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Avian flu: preparing for a pandemic

Avian Flu
Volume V, Issue 1January 2006 Risk Alert
A report for clients and colleagues of Marsh on risk-related topics Avian Flu: Preparing for a Pandemic
With contributions from Kroll and Mercer Management Consulting A Brief History of Flu Pandemics . . . . . . . . . . . . . . . 2
The Emergence of H5N1—Avian Flu. . . . . . . . . . . . . . . 4 Corporate Preparedness and Business Continuity . . . . . . 8
Immense Challenges for the Health Care System . . . . . . 14
Insurance Coverage Questions . . . . . . . . . . . . . . . . 16
Abbreviations and Acronyms in This Issue . . . . . . . . . 26
Marsh publishes Risk Alert to keep its clients and colleagues informed on criticalissues related to risk. For additional copies, please contact questions@marsh.com.
This report is also available for download at http://www.marsh.com.
Author: Tom Walsh Editor: Meike Olin, CPCU, CIC Production Manager: Christine Reilly Publisher: Timothy J. Mahoney With increasing urgency over the past year, a variety of govern-ments, nongovernmental organizations, industry groups, andmedia outlets have trumpeted the potential dangers of avianinfluenza, commonly called "bird flu." Of the 139 people known to have been infected with avian flu as of the publication date, ‘It is only a matter of
71 have died—a fearsome mortality rate. Suddenly, the word time before an avian
"pandemic" is on the tongues of world leaders, references to the flu virus—most likely
catastrophic 1918 Spanish Flu are common, and many businessesare nervously looking for gaps in their business-continuity plans.
H5N1—acquires the
Human deaths from the bird flu have been reported in five coun- ability to be transmitted
tries. Thus far, the spread of the virus to humans has largely been from human to human,
accomplished through contact with infected birds, although a sparking the outbreak
few possible cases of human-to-human transmission are beinginvestigated. These cases involved families where prolonged daily of human pandemic
contact and exposure existed. The possibility that the virus will influenza. We don't know
mutate to allow sustained human-to-human transmission hashealth authorities on high alert.
when this will happen.
"It is only a matter of time before an avian flu virus—most likely But we do know that it
H5N1—acquires the ability to be transmitted from human to human, sparking the outbreak of human pandemic influenza.
We don't know when this will happen. But we do know that it —Lee Jong-wook, director-general will happen," Lee Jong-wook, director-general of the World Health of the World Health Organization Organization (WHO), said during a recent gathering of healthexperts from more than 100 countries.
Likewise, businesses would be well-advised to ensure their emergency-response and business-continuity plans are up-to-date and include specific planning for dealing with a pandemic.
This issue of Risk Alert aims to:  provide background information on avian flu and human influenza pandemics;  discuss corporate preparedness and business-continuity management (BCM) through the lens of a pandemic;  highlight the international implications of a pandemic; and  outline some of the potential insurance coverage issues related to pandemics.
Volume V, Issue 1, January 2006 1 A Brief History of Flu Pandemics
Business Questions About
Avian Flu/Pandemic

A pandemic occurs when a new strain of the influenza A virus strikes humans, spreads easily from person to person, and causes Here are some questions risk serious illness with a high death rate. Since at least the 16th cen- managers should consider asking tury, flu pandemics have swept the globe an average of three times themselves about a potential avian per century, emerging every 10 to 50 years. In the 20th century, pandemics emerged in 1918, 1957, and 1968. Nearly 40 years after  How do we anticipate risks from the last pandemic, the appearance of an especially virulent strain a pandemic that could harm our company? of flu in birds in 1997 and again in 2004 raised an alarm amongworld authorities when it infected a small number of people.
 How can we respond effectively to the threat of a pandemic? "We expect the next influenza pandemic to come at any time  What should we do if employees now, and it's likely to be caused by a mutant [strain] of the virus are exposed to or develop avian flu? that is currently causing bird flu in Asia," Dr. David Nabarro, coor-  Can we keep our business operating dinator of avian flu response efforts for the United Nations, said if employees or a critical employeeis infected? in September 2005.
 How can we manage pandemic- No one can predict with accuracy the extent of damage the related disruptions in our supplychains? next flu pandemic will cause. Projections of deaths, illness, andeconomic damage are generally built by extrapolating from past  How should we communicate to our customers, employees, and pandemics. Following is a brief look at the characteristics of the suppliers the steps we are taking three pandemics of the 20th century.
to deal with avian flu?  Will property and/or casualty policies Influenza Pandemic Comparisons
cover pandemic-related claims? Worldwide
Worldwide
 How much will avian flu cost?  What are the potential impacts Avian flu estimates (if pandemic were to emerge in 2006) Sources: Population data from U.S. Census Bureau
Death estimates from World Health Organization and others The Spanish Flu of 1918-1919
The first pandemic of the 20th century is widely regarded as thedeadliest disease in human history. Death estimates worldwide range from 20 million to more than 100 million. The following aresome of the characteristics of the 1918 flu outbreak:  Outbreaks occurred simultaneously in Europe and several states in the United States.
