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Health and Climate Change in Developing Countries. Case Study: Cholera protection for women micro-entrepreneurs in Haiti
1. Health and Climate Change in
Developing Countries
Case study: Cholera protection for women entrepreneurs in Haiti
GRF One Health Summit 2012 in Davos
Urs Widmer, Senior Medical Officer, Swiss Reinsurance Company
2. Paleovirology — ghosts and gifts of viruses past
Michael Emerman
PLoS Biol. 2010 Feb 9;
8(2):e1000301
?CROI 2012?.
TRIM5 restriction of HIV-1
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 2
3. TRIM5 is an innate immune sensor for the
TRIM5 retrovirus capsid lattice
Nature. 2011 Apr 21;472(7343):361-5
Markus Grütter
Jeremy Luban
TRIM5 does double duty. Bruce Beutler: How mammals sense infection: from endotoxin to
Nature. 2011 Apr 21;472(7343):305-6. the Toll-like receptors. NP prize lecture 2012
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 3
4. Relationship of
Primate
Immunodeficiency
Retroviruses
Cell 133, May 16, 2008
Virus Prevalence Inferred origin
HIV-1 Global Common
Chimpanzee
HIV-2 West Africa Sooty Mangabey
SIV =
Simian immunodeficiency virus
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 4
5. Public-Private Partnership in Risk
Management
Effective reduction and financing of catastrophic risks require a
combined response by private and public sector
Public sector Private sector
•Political and legal power to set •Financial resources but lacks
framework that facilitate adaptive legitimation to set up framework
response by individuals, public and needed
private sector •Broad geographical diversification
•Operates under significant financial allows to absorb risks in cost-efficient
constraints. As costs of disaster rise, way
ability of governments to cope with •Knowledge and Experience in
costs is stretched catastrophe risk management
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 5
6. Case studies
Natural Disasters
•Mexico MultiCat – Funding for immediate relief efforts after disasters
•Caribbean Catastrophe Risk Insurance facility (CCRIF)
•Haiti – The Microinsurance Catastrophe Risk Organization (MiCRO)
•Turkish Catastrophe Insurance Pool (TCIP)
•Central America: Facility to insure governments
Agriculture
•IFC: Global Index Insurance Facility
•China: Agricultural insurance scheme
•Malawi: Index drought insurance
•Mexico: Satellite-based index insurance
•Canada: Wildfire suppression cost insurance
•India: Weather insurance market
•India: Modified National Agriculture Insurance Scheme (MNAIS)
Life, Health and Pensions
•India: Health Microinsurance
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 6
7. Case study Haiti: The Microinsurance
Catastrophe Risk Organization (MiCRO)
Solution features
Insured Peril: Hurricane, earthquake and rainfall
Payments are made to microfinance borrowers post-disaster to reduce
their loans and provide emergency cash Swiss Re
Parametric and basis risk policies are distributed through a local Parametric
Haitian microfinance institution, Fonkoze payments to Parametric
MiCRO in case of premium paid to
Trigger: Index measured at Fonkoze branches in Haiti triggered loss Swiss Re
Basis risk absorbed by new donor funded company, MiCRO
Inception: March 2011 MiCRO
Loss settlement Parametric and
Involved parties payment from Basis Risk
Insured: Fonkoze MiCRO for both premiums paid to
parametric and MiCRO
Sole Reinsurer: Swiss Re basis risk claims
Other partners: MercyCorps, CaribRM, Guy Carpenter
Fonkoze
Loan reduction Fonkoze
Background information and emergency borrowers receive
Haiti is a nation that susceptible to catastrophes and is unprepared for cash payment insurance within
the costs of response post-disaster loan agreement
Prior to the setup of MiCRO, Fonkoze's clients bore 100% of the risk of
natural disasters.
Protected
MiCRO was named ―Company Launch of the Year‖ at The Review magazine’s Loan-holders
annual Worldwide Reinsurance Awards in September 2011.
