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Health and Climate Change in Developing Countries. Case Study: Cholera protection for women micro-entrepreneurs in Haiti
 

Health and Climate Change in Developing Countries. Case Study: Cholera protection for women micro-entrepreneurs in Haiti

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GRF One Health Summit 2012, Davos: Presentation by Urs WIDMER, Swiss Reinsurance Company, Switzerland

GRF One Health Summit 2012, Davos: Presentation by Urs WIDMER, Swiss Reinsurance Company, Switzerland

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  • The dashed line at the top line represents the time period for paleoviruses. The red lightning bolts represent dates of known recent and ancient viruses based either on historical records, molecular clocks, or on endogenous retroviruses in the human genome for SARS-Co [38], HIV-1 and -2 [39], dengue (DEN) [40], measles [13], smallpox [41], HERV-K(HML2) [42], or PtERV[27], and older endogenous retroviruses shared among all hominoids or all primates [43]. The blue, green, and orange lightning bolts represent inferred viruses based on positive selection of TRIM5 [18], and the brown line is an inferred virus based on positive selection of ZAP [19] simplified for representation, here. Each color corresponds to inferred paleoviruses based on positive selection on a particular antiviral gene calculated on the phylogenetic tree in the bottom of the figure where the lineage under selection has the same color coding, and the dates correspond to dates of the ancestors [44]. Although one virus is shown per episode of selection, there could be many different waves of similar viruses during that time period. Purple branches refer to selections due to inferred paleoviruses in lineages that do not lead directly to humans. There is considerable uncertainty associated with most of the dates referred to in this figure.TRIM5 restriction of HIV-1 has decreased during evolution leading tohumans. The shading of the rectangle represents the degree that TRIM5 will limit infection ofHIV-1 (darker color means TRIM5 decreases HIV-1 infection more) and the X-axis indicates time inmillions of years from the present. Each dotted line represents the reconstruction of TRIM5 as itlikely existed at a node of a phylogenetic tree indicating a common ancestor of humans withchimpanzees, gorillas, orangutans, gibbons, and Old World monkeys (rhesus). Original data isfound in [30] and shows that the antiviral gene TRIM5 restricted HIV-1 better at points inevolution earlier than the chimp–human common ancestor than it does after that. On the rightshows an amino acid sequence of a region of TRIM5 containing amino acids that confer resistanceor susceptibility to HIV-1 with the amino acids that are under the strongest positive selection inred [14]. Changes in this region cause a gain of restriction to some viruses, while causing a loss toothers [33,45–47]. The R332 amino acid, which represents the single largest determinant of loss ofresistance to HIV-1 [48,49], was fixed before the chimp–human common ancestor, but positiveselection has continued in TRIM5 along the human lineage beyond this point.doi:10.1371/journal.pbio.1000301.g002
  • Shown are the phylogenetic relationships of primate immunodeficiency retroviruses (black lines), includingHIV-1 and HIV-2 in humans (red lines). The precursor of HIV-1 is a virus found in chimpanzees, SIVcpz,which is in turn the product of a recombination between SIVrcm (in red-capped mangabeys) and SIVgsn(in greater spot-nosed monkeys). (Phylogenetic relationships are based on a figure by M. Worobey; photosof nonhuman primates are courtesy of B. Hahn.)

Health and Climate Change in Developing Countries. Case Study: Cholera protection for women micro-entrepreneurs in Haiti Health and Climate Change in Developing Countries. Case Study: Cholera protection for women micro-entrepreneurs in Haiti Presentation Transcript

