CONTINGENCY PLANNING

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CONTINGENCY PLANNING

• AVIAN FLU PANDEMIC
• SIZING THE RISKS AND PLACING THEM IN PERSPECTIVE
• Note Information Sources and attributions
  for this presentation are listed at the
  end of this document.

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INFLUENZA (FLU)

• PATHOGEN AN ORGANISM THAT CAUSES DISEASE IN
  ANOTHER ORGANISM
• TYPES OF PATHOGENS
• VIRUS (A CAUSE OF INFLUENZA OR FLU)
• MATERIAL ENCLOSED IN A SINGLE PROTEIN CELL.
  PREVENTED BY VACCINE AND TREATED WITH ANTIVIRALS
  (E.G. TAMIFLU)
• BACTERIA (e.g. E-COLI)
• REPRESENTS THE NEXT LEVEL OF COMPLEXITY
  CONSISTING OF MANY CELLS. TRANSMISSION PREVENTED
  BY USE OF ANTI-BACTERIAL AGENTS (E.G. CHLORINE
  BLEACH). TREATED WITH ANTI-BIOTICS (PENICILLIN,
  ARITHROMICIN, AMOXICILLIN).

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HISTORICAL PERSPECTIVE

• 1918-19 FLU PANDEMIC RESULTED IN 40-100 MIL.
  FATALITIES WORLD-WIDE WITH UP TO 20 OF WORLD
  POP. INFECTED.
• 500,000 US FATALITIES (US LIFE SPAN DEPRESSED 10
  YRS.)
• FATALITY RATE 2.5 TO 5 (BUT MUCH HIGHER AMONG
  SOME POPULATIONS.)

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HISTORICAL PERSPECTIVE

• 1918-19 PANDEMIC BEGAN WITH MILD OUTBREAKS IN
  1918 WITH THE MOST LETHAL WAVE SPREADING THE
  GLOBE IN 1919.
• BY DEC. 1919 INFLUENZA HAD VIRTUALLY
  DISAPPEARED.
• THE FIRST WAVE IN THE U.S. CAME WITH RETURNING
  WW1 TROOPS IN BOSTON AND PHILADELPHIA AND RAPIDLY
  SPREAD TO ARMY POSTS AND GENERAL POPULATION.

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HISTORICAL PERSPECTIVE

• THE EFFECT AND RESPONSE IN THE U.S. TO THE
  1918-1919 PANDEMIC (VARIED CONSIDERABLY BY CITY
  AND STATE)
• RESTRICTIONS ON PUBLIC GATHERINGS (churches,
  theaters, stadiums, expositions, conventions,
  etc. were closed)
• REGIONAL QUARANTINES ON TRAVEL AND INFECTED
  HOUSEHOLDS.

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HISTORICAL PERSPECTIVE

• RETAIL ESTABLISHMENTS COULD NOT ADMIT PATRONS
  CUSTOMERS HAD TO PLACE THEIR ORDERS FROM THE
  FRONT DOOR.
• 2-5 IMPACT ON US GDP (ESTIMATED)
• (CONTEXT 9/11 TERROR ATTACKS COST U.S. BUSINESS
• 3-400 B. AND SHORT TERM EFFECT ON GPD OF
  lt0.5.)

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ANATOMY OF INFLUENZA

• 1918 STRAIN H1N1 (IDENTIFIED IN 1998 FROM TISSUE
  SAMPLES OF 1918 VICTIMS)
• CURRENT STRAIN CAUSING CONCERN H5N1.
• NEARLY IDENTICAL TO H1N1.
• VIRUS STRAINS RAPIDLY MUTATE DURING REPLICATION
  REQUIRING A NEW VACCINE EVERY YEAR.

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ANATOMY OF INFLUENZA

• H5N1 IS PRESENT IN MIGRATORY BIRD POPULATIONS
  WHICH CONTAMINATE DOMESTIC BIRDS / SWINE.
• IN SOME CULTURES PEOPLE COHABIT SPACE WITH
  DOMESTICATED BIRDS VIRUS JUMPS SPECIES TO
  INFECT HUMANS.
• NO STRONG EVIDENCE YET OF HUMAN TO HUMAN
  TRANSMISSION BUT IS LIKELY AT SOME POINT.

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ANATOMY OF INFLUENZA

• AS OF 1-1-06, 142 CONFIRMED HUMAN CASES WITH 74
  DEATHS. (MORTALITY RATE OF 52)
• WILD BIRD MIGRATION SEASONS COMPLETED THIS IS
  THE HIGHEST RISK PERIOD.
• CHANCE OF FURTHER SPREAD IN IMMEDIATE TIME-FRAME
  (6-9 MONTHS) IS NOW DIMINISHED.