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 7
8. Simplified Technical Structure
Swiss Re
Parametric premium paid Parametric payments to MiCRO
to Reinsurers in case of triggered loss
Basis Risk
MDTF
(DFID, SDC) MiCRO
Microinsurance premiums Loss settlement payment from
paid to MiCRO MiCRO
Insured Organization
Insured
Beneficiaries
Note added in
Sub-claims settled by organization
proof: should be
female symbol
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 8
9. Heavy rains June 2011
and Hurricane Season 2011
Source: MiCRO (Microinsurance Catastrophe Risk Organization)
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 9
10. Important risks (Case study Haiti)
Earthquake of January 2010 took over 220 000 lives. Already fragile
infrastructure was destroyed, 1 million people living in makeshift camps
Oct 19, 2010 Outbreak of Cholera, as of Nov 17, 2010 18382 hospital admissions,
and 1110 deaths due to cholera
Heavy rains June 2011 Epidemic curve for Haiti cholera
outbreak
No of people
Fatality rate
Lancet Infect Dis 2010; 10: 813
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 10
11. 2011 Clinton Global Initiative (CGI)*
Swiss Re commits to offering cholera insurance in Haiti
Michel Liès (former Swiss Re chairman of global partnerships, now
CEO) : Some 4000 women who lost their homes or business
assets in the floods earlier 2011 have already received more than
USD 1 million in payment.
We expect the cholera policy will be similar effective in ensuring that
the infection of an income provider does not result in destitution for
the entire family.
CGI established 2005 by Bill Clinton to bring together global leaders to
alleviate poverty, create a cleaner environment and increase access to
health care and education.
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 11
12. Summary and Conclusion
Reinsurers have identified and studied climate change as emerging
risk for almost 20 years
Expertise in natural and man-made catastrophic risks, tradition of
systemic risk analysis and management
Priority of ex-ante instruments vs ex-post financing in overall risk
financing strategy
Policy and insurance should be informed by Science and Ethics,
but "nothing without us"
One health awareness might help to develop hybrid insurance
products combining
– agriculture insurance (risks: climate change, financial and prize shocks)
– cover for earthquake and hurricane risks
– Life, health and pension products
GRF Davos 2012 | Health & Climate Change Dev Countries | Urs Widmer 12
The dashed line at the top line represents the time period for paleoviruses. The red lightning bolts represent dates of known recent and ancient viruses based either on historical records, molecular clocks, or on endogenous retroviruses in the human genome for SARS-Co [38], HIV-1 and -2 [39], dengue (DEN) [40], measles [13], smallpox [41], HERV-K(HML2) [42], or PtERV[27], and older endogenous retroviruses shared among all hominoids or all primates [43]. The blue, green, and orange lightning bolts represent inferred viruses based on positive selection of TRIM5 [18], and the brown line is an inferred virus based on positive selection of ZAP [19] simplified for representation, here. Each color corresponds to inferred paleoviruses based on positive selection on a particular antiviral gene calculated on the phylogenetic tree in the bottom of the figure where the lineage under selection has the same color coding, and the dates correspond to dates of the ancestors [44]. Although one virus is shown per episode of selection, there could be many different waves of similar viruses during that time period. Purple branches refer to selections due to inferred paleoviruses in lineages that do not lead directly to humans. There is considerable uncertainty associated with most of the dates referred to in this figure.TRIM5 restriction of HIV-1 has decreased during evolution leading tohumans. The shading of the rectangle represents the degree that TRIM5 will limit infection ofHIV-1 (darker color means TRIM5 decreases HIV-1 infection more) and the X-axis indicates time inmillions of years from the present. Each dotted line represents the reconstruction of TRIM5 as itlikely existed at a node of a phylogenetic tree indicating a common ancestor of humans withchimpanzees, gorillas, orangutans, gibbons, and Old World monkeys (rhesus). Original data isfound in [30] and shows that the antiviral gene TRIM5 restricted HIV-1 better at points inevolution earlier than the chimp–human common ancestor than it does after that. On the rightshows an amino acid sequence of a region of TRIM5 containing amino acids that confer resistanceor susceptibility to HIV-1 with the amino acids that are under the strongest positive selection inred [14]. Changes in this region cause a gain of restriction to some viruses, while causing a loss toothers [33,45–47]. The R332 amino acid, which represents the single largest determinant of loss ofresistance to HIV-1 [48,49], was fixed before the chimp–human common ancestor, but positiveselection has continued in TRIM5 along the human lineage beyond this point.doi:10.1371/journal.pbio.1000301.g002
Shown are the phylogenetic relationships of primate immunodeficiency retroviruses (black lines), includingHIV-1 and HIV-2 in humans (red lines). The precursor of HIV-1 is a virus found in chimpanzees, SIVcpz,which is in turn the product of a recombination between SIVrcm (in red-capped mangabeys) and SIVgsn(in greater spot-nosed monkeys). (Phylogenetic relationships are based on a figure by M. Worobey; photosof nonhuman primates are courtesy of B. Hahn.)