““This is the worst virus This is the worst virus I’ve ever met in my I’ve ever met in my long career.’’long career.’’

Robert Webster, renowned avian Robert Webster, renowned avian influenza expert, on the H5N1 subtypeinfluenza expert, on the H5N1 subtype

Toll of SARSToll of SARS

Ontario: 375 probable and suspect Ontario: 375 probable and suspect cases, 44 deathscases, 44 deaths

Worldwide: ≈8,100 probable cases, Worldwide: ≈8,100 probable cases, 774 deaths774 deaths

C$1 billion in economic losses for C$1 billion in economic losses for TorontoToronto

US$60 billion in overall loss in US$60 billion in overall loss in demand and in business revenue in demand and in business revenue in East and SE Asia*East and SE Asia*

(Source: Asian Development Bank)(Source: Asian Development Bank)

Pandemic ProjectionsPandemic Projections

United StatesUnited States

314,000 – 314,000 – 733,000 733,000 hospitalizationshospitalizations

Economic losses: Economic losses: Up to $166.5 Up to $166.5 billionbillion(sources: 1st draft, US (sources: 1st draft, US

pandemic plan; CDC)pandemic plan; CDC)

WorldwideWorldwide

6.4 mil to 28.1 6.4 mil to 28.1 mil mil hospitalizationshospitalizations

874 mil to 1.6 bil 874 mil to 1.6 bil require a require a doctor’s caredoctor’s care

(Source: WHO)(Source: WHO)

““The point isn’t the exact The point isn’t the exact number. The point is: number. The point is: Imagine a lot of people ill Imagine a lot of people ill in a very short space of in a very short space of time. More than you’ve time. More than you’ve ever seen.”ever seen.”

Martin Meltzer, health economist, CDCMartin Meltzer, health economist, CDC

Global Fatality ProjectionsGlobal Fatality Projections

2 million to 7.4 million 2 million to 7.4 million 100 million100 million 180 million to 360 million180 million to 360 million 1 billion 1 billion

““It is a big, big issue. I mean, It is a big, big issue. I mean, it’s almost imponderable. it’s almost imponderable.

““I have to admit: the more I have to admit: the more research I did, the more research I did, the more frightened I became.”frightened I became.”

Sherry Cooper, chief economist, BMO Nesbitt Sherry Cooper, chief economist, BMO Nesbitt BurnsBurns

State of Global PlanningState of Global Planning

≈≈40 countries have drafted 40 countries have drafted pandemic plans, of varying levels pandemic plans, of varying levels of detail.of detail.

– 31 of those are countries in the 31 of those are countries in the WHO’s European region. WHO’s European region.

– 22ndnd iteration of U.S. plan iteration of U.S. plan expected shortlyexpected shortly

““Any way to address Any way to address stockpiling issues is stockpiling issues is going to be resource going to be resource intensive and intensive and expensive. expensive.

““There’s nothing on the There’s nothing on the cheap.”cheap.”

Dr. Keiji Fukuda, WHODr. Keiji Fukuda, WHO

Antiviral stockpilingAntiviral stockpiling ≈≈30 countries have ordered antiviral 30 countries have ordered antiviral

drugs. Delivery staggered.drugs. Delivery staggered.– U.S. : 2.3 mil courses Tamiflu in stock. U.S. : 2.3 mil courses Tamiflu in stock.

Will buy additional 20 mil courses.Will buy additional 20 mil courses. 84,300 courses of Relenza in stock.84,300 courses of Relenza in stock.

– Canada: enough drug in hand to treat ≈ 8 Canada: enough drug in hand to treat ≈ 8 % of the population. % of the population.

– Australia: enough drug in stock to treat Australia: enough drug in stock to treat 16 % of its people. 16 % of its people.

– Finland: enough drug in stock to treat 25 Finland: enough drug in stock to treat 25 % of its people. % of its people.

– UK: To buy ≈15 mil treatment courses, UK: To buy ≈15 mil treatment courses, half this year, half next.half this year, half next.

≈≈30 countries have ordered antiviral 30 countries have ordered antiviral drugs. Delivery staggered.drugs. Delivery staggered.– U.S. : 2.3 mil courses Tamiflu in stock. U.S. : 2.3 mil courses Tamiflu in stock.

