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Five countries have been rated as ‘extreme risk’ for the spread of influenza, including Singapore (1), UK (2), South Korea (3), the Netherlands (4) and Germany (5), while Belgium (6), North Korea (7), Italy (8), France (9) and Spain (10) are rated ‘high risk.’
For developed and highly globalised countries, such as those in Western Europe, transient populations combined with a large number of international arrivals for tourism and business increase the probability of infected individuals crossing into their borders. This is a key factor in intensifying the risk of an influenza pandemic, which is compounded by densely populated areas with large urban populations, increasing the potential number of people a carrier will come into contact with.
In 2011, the UK saw 69.4 million people use Heathrow Airport for travel, while nearly 100,000 a day flew in and out of Gatwick. These numbers will surge this summer with the London Olympic Games, when an additional 5.3 million international tourists are expected in the UK. During the games, London is estimated to see almost 800,000 additional people use public transport each day and such a large influx of visitors into a relatively small area will exacerbate the already significant risk of spread in the country, particularly since visitors from countries most at risk of a pandemic emergence will feature high in these influxes.
Maplecroft’s findings also reveal that the UK, Netherlands and Germany are among the ten countries with the highest capacity to contain a pandemic should one occur. They feature alongside other highly developed nations including: Andorra, Norway, Luxembourg, Belgium, Australia, Finland and the US. These countries’ capacity to contain or slow an outbreak of influenza depends on several complex factors, including wealth, an effective health infrastructure, well developed educational resources, advanced information and communication networks, and strong governance.
Effective governance is particularly important in the capacity to contain an outbreak of an influenza strain. Following the outbreak of the H1N1 swine flu in 2009 the British government employed comprehensive measures to contain an outbreak of an influenza strain, including the UK Pandemic Preparedness Strategy 2011, which sets out a UK-wide strategic approach to planning for and responding to the demands of an influenza pandemic.
Meanwhile, South East Asia poses the highest risk of the emergence of a strain of influenza with six out of the 10 highest risk countries within the Influenza Pandemic Risk Index – Risk of Emergence. These include Cambodia (1), China (3) and Viet Nam (4), which are rated as ‘extreme risk,’ while Laos (5), Indonesia (7) and Thailand (8) are classified as ‘high risk.’ The others include: Bangladesh (2), Nigeria (6), Pakistan (9) and Haiti (10).
South East Asia poses a particular risk of emerging strains of influenza as a significant proportion of the domestic bird population of approximately six billion are kept in smallholdings of 5-15 birds where open coops are common and the hygiene and preventative measures are not necessarily observed. These factors increase human exposure to animals and increase the likelihood of influenza transmission from animal to human.
China (3) is of particular concern, in terms of emergence of a strain of flu. Its’ rapidly expanding economy and increasingly wealthy population has enabled more families to add more meat to their diets, resulting in a surge in livestock numbers. In 2003, this resulted in the emergence of a strain of a highly pathogenic avian influenza in the country. The deaths of two Chinese men resulting from avian influenza in January confirm the ongoing seriousness of the situation. Twenty seven of the forty one confirmed cases in China have been fatal.
The likelihood that influenza strains will emerge within China takes on extra significance in light of the fact that the country is also highly vulnerable to the spread of disease (it ranks 18th and high risk in Maplecroft’s Risk of Spread Index), which increases the risk of a pandemic outbreak. According to Maplecroft’s results, the country is constrained by high risk of spread and a medium capacity to contain an outbreak, suggesting that spending levels on health should continue to increase to mitigate the risks of a pandemic.
The release of Maplecroft’s IPRI tallies with recent research by the WHO, which highlights the risks associated with the spread of anti-biotic resistant diseases. Although Maplecroft’s indices illustrate the risk of spread and capacity to contain the outbreak of an influenza virus, they can be used as a proxy for bacterial infections which have a similar method of transmission such as Tuberculosis.
Viral infections can affect the immune response, potentially leaving the body open to attack from bacterial infections. For example, HIV increases the risk of developing Tuberculosis by between 20 and 37 times. The risks associated with a viral outbreak are also compounded by the increasing resistance of bacterial diseases to antibiotics. Coupled with this, the number of antibiotic resistant diseases is growing; as more drug resistant strains emerge, higher mortality rates and spiralling costs are predicted by the WHO , particularly in populations already suffering from viral outbreaks.
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