research presented the results of his work on spatial analysis of the SARS epidemic in China. Using spatial statistical methods and geographic information systems, it was possible to identify hot spots within the city.

The Chinese animal health experts in attendance gave three presentations. In the first, Dr. Wen-jun Long identified the main animal diseases in circulation and outlined the policy responses, their strengths, and weaknesses. The Government of China is stressing voluntary animal health insurance, but the large number of scattered small farmers means that costs are high from the standpoint of insurance companies. Moreover, insurance premiums are expensive from farmers' points of view. Dr. Hua Pu from the Agriculture Academy reported the results of a cost-benefit analysis of various approaches to avian influenza control in two model districts, one characterized by a preponderance of small farms and a second characterized by a preponderance of medium-and large-scale farms. Vaccination of birds, he found, was the policy of choice in settings characterized by a preponderance of small farms. Whatever cost-disadvantages arose from the many small flocks to be vaccinated were more than compensated for by even greater cost disadvantages in alternative approaches such as improving animal transport. Prof. Ji-min Wang and Jia-jun Wu summarized initiatives being taken by the Ministry of Agriculture and the Chinese Centre for Animal Disease Control, respectively, in the area of animal health.

The human side of infectious disease policy in China was present by Professor Guang Zeng, head of the Field Epidemiology Training Program at the Chinese Centre for Disease Control. Drawing on his experience as the chief government adviser during the SARS epidemic, he stressed that once the attention of policy makers is secured, the Government of China is capable of impressive focused response. He expressed confidence that, in the event of an influenza pandemic, an emergency vaccination program would be effective in choking off the epidemic once a vaccine was available. However, he drew attention to the lack of hospital beds that would be required even in the event of a relatively mild pandemic.

Three IIASA researchers presented papers. Dr. Steven Ney of IIASA and Singapore Management University described pandemic preparedness planning from a political science point of view, focusing on experiences in Singapore, Malaysia, Thailand, and the Philippines. He raised the paradox that health systems which are most efficient in their day-to-day operation, such as Singapore's, may find themselves lacking spare capacity in the event of a pandemic, and end up performing less well than systems with greater slack resources. He drew attention to the qualitatively different approaches to planning being taken, with some plans focusing on process and others on precise interventions. Dr. Andrew Noymer of IIASA and the University of California at Irvine presented his work on selective mortality of the 1918 pandemic, in which it is demonstrated that the epidemic was particularly deadly for those suffering from tuberculosis. When a pandemic hits, he argued, it does not hit equally; its effects are mediated through a pre-existing epidemiological context. Dr. Gui Ying Cao of IIASA presented work done by the Land Use Program of IIASA on the basis of detailed China population projections produced by the IIASA Forestry Program using approaches developed in the Population Program. The Land Use Program has developed sophisticated projections of hot spots characterized by a high density of livestock production, and human population, with consequent implications for emergent zoonoses.

Dr Larry Willmore of IIASA and Dr Cheng-li Huang of the Institute for Population Research, serving as rapporteurs, summarized the main points raised. With their interventions as a foundation, the round table closed with a spirited hour-long discussion of optimal responses to the threat of pandemic influenza in China. The main subject of debate was the combination of animal and human health interventions. While no answers were forthcoming, there was consensus that the mechanisms for coordination between the human and animal sides are present but need to be better utilized.

Agenda

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On 4-5 August, 2006, a scoping workshop was held at IIASA on Policy and Social Science Aspects of Pandemic Influenza.

The workshop was attended by a diverse group of epidemiologists, economists, demographers, political scientists, and computer scientists from the U.S., U.K., Sweden, Norway, Finland, and Japan.

For further information please follow the links below:

Agenda
Participants List
Overview Presentation

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Last updated: 06 Aug 2008