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ANATOMY OF INFLUENZA

• NORTH AMERICA IS AT LEAST RISK DUE TO
• N. S. AMERICAN BIRD MIGRATION PATTERNS HAVE
  MINIMAL INTER-MINGLING WITH INFECTED BIRD
  POPULATIONS FROM OTHER PARTS OF THE WORLD.
• DOMESTIC FLOCKS OF FARM BIRDS ARE PRIMARILY
  RAISED IN BIO-SECURE COMPLEXES MINIMIZING
  RISK OF CONTACT WITH WILD-INFECTED BIRDS.
• REASONABLY INTENSE SURVEILLANCE OF WILD MIGRATORY
  BIRD POPULATIONS.

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U.S. GOVERNMENT
PREPAREDNESS

• HHS FUNDING FOR FLU PREVENTION
• 2001 39.3M
• 2002 47M
• 2003 101M
• 2004 215M
• 2005 283M
• INFERENCE THIS REFLECTS A GROWING CONCERN
  IN GOVERNMENT SECTOR

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U.S. GOVERNMENT
PREPAREDNESS

• ON 9/15/2005 HHS AWARDED 100M TO SANOFI
  PASTEUR TO MANUFACTURE VACCINE. (SUFFICIENT TO
  INNOCULATE 20M AMERICANS)
• US POPULATION IS 295M. SUFFICIENT VACCINE FOR
  JUST 7 OF POPULATION.
• CONTEXT US IS SPENDING 5B / MONTH IN IRAQ
  AND 60 MIL. A MONTH IN AFGANISTAN ON THE WAR ON
  TERROR.

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U.S. GOVERNMENT
PREPAREDNESS

• HHS HAS ORDERED 20 MIL. DOSES OF TAMIFLU. U.S.
  CURRENTLY HAS 2.8 MIL. DOSES STOCKPILED.
• PANDEMIC RESPONSE PLAN AT FEDERAL LEVEL IS IN
  EMBRIONIC STAGES AND IS EXPECTED TO ESCALATE IN
  2006.

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ISSUES / CONCERNS

• US HAS ONLY 1 VACCINE MAKER (SANOFI PASTEUR A
  FRENCH OWNED ENTITY)
• VACCINE PRODUCTION REPRESENTS lt 3 OF
  PHARMACEUTICAL OUTPUT WORLD-WIDE.
• NO INCENTIVE FOR PHARM. MFGRS. TO PRODUCE
  VACCINES DUE TO CYCLICAL NATURE OF PRODUCT DEMAND
  AND LOW PROFIT MARGINS.

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ISSUES / CONCERNS

• LIABILITY ISSUES ASSOCIATED WITH VACCINES IS A
  MAJOR CONCERN FOR PHARM. MANUFACTURERS THEREBY
  KEEPING THEM OUT OF THE MARKET.
• STATUATORY RELIEF IS REQUIRED TO RELEASE
  MANUFACTURERS FROM PRODUCT LIABILITY TO INCENT
  THEM TO PRODUCE VACCINES.
• IN A FREE MARKET SYSTEM, INCENTIVES / SUBSIDIES
  MUST BE PROVIDED TO PHARMECUTICAL MANUFACTURERS
  BEFORE THEY WILL PRODUCE VACCINES.

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ISSUES / CONCERNS

• REALITY ANY VACCINE WILL TAKE 6 MONTHS TO
  PRODUCE.
• HOARDING OF TAMIFLU BY DEEP POCKETED ENTITIES
  (E.G. VIRGIN ATLANTIC, G.E. ) - ETHICAL ISSUES.
• COUNTERFEIT TAMIFLU HAS ALREADY BEEN INTERCEPTED
  MORE EXPECTED.

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RISKS

• EPIDEMEOLOGISTS A PANDEMIC IS PROBABLE DUE TO
  THE MOBILITY MIGRATORY BIRDS AND THE INABILITY TO
  CONTROL THE MIGRATION IF HUMAN TO HUMAN
  TRANSMISSION TAKES PLACE.
• LACK OF SURVEILLANCE CAPABILITIES AND PUBLIC
  HEALTH INFRASTRUCTURE IN SOME VENUES WHERE SPREAD
  OF VIRUS IS LIKELY.
• COUNTRIES MINIMIZING SCOPE OF EPIDEMICS AND
  HIDING INFORMATION.
• THE VASTLY INCREASED MOBILITY OF THE HUMAN
  POPULATION SINCE 1918.

