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Economics and the Zika Virus
- 1. 3/9/2016 Economics & the Zika virus Stefano Bertozzi UC Berkeley School of Public Health
- 2. 2 Potential Macro-economic Impact of the Zika Virus World Bank estimates, 2/16 • Potential impact for the Latin American and Caribbean region could reach $3.5 billion in 2016 – 0.06% of annual GDP across the region – Impact on already troubled economies in the region • Economic impact expected in the short and longer terms – Short term impact on potential decline in tourism (plane ticket bookings are down 3.4%) – Longer-term impact due to delayed child-bearing in a region where population growth rates are already slowing World Bank. The short-term economic costs of Zika in Latin America and the Caribbean (LCR), 2/18/16
- 3. 3 World Bank. The short-term economic costs of Zika in Latin America and the Caribbean (LCR), 2/18/16 Short-term (2016) Economic Impact of Zika Income foregone Fiscal revenues foregone USD Mn % of GDP USD Mn % of GDP Latin America and Caribbean 3478 0.06 420 0.01 Largest impacts in USD Mexico 744 0.06 80 0.01 Cuba 664 0.86 na na Dominican Republic 318 0.50 43 0.07 Brazil 319 0.01 75 0.00 Argentina 229 0.04 72 0.01 Significant Impacts, as % of GDP Belize 21 1.22 5 0.29 Cuba 664 0.86 na na Jamaica 112 0.81 27 0.19 Dominica 4 0.77 1 0.18 Dominican Republic 318 0.50 43 0.07
- 4. 4 Cost-Effectiveness Estimates: Considerations • Decision making with multiple unknowns – Incidence of adverse outcomes (microcephaly and Guillain-Barré) – Potential of multifactoral causes of both • Potential for significant heterogeneity in incidence of adverse outcomes – Window of vulnerability in pregnancy – Duration of sexual transmission risk – Durability of immunity following infection – Sensitivity/specificity of serological testing (now and in the future)
- 5. 5 Cost-Effectiveness of Prevention Options • Primary prevention – Vaccine Development – up to a 10 year horizon • CE of development; CE of different implementation strategies
- 6. 6 PTRS = P(Technical & Regulatory Success) Cost-Effectiveness of Zika Vaccine Development Cost-effectivenessofavaccine Zika vaccines would, however, face the same problem as vaccines for chikungunya, West Nile, St. Louis encephalitis, and other arboviruses: since epidemics appear sporadically and unpredictably, preemptively vaccinating large populations in anticipation of outbreaks may be prohibitively expensive and not cost-effective, yet vaccine stockpiling followed by rapid deployment may be too slow to counter sudden explosive epidemics. Source: Zika Virus in the Americas — Anthony S. Fauci, M.D., and David M. Morens, M.D. “Yet Another Arbovirus Threat” N Engl J Med 2016
- 7. 7 Cost-Effectiveness of Prevention Options • Primary prevention – Vaccine Development – up to a 10 year horizon • CE of development; CE of different implementation strategies – Vector control of Aedes aegypti addresses three diseases: dengue, chikungunya and Zika • Decrease dengue and it may reduce the severity of Zika? • Decrease the attack rate and potentially increase the probability of Zika infection during pregnancy in the future
- 9. 9 Cost-Effectiveness of Prevention Options • Primary prevention – Vaccine Development – up to a 10 year horizon • CE of development; CE of different implementation strategies – Vector control of Aedes aegypti addresses three diseases: dengue, chikungunya and Zika • Decrease the attack rate and potentially increase the probability of Zika infection during pregnancy in the future • Decrease dengue and it may reduce the severity of Zika? • Secondary prevention – Family planning (or travel to low-risk location) until vaccine available – Serologic testing & family planning
- 10. 10 % of Women Seropositive prior to Pregnancy Cost-Effectiveness of Family Planning IncidenceamongPregnantWomen
- 11. 11 % of Women Seropositive prior to Pregnancy IncidenceamongPregnantWomen Cost-Effectiveness of Adding Screening to Family Planning
Editor's Notes
- Good reference: http://www.latinpost.com/articles/115948/20160222/zika-virus-impacts-latin-america-economy.htm WB Brief: http://pubdocs.worldbank.org/pubdocs/publicdoc/2016/2/410321455758564708/The-short-term-economic-costs-of-Zika-in-LCR-final-doc-autores-feb-18.pdf Plane ticket bookings are down 3.4% compared with this time in 2015. Brazil’s economy already expected to contract by 3.5% this year (causes include decline in petroleum prices) Region as a whole has declining fertility rates. Brazil, Chile, Uruguay already have below replacement level total fertility rates (TFR). By 2025, Venezuela, Colombia, Argentina all expected to drop below 2.1 (Replacement rate).