Will buy additional 20 mil courses.Will buy additional 20 mil courses. 84,300 courses of Relenza in stock.84,300 courses of Relenza in stock.

– Canada: enough drug in hand to treat ≈ 8 Canada: enough drug in hand to treat ≈ 8 % of the population. % of the population.

– Australia: enough drug in stock to treat Australia: enough drug in stock to treat 16 % of its people. 16 % of its people.

– Finland: enough drug in stock to treat 25 Finland: enough drug in stock to treat 25 % of its people. % of its people.

– UK: To buy ≈15 mil treatment courses, UK: To buy ≈15 mil treatment courses, half this year, half next.half this year, half next.

H5N1 vaccinesH5N1 vaccines Vaccine productionVaccine production

– U.S. has completed Phase 1 testing U.S. has completed Phase 1 testing of an H5N1 vaccine of an H5N1 vaccine

– Japan, Australia, Canada, Britain, Japan, Australia, Canada, Britain, France are working on or have France are working on or have stated intentions to make H5N1 stated intentions to make H5N1 vaccine for testing or stockpilingvaccine for testing or stockpiling

– Several companies (Sanofi, GSK) Several companies (Sanofi, GSK) working on an H5N1 vaccine for working on an H5N1 vaccine for own purposes.own purposes.

Vaccine productionVaccine production– U.S. has completed Phase 1 testing U.S. has completed Phase 1 testing

of an H5N1 vaccine of an H5N1 vaccine – Japan, Australia, Canada, Britain, Japan, Australia, Canada, Britain,

France are working on or have France are working on or have stated intentions to make H5N1 stated intentions to make H5N1 vaccine for testing or stockpilingvaccine for testing or stockpiling

– Several companies (Sanofi, GSK) Several companies (Sanofi, GSK) working on an H5N1 vaccine for working on an H5N1 vaccine for own purposes.own purposes.

Vaccine Production CapacityVaccine Production Capacity

Global: ≈900 mil 15 mcg Global: ≈900 mil 15 mcg doses/yeardoses/year

U.S.: ≈180 mil single U.S.: ≈180 mil single doses/year (excluding doses/year (excluding MedImmune’s FluMist)MedImmune’s FluMist)

Capacity to VaccinateCapacity to Vaccinate

NIH testing shows 2 x 90 mcg of NIH testing shows 2 x 90 mcg of vaccine needed to produce vaccine needed to produce good immune response.good immune response.

Based on that dosing regime:Based on that dosing regime:

- Global output: 75 mil - Global output: 75 mil people/yearpeople/year

- U.S. output: 15 mil people/year- U.S. output: 15 mil people/year

Candling eggs used for growing Candling eggs used for growing

influenza virusinfluenza virus

““Infectious disease experts Infectious disease experts are quaking in their boots, are quaking in their boots, and then they are harnessing and then they are harnessing their fears, setting priorities, their fears, setting priorities, planning and preparing. planning and preparing.

““The public needs to go The public needs to go through the same process.”through the same process.”

Peter Sandman, risk communications specialistPeter Sandman, risk communications specialist

Private Tamiflu salesPrivate Tamiflu sales

U.S. sales more than 3 times U.S. sales more than 3 times higher for Jan.-June 2005 than higher for Jan.-June 2005 than all of 2004.all of 2004.

Canadian sales for 12 months Canadian sales for 12 months to June 2005 3.5 times higher to June 2005 3.5 times higher than sales for entire 2004.than sales for entire 2004.

New Zealand sales up 500 per New Zealand sales up 500 per cent this year over last.cent this year over last.

““What I’ve argued many, many What I’ve argued many, many places is that what we might places is that what we might face is a gigantic catastrophe. face is a gigantic catastrophe. And what we ought to be And what we ought to be trying to do is to turn that trying to do is to turn that gigantic catastrophe into an gigantic catastrophe into an ordinary disaster. ordinary disaster.

““That would be a laudable That would be a laudable human goal.’’human goal.’’

Dr. David Fedson, retired Aventis executiveDr. David Fedson, retired Aventis executive