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RISKS

• W.H.O. WORST CASE SCENARIO
• A 10 CHANCE OF 150M DEATHS WORLD-
• WIDE FROM A PANDEMIC.
• W.H.O. BEST CASE SCENARIO
• 2 - 7.4 MILLION FATALITIES WORLD-WIDE FROM A
  PANDEMIC.

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INFORMED PROJECTIONS /
ECONOMIC IMPACT (U.S)

• CONTEXT
• THE CDC HAS PREPARED DETAILED ECONOMIC
  IMPACT STATEMENTS AS A RESULT OF A PANDEMIC TO
  JUSTIFY GOVERNMENT INVESTMENTS IN PREVENTIVE
  MEASURES
• SUMMARY
• 89,000-207,000 U.S. DEATHS WILL RESULT FROM A
  PANDEMIC (.001 OF U.S. POPULATION) (context
  annual
• US deaths from auto accidents in 2005 was
  42,000)
• 314,000-734,000 HOSPITALIZATIONS WILL OCCUR IN
  THE U.S. (.002 OF U.S. POPULATION). (context
  84,000 hospitalizations
• typically take place annually in the USA as
  a result of Flu)

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INFORMED PROJECTIONS /
ECONOMIC IMPACT (U.S)

• 18-42 MILLION MEDICAL OUT- PATIENT VISITS WILL
  OCCUR IN THE U.S. (14 OF U.S. POPULATION)
• FINANCIAL IMPACT TO U.S. GOVERNAMENT (LOST
  TAX REVENUE, ETC. WILL BE 71-166B.)
• NOTE THIS DOES NOT TAKE INTO ACCOUNT THE
  LOSS OF DOMESTIC ECONOMIC ACTIVITY / INTANGIBLE
  ECONOMIC IMPACTS.

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INFORMED PROJECTIONS /
ECONOMIC IMPACT (U.S)

• VAST IMPROVEMENTS IN INFORMATION SHARING AND
  MEDICAL CARE HAVE OCCURRED SINCE 1918.
• IMMUNIZING THE ENTIRE U.S. POPULATION IS
  UNNECESSARY (ONLY HIGH RISK POPULATION SHOULD BE
  TARGETED)
• IF SURVEILLANCE MECHANISMS ARE ADEQUATELY
  DEPLOYED, AND IF CONTINGENCY PLANS ARE
  IMPLEMENTED DURING A MAJOR OUTBREAK, THE RISK TO
  THE HEALTHY U.S. POPULATION MAY BE MINIMIZED.

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ANECDOTALLY

• THE MOST EXPOSED POPULATIONS
• 2ND AND 3RD WORLD COUNTRIES WITH INADEQUATE
  PUBLIC HEALTH MECHANISMS.
• VENUES WHERE MIGRATING BIRD POPULATION IS NOT
  CLOSELY MONITORED FOR PRESENCE OF VIRUS.
• VENUES THAT ARE NOW EXPERIENCING INITIAL SIGNS OF
  TRANSMISSION OF H5N1 IN DOMESTIC BIRD POPULATIONS
  AND HUMANS.

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VENUES OF CONCERN

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LIKELY U.S. GOVERNMENT
RESPONSE IN A PANDEMIC

• RAPID DEPLOYMENT OF VACCINE PROGRAM TARGETED TO
  HIGH RISK POPULATION.
• INFECTED PERSONS TREATED WITH ANTI-VIRALS.
• SELECTED QUARANTINES OF PERSONS EXPOSED -
  SANCTIONS FOR QUARANTINE VIOLATIONS.
• SELECTED QUARANTINES OF VENUES WITH HIGH
  INFECTION RATES.
• RESTRICTIONS ON ENTRY OF PERSONS FROM NON-US
  VENUES WITH HIGH INFECTION RATES.

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LIKELY U.S. GOVERNMENT
RESPONSE IN A PANDEMIC

• TIGHTER BORDER CONTROLS HEALTH SURVEILLANCE OF
  ENTERING PERSONS.
• ESTABLISHMENT OF INTERIM QUARANTINE SITES FOR
  INFECTED PERSONS IN VENUES FOR HIGH INFECTION
  RATES.
• REGULATORY CANCELLATION OF PUBLIC EVENTS
• IN VENUES WITH HIGH INFECTION RATES.
• PROMULGATION OF EMERGENCY GUIDELINES FOR STATES /
  CITIES TO FOLLOW TO CONTAIN INFECTION RATES.

