100 Years Later: Modeling Why a Modern-Day Influenza Pandemic Would Still Disproportionately Affect Low and Middle-Income Countries Open Access

Lebeaux, Rebecca (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/0g354f24x?locale=en


As of the publishing of this thesis, one hundred years have passed since the last severe influenza pandemic in 1918 which caused catastrophic morbidity and mortality. Some countries and individuals faced worse health outcomes than others. Unfortunately, given the mutation rate of the influenza virus and growing globalization, another pandemic will likely occur. Previous research has extrapolated that an excess amount of deaths will occur in low and middle-income countries. This thesis used SIR models to explore what country-level and individual host factors would be most influential in causing inequities in morbidity and mortality across countries in an influenza pandemic of similar severity to the 1918 influenza pandemic. The results indicate that discrepancies in pandemic preparedness and surge capacity measures, facilitated by variant recovery and transmission rates, cause the biggest differentials in total attack rates (TAR), case-fatality rates, peak day of infection, and the number of individuals affected on the peak day of infection across countries of varying income levels. Specifically due to country-level factors, the TAR and case-fatality rate for a high-income country was 19.5% and 0.845% respectively compared to a low-income country which had a TAR of 72.1% and case-fatality rate of 2.50%. Acknowledging that vast disparities between countries can be remedied through better pandemic preparedness and surge capacity measures offers policy-makers the opportunity to alleviate the impact of another 1918-like influenza pandemic.

Table of Contents

Introduction 1

Background 2

Model Design and Base Model 16

Modeling Country-Level and Individual Host Factors 21

Country-Level Factors 24

Individual Host Factors 38

Results by Factor 46

Modeling Countries by Income Level 57

Results of Modeling Countries by Income Level 59

Evaluating the Impact Parameters and Initial Conditions 63

Discussion 68

Conclusion 76

References 78

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