Economic evaluation of border closure for a generic severe pandemic threat using New Zealand Treasury methods.

OBJECTIVE: To perform a comprehensive economic evaluation of border closure for an island nation in the face of severe pandemic scenarios. METHODS: The costing tool developed by the New Zealand (NZ) Treasury (CBAx) was used for the analyses. Pandemic scenarios were as per previous work;1 epidemiological data were from past New Zealand influenza pandemics. RESULTS: The net present value of successful border closure was NZ$7.86 billion for Scenario A (half the mortality rate of the 1918 influenza pandemic) and $144 billion for preventing a more severe pandemic (10 times the mortality of scenario A). Cost-utility analyses found border closure was relatively cost-effective, at $14,400 per QALY gained in Scenario A, and cost-saving for Scenario B (taking the societal perspective). CONCLUSIONS: This work quantifies the economic benefits and costs from border closure for New Zealand under specific assumptions in a generic but severe pandemic threat (e.g. influenza, synthetic bioweapon). Preparing for such a pandemic response seems wise for an island nation, although successful border closure may only be feasible if planned well ahead. Implications for public health: Policy makers responsible for generic pandemic planning should explore how border closure could be implemented, including practical and legal frameworks.

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention.

BACKGROUND: Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. OBJECTIVE: To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. METHODS: An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). RESULTS: For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, "Scenario A"), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of "Scenario A", or 2.75% of the country's population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for "Scenario A" times three for 26 weeks of border closure-but not for only 12 weeks of closure when it would still be beneficial). CONCLUSIONS: This "proof-of-concept" work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective.

What's new with the flu? Reflections regarding the management and prevention of influenza from the 2nd New Zealand Influenza Symposium, November 2015.

Influenza is a common respiratory viral infection. Seasonal outbreaks of influenza cause substantial morbidity and mortality that burdens healthcare services every year. The influenza virus constantly evolves by antigenic drift and occasionally by antigenic shift, making this disease particularly challenging to manage and prevent. As influenza viruses cause seasonal outbreaks and also have the ability to cause pandemics leading to widespread social and economic losses, focused discussions on improving management and prevention efforts is warranted. The Immunisation Advisory Centre (IMAC) hosted the 2nd New Zealand Influenza Symposium (NZiS) in November 2015. International and national participants discussed current issues in influenza management and prevention. Experts in the field presented data from recent studies and discussed the ecology of influenza viruses, epidemiology of influenza, methods of prevention and minimisation, and experiences from the 2015 seasonal influenza immunisation campaign. The symposium concluded that although much progress in this field has been made, many areas for future research remain.

Building a reliable measure for unobtrusive observations of street-connecting pedestrian walkways.

There is evidence that good urban design, including street connectivity, facilitates walking for transport. We, therefore, piloted a short survey on 118 such walkways in nine suburbs in Wellington, New Zealand's capital. The instrument appeared feasible to use and performed well in terms of inter-rater reliability (median Kappa score for 15 items: 0.88). The study identified both favorable features (e.g., railings by steps), but also problematic ones (e.g., concerning graffiti, litter, and insufficient lighting and signage). There is scope for routinising the monitoring of walkway quality so that citizens and government agencies can work together to enhance urban walkability.

Vaccines to prevent pneumonia and improve child survival.

For more than 30 years, vaccines have played an important part in pneumonia prevention. Recent advances have created opportunities for further improving child survival through prevention of childhood pneumonia by vaccination. Maximizing routine immunization with pertussis and measles vaccines, coupled with provision of a second opportunity for measles immunization, has rapidly reduced childhood deaths in low-income countries especially in sub-Saharan Africa. Vaccines against the two leading bacterial causes of child pneumonia deaths, Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (pneumococcus), can further improve child survival by preventing about 1,075,000 child deaths per year. Both Hib and pneumococcal conjugate vaccines have proven safety and effectiveness for prevention of radiologically confirmed pneumonia in children, including in low-income and industrializing countries. Both are recommended by WHO for inclusion in national programmes, and, at sharply tiered prices, these vaccines generally meet international criteria of cost-effectiveness for low-income countries. Vaccines only target selected pneumonia pathogens and are less than 100% effective, so they must be complemented by curative care and other preventative strategies. As part of a comprehensive child survival package, the particular advantages of vaccines include the ability to reach a high proportion of all children, including those who are difficult to reach with curative health services, and the ability to rapidly scale up coverage with new vaccines. In this review, we discuss advances made in optimizing the use of established vaccines and the potential issues related to newer bacterial conjugate vaccines in reducing childhood pneumonia morbidity and mortality.