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EXPECTED EMOTIONAL
RESPONSE TO PANDEMIC

• MEDIA WILL HYPE ANY OUTBREAK IN NON-U.S. VENUES
  AND CAUSE SOME LEVELS OF PANIC / OVER-REACTION
  DOMESTICALLY.
• DOMESTICALLY - GOVERNMENT AGENCIES WILL BE
  CHALLENGED TO MANAGE THE FEAR.
• HIGH LEVELS OF ABSENTEEISM MIGHT OCCUR IN SCHOOLS
  / COLLEGES AND WORK-PLACES IN THE INITIAL PERIOD
  OF DISCLOSURE OF THE OUTBREAK.
• SLIGHT RISK OF SOCIAL DISORDER IN VENUES WITH
  HIGH INFECTION RATES.
• TRAVEL (BUSINESS AND LEISURE) MAY BE
  SIGNIFICANTLY CURTAILED.

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POSSIBLE DOMESTIC IMPACTS AS A RESULT OF A
PANDEMIC

• MAJOR CONCERNS / RISKS TO CONSIDER IN
  PLANNING INITIATIVES
• GLOBAL TRAVEL RESTRICTIONS. (MOST DOMESTIC
  AIRLINES ARE ALREADY ON THE FINANCIAL BRINK)
• IMPACT OF DOMESTIC TRAVEL RESTRICTIONS (Air, Rail
  and ground).
• INDUSTRIES LIKELY IMPACTED IN A SEVERE OUTBREAK
• HOSPITALITY, LEISURE, TOURISM, RESTAURANTS,
  SPORTING EVENTS, CONVENTION CENTER VENUES,
  TRANSPORTATION, ANCILLARY SERVICES SUPPORTING THE
  INDUSTRIES AND THE HEALTH CARE INDUSTRY.

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CONTINGENCY PLANNING
SCENARIOS

• IMPAIRMENT ON THE MOVEMENT OF VITAL COMMODITIES
  (JUST IN TIME STRATEGY FOR RETAILERS AND
  MANUFACTURERS COULD BE IN JEOPARDY)
• POSSIBLE IMPAIRMENT OF DELIVERY OF VITAL
  GOVERNMENT SERVICES IN VENUES WITH HIGH INFECTION
  RATES.
• STOCK AND BOND MARKETS ARE EMOTIONALLY DRIVEN -
  DOWNTURN IS LIKELY IF THE EVENT IS SEVERE AND
  RESPONSE IS NOT EFFECTIVE.

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PLANNING APPROACHES
CONSIDERATIONS

• TOP-DOWN SUPPORT RESOURCES FOR ANY PLANNING
  EFFORT IS REQUIRED UP FRONT.
• PLANS MUST BE COMMUNALY DEVELOPED WITH
  STAKEHOLDERS FROM VARIED GROUPS IN THE
  ORGANIZATION.
• ASSUMPTION THE ENTERPRISES MOST CRITICAL
  FUNCTIONS / PROCESSESS HAVE ALREADY BEEN
  IDENTIFIED THROUGH A CREDIBLE PROCESS.

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PLANNING APPROACHES
CONSIDERATIONS

• FOCUS ON HOW TO CONTINUE TO OPERATE CRITICAL
  FUNCTIONS WITH A HIGH RATE OF ABSENTEEISM.
• DEVISE ALTERNATIVE WORK STRATEGIES.
• ANTICIPATING VARIOUS SCENARIOS, INTERNAL
  COMMUNICATIONS TO EMPLOYEES AND CONTRACTORS
  SHOULD BE PRE-SCRIPTED.

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PLANNING APPROACHES
CONSIDERATIONS

• PLANS SHOULD TAKE INTO ACCOUNT VARIED KINDS AND
  LEVELS OF IMPAIRMENT AS A CONSEQUENCE OF A
  MAJOR FLU OUTBREAK
• FOR EXAMPLE
• LEVEL 1 10 OF EMPLOYEES / CONTRACTORS ARE
  ABSENT AND LIKELY TO BE ABSENT FOR gt1 WEEK
• LEVEL 2 20 OF EMPLOYEES ARE ABSENT
• LEVEL 3 30 OF EMPLOYEES ARE ABSENT

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PLANNING APPROACHES
CONSIDERATIONS

• VARIED LEVELS OF IMPAIRMENT (CONTINUED)
• SUPPLY CHAIN WILL BE DISRUPTED FOR 1 WEEK, 2
  WEEKS, 3 WEEKS, ETC.
• TRAVEL WILL BE CURTAILED FOR 2 WEEKS, 3 WEEKS,
  ETC.
• DIMINISHED CAPACITY TO DELIVER SERVICES / GOODS
  FOR 2 WEEKS, 3 WEEKS, ETC.