- http://www.bbc.com/news/health-35727047 Phase I trials expected to start late Summer, early Fall 2016 (Fauci, NIH) will focus on pregnant women, women of childbearing age NIAID is actively working on vaccine candidates to prevent Zika virus infection. Fortunately, NIAID scientists had already created vaccine platforms for other flaviviruses that can be used as a starting point for a Zika vaccine. Specifically, NIAID is currently pursuing several vaccine approaches: A DNA-based vaccine that uses a strategy similar to an investigational flavivirus vaccine for West Nile Virus. That vaccine, which was developed by scientists at NIAID’s Vaccine Research Center, was found to be safe and induced an immune response when tested in a phase 1 clinical trial. A live-attenuated (live but weakened virus, so that it cannot cause disease) investigational Zika vaccine building on a similar vaccine approach for the closely-related dengue virus. An investigational Zika vaccine that uses a genetically engineered version of vesicular stomatitis virus---an animal virus that primarily affects cattle. VSV was successfully used in an investigational Ebola vaccine tested by NIAID. This vaccine approach is at an early stage with plans underway to evaluate the Zika vaccine candidate in tissue culture and animal models. It is possible that an investigational Zika vaccine will be ready to enter early-stage human trials in 2016. An early-stage trial would examine whether an experimental vaccine is safe and generates immune responses in vaccinated volunteers.
- http://www.bbc.com/news/health-35727047 Phase I trials expected to start late Summer, early Fall 2016 (Fauci, NIH) will focus on pregnant women, women of childbearing age NIAID is actively working on vaccine candidates to prevent Zika virus infection. Fortunately, NIAID scientists had already created vaccine platforms for other flaviviruses that can be used as a starting point for a Zika vaccine. Specifically, NIAID is currently pursuing several vaccine approaches: A DNA-based vaccine that uses a strategy similar to an investigational flavivirus vaccine for West Nile Virus. That vaccine, which was developed by scientists at NIAID’s Vaccine Research Center, was found to be safe and induced an immune response when tested in a phase 1 clinical trial. A live-attenuated (live but weakened virus, so that it cannot cause disease) investigational Zika vaccine building on a similar vaccine approach for the closely-related dengue virus. An investigational Zika vaccine that uses a genetically engineered version of vesicular stomatitis virus---an animal virus that primarily affects cattle. VSV was successfully used in an investigational Ebola vaccine tested by NIAID. This vaccine approach is at an early stage with plans underway to evaluate the Zika vaccine candidate in tissue culture and animal models. It is possible that an investigational Zika vaccine will be ready to enter early-stage human trials in 2016. An early-stage trial would examine whether an experimental vaccine is safe and generates immune responses in vaccinated volunteers.
- http://www.bbc.com/news/health-35727047 Phase I trials expected to start late Summer, early Fall 2016 (Fauci, NIH) will focus on pregnant women, women of childbearing age NIAID is actively working on vaccine candidates to prevent Zika virus infection. Fortunately, NIAID scientists had already created vaccine platforms for other flaviviruses that can be used as a starting point for a Zika vaccine. Specifically, NIAID is currently pursuing several vaccine approaches: A DNA-based vaccine that uses a strategy similar to an investigational flavivirus vaccine for West Nile Virus. That vaccine, which was developed by scientists at NIAID’s Vaccine Research Center, was found to be safe and induced an immune response when tested in a phase 1 clinical trial. A live-attenuated (live but weakened virus, so that it cannot cause disease) investigational Zika vaccine building on a similar vaccine approach for the closely-related dengue virus. An investigational Zika vaccine that uses a genetically engineered version of vesicular stomatitis virus---an animal virus that primarily affects cattle. VSV was successfully used in an investigational Ebola vaccine tested by NIAID. This vaccine approach is at an early stage with plans underway to evaluate the Zika vaccine candidate in tissue culture and animal models. It is possible that an investigational Zika vaccine will be ready to enter early-stage human trials in 2016. An early-stage trial would examine whether an experimental vaccine is safe and generates immune responses in vaccinated volunteers.