  • Health and Climate Change inDeveloping CountriesCase study: Cholera protection for women entrepreneurs in HaitiGRF One Health Summit 2012 in DavosUrs Widmer, Senior Medical Officer, Swiss Reinsurance Company
  • Paleovirology — ghosts and gifts of viruses past Michael Emerman PLoS Biol. 2010 Feb 9; 8(2):e1000301 ?CROI 2012?. TRIM5 restriction of HIV-1GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 2
  • TRIM5 is an innate immune sensor for theTRIM5 retrovirus capsid lattice Nature. 2011 Apr 21;472(7343):361-5 Markus Grütter Jeremy Luban TRIM5 does double duty. Bruce Beutler: How mammals sense infection: from endotoxin toNature. 2011 Apr 21;472(7343):305-6. the Toll-like receptors. NP prize lecture 2012GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 3
  • Relationship of Primate Immunodeficiency Retroviruses Cell 133, May 16, 2008 Virus Prevalence Inferred origin HIV-1 Global Common Chimpanzee HIV-2 West Africa Sooty Mangabey SIV = Simian immunodeficiency virusGRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 4
  • Public-Private Partnership in Risk Management Effective reduction and financing of catastrophic risks require a combined response by private and public sectorPublic sector Private sector•Political and legal power to set •Financial resources but lacksframework that facilitate adaptive legitimation to set up frameworkresponse by individuals, public and neededprivate sector •Broad geographical diversification•Operates under significant financial allows to absorb risks in cost-efficientconstraints. As costs of disaster rise, wayability of governments to cope with •Knowledge and Experience incosts is stretched catastrophe risk management GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 5
  • Case studies Natural Disasters •Mexico MultiCat – Funding for immediate relief efforts after disasters •Caribbean Catastrophe Risk Insurance facility (CCRIF) •Haiti – The Microinsurance Catastrophe Risk Organization (MiCRO) •Turkish Catastrophe Insurance Pool (TCIP) •Central America: Facility to insure governments Agriculture •IFC: Global Index Insurance Facility •China: Agricultural insurance scheme •Malawi: Index drought insurance •Mexico: Satellite-based index insurance •Canada: Wildfire suppression cost insurance •India: Weather insurance market •India: Modified National Agriculture Insurance Scheme (MNAIS) Life, Health and Pensions •India: Health MicroinsuranceGRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 6
  • Case study Haiti: The MicroinsuranceCatastrophe Risk Organization (MiCRO)Solution features Insured Peril: Hurricane, earthquake and rainfall Payments are made to microfinance borrowers post-disaster to reduce their loans and provide emergency cash Swiss Re Parametric and basis risk policies are distributed through a local Parametric Haitian microfinance institution, Fonkoze payments to Parametric MiCRO in case of premium paid to Trigger: Index measured at Fonkoze branches in Haiti triggered loss Swiss Re Basis risk absorbed by new donor funded company, MiCRO Inception: March 2011 MiCRO Loss settlement Parametric andInvolved parties payment from Basis Risk Insured: Fonkoze MiCRO for both premiums paid to parametric and MiCRO Sole Reinsurer: Swiss Re basis risk claims Other partners: MercyCorps, CaribRM, Guy Carpenter Fonkoze Loan reduction FonkozeBackground information and emergency borrowers receive Haiti is a nation that susceptible to catastrophes and is unprepared for cash payment insurance within the costs of response post-disaster loan agreement Prior to the setup of MiCRO, Fonkozes clients bore 100% of the risk of natural disasters. Protected MiCRO was named ―Company Launch of the Year‖ at The Review magazine’s Loan-holders annual Worldwide Reinsurance Awards in September 2011.GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 7
  • Simplified Technical Structure Swiss Re Parametric premium paid Parametric payments to MiCRO to Reinsurers in case of triggered loss Basis Risk MDTF (DFID, SDC) MiCRO Microinsurance premiums Loss settlement payment from paid to MiCRO MiCRO Insured Organization InsuredBeneficiaries Note added in Sub-claims settled by organization proof: should be female symbolGRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 8
  • Heavy rains June 2011and Hurricane Season 2011 Source: MiCRO (Microinsurance Catastrophe Risk Organization)GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 9
  • Important risks (Case study Haiti) Earthquake of January 2010 took over 220 000 lives. Already fragile infrastructure was destroyed, 1 million people living in makeshift camps Oct 19, 2010 Outbreak of Cholera, as of Nov 17, 2010 18382 hospital admissions, and 1110 deaths due to cholera Heavy rains June 2011 Epidemic curve for Haiti cholera outbreak No of people Fatality rate Lancet Infect Dis 2010; 10: 813GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 10
  • 2011 Clinton Global Initiative (CGI)*Swiss Re commits to offering cholera insurance in HaitiMichel Liès (former Swiss Re chairman of global partnerships, now CEO) : Some 4000 women who lost their homes or business assets in the floods earlier 2011 have already received more than USD 1 million in payment.We expect the cholera policy will be similar effective in ensuring that the infection of an income provider does not result in destitution for the entire family. CGI established 2005 by Bill Clinton to bring together global leaders to alleviate poverty, create a cleaner environment and increase access to health care and education.GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 11
  • Summary and Conclusion Reinsurers have identified and studied climate change as emerging risk for almost 20 years Expertise in natural and man-made catastrophic risks, tradition of systemic risk analysis and management Priority of ex-ante instruments vs ex-post financing in overall risk financing strategy Policy and insurance should be informed by Science and Ethics, but "nothing without us" One health awareness might help to develop hybrid insurance products combining – agriculture insurance (risks: climate change, financial and prize shocks) – cover for earthquake and hurricane risks – Life, health and pension productsGRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 12
  • Thank youSource: MiCRO (Microinsurance Catastrophe Risk Org) Source: Nature 478: 295(2011)
  • Legal notice©2012 Swiss Re. All rights reserved. You are not permitted to create anymodifications or derivatives of this presentation or to use it for commercialor other public purposes without the prior written permission of Swiss Re.Although all the information used was taken from reliable sources, Swiss Redoes not accept any responsibility for the accuracy or comprehensiveness ofthe details given. All liability for the accuracy and completeness thereof orfor any damage resulting from the use of the information contained in thispresentation is expressly excluded. Under no circumstances shall Swiss Reor its Group companies be liable for any financial and/or consequential lossrelating to this presentation.GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 14