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PLANNING BY FUNCTION

• HUMAN RESOURCES
• PLAN FOR DEALING WITH EXCESSIVE AND PROLONGED
  ABSENTEEISM.
• PLAN FOR DEALING WITH HIGH LEVEL OF DISABILITY
  BENEFIT CLAIMS.
• INTERNAL PLAN TO DEAL WITH INCREASED VOLUME OF
  HEALTH BENEFIT ISSUES WITH FEWER PEOPLE.
• PAYROLL
• PLAN FOR CONTINUING PAYROLL OPERATIONS WHEN
  PERSONNEL ARE ON BENEFITS.
• INTERNAL PLAN FOR CONTINUED OPERATIONS WITH FEWER
  STAFF TO PERFORM NECESSARY WORK.

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PLANNING BY FUNCTION

• FACILITIES OPERATIONS
• PLAN FOR CONTINUED OPERATIONS OF HVAC AND
  REQUIRED MAINTENANCE OF CRITICAL EQUIPMENT WITH
  DIMINISHED STAFF.
• PLAN FOR OPERATING WITHOUT NORMAL LEVEL OF
  SUPPORT FROM CRITICAL CONTRACTORS.
• DEVISE MODIFIED / SPECIALIZED CLEANING OPERATIONS
  TO SUPPORT INFECTION CONTROLS.
• SECURITY
• PLAN FOR CONTINUED RESPONSE TO ON-SITE
  EMERGENCIES WITH FEWER STAFF.
• PLAN FOR MONITORING ACCESS WITH LESS STAFF.

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PLANNING BY FUNCTION

• MANUFACTURING
• PLAN FOR PRODUCING AND TESTING PRODUCTS WITH
  FEWER STAFF.
• PLAN IN THE EVENT RAW MATERIALS / COMPONENT
  DELIVERY IS STALLED.
• PLAN FOR IMPAIRED ABILITY TO SHIP PRODUCT TO
  CUSTOMERS IN ACCORDANCE WITH CONTRACTURAL
  AGREEMENTS.
• SUPPLIERS IN AFFECTED VENUES WILL LIKELY MISS
  COMMITMENTS IDENTIFY ALTERNATIVES IN THE PLAN.
• SERVICE INDUSTRY
• PLAN TO FOCUS ON DELIVERY OF PERSONNEL / SERVICES
  TO MOST CRITICAL / VALUED CUSTOMERS WHEN STAFFING
  IS IMPAIRED.

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PLANNING BY FUNCTION

• SUPPLY CHAIN / PROCUREMENT
• ALTERNATE SUPPLIERS HAVE BEEN IDENTIFIED AND
  QUALIFIED.
• PLAN TO SPEED ACQUISITION PROCESS DUE TO SPECIAL
  CIRCUMSTANCES.
• EMPLOYEE COMMUNICATIONS
• PRE-SCRIPED MESSAGES TO COMMUNICATE ALTERED WORK
  PROCESSES AND CONDITIONS DURING AN EMERGENCY.
• IT/CIO
• CAPACITY TO HANDLE INCREASED DEMAND FOR
  TELECOMMUTING FOR CRITICAL FUNCTIONS / PERSONNEL.
• CAPACITY TO HANDLE INCREASED DEMAND FOR
  TELECONFERENCE SERVICES AND INCREASED REMOTE
  ACCESS CAPACITY WHEN TRAVEL / MEETINGS ARE
  CANCELLED.

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ERIC LEITZ PRINCIPAL Targeted Risk Control
LLC 610 861 7349 CELL 610 216 8749 EMAIL
leitz_at_rcn.com

Information Sources for this presentation
Books Americas Forgotten Pandemic,
author Alfred Crosby Threat of Pandemic
Influenza, author Stacey Knobler
Internet and Media Sources US Dep. Of Health and
Human Services bulletins US Department of HHS
Economic impact study US Center for Disease
Control Stanford University Medical History
Library Harvard University Gazette US Department
of Commerce World Health Organization
Bulletins Journal of Emerging Infectious
Diseases White House news releases CNN ABC
News NY Times Wall Street Journal