 The pandemic broke in two waves. The first, in the spring and summer of 1918, was highly contagious, but did not cause One of the Spanish Flu's
many deaths. The second wave crashed across the world with most troubling aspects
remarkable speed and lethality. The death rate was 10 timesgreater in the second wave than the first.
was that most deaths
 One of the Spanish Flu's most troubling aspects was that most occurred in people in
deaths occurred in people in "the prime of life," between 15 "the prime of life,"
and 35 years old. With most influenza strains, the majority ofdeaths occur among the very young, the very old, and people between 15 and 35
with compromised immune systems.
 The flu infected about 25 percent to 30 percent of the world's population, striking every continent.
The Pandemic of 1957-1958
Science and medicine made immense strides between 1918 and1957. By 1957, vaccines for seasonal flu existed; antibiotics hadbeen discovered that could be used to treat flu-related pneumonia;and the WHO's Global Influenza Surveillance Network, whichmonitors and tracks the flu's spread, was 10 years old. The follow-ing are some of the characteristics of the 1957-1958 pandemic:  A milder strain of the flu virus was at the root of the pandemic, as compared with the 1918 pandemic.
 Detection of outbreaks in Hong Kong and Singapore in early May led to the identification of the exact virus strain; so that by the end of the month, samples of the virus were available to vaccine manufacturers.
 The pandemic touched all corners of the world within six months. As was the case in 1918, the first wave of the pandemic caused fewer deaths than the second wave.
 An estimated 2 million people died during the pandemic. Unlike the situation in 1918, deaths were primarily among the elderly.
 As is the case now, one of the major stumbling blocks to producing sufficient amounts of the vaccine was the lack ofmanufacturing capacity.
Volume V, Issue 1, January 2006 3 The Pandemic of 1968-1969
The last pandemic of the 20th century was the least severe of the three. The following are some of the characteristics of the1968-1969 pandemic:  Symptoms were much milder, and the mortality rate was Concern about H5N1
much lower than with the 1957 pandemic: possibly because it was a similar strain to that virus. Since only 11 years had heightened after
passed between the two pandemics, many people were alive scientists reported
who had been exposed to the 1957 flu and, thus, had receivedsome level of natural protection.
in October 2005 that
 The pandemic led to about 1 million deaths.
genetic detective work
had traced the 1918
The Emergence of H5N1—Avian Flu
influenza to an avian
In 1997, an outbreak of avian influenza among poultry in Hong Kong was traced to the H5N1 virus strain (see sidebar on page 5).
The outbreak was accompanied by 18 cases of human infection;six of those people died. There was immediate apprehensionamong world health officials, as this was the first time an avianflu virus was known to have infected humans. Concern aboutH5N1 heightened after scientists reported in October 2005 thatgenetic detective work had traced the 1918 influenza to an avianflu virus. An aggressive response, in which more than 1.5 millionchickens and other fowl were destroyed, helped stem the 1997outbreak; and the threat disappeared—temporarily.
In late 2003, the H5N1 virus was identified as the culprit in thedeaths of chickens at a commercial farm in South Korea. Ridingthe wings of migratory birds, the virus has since moved fromAsia, where it is now endemic, to Eastern Europe. The H5N1 subtype is expected to appear in more countries through birdmigration. More than 150 million domestic fowl in Asia havebeen killed in an effort to stop the spread among birds—with the hope that doing so will prevent further infection of people.
China is attempting the largest animal inoculation program ever,an effort to vaccinate up to 14 billion domestic birds.
The virus has also been found in domestic pigs in China and incaptive tigers and leopards in Thailand that had been fed rawchicken carcasses. Experiments with house cats in the Netherlandshave also shown the possibility that cats could act as a host forthe virus.
Human infection with H5N1: Thus far, most cases of avian flu
Birds, Influenza, and the
in humans appear to have resulted from contact with infected H5N1 Virus Strain
birds—such as breathing in dust containing bird feces—from Bird populations are a natural contaminated surfaces, or from ingestion of uncooked or under- reservoir for influenza A viruses. All cooked poultry or poultry products. Investigations are under way known subtypes of influenza A—the in a few cases into the possibility of human-to-human infection.
most harmful to humans—are foundin birds, though most do not appear As long as the disease lacks the ability to move easily from to cause illness in birds.
person to person, there will be no pandemic. But the possibility Influenza A viruses are named based exists for a mutation to occur that will allow easy human-to- on the two sets of proteins that human infection and give rise to a pandemic.
extend from their outer surface likespikes on a mace.
Scientists say such a mutation could happen if, for example, a The "H" stands for hemagglutinin, person sick with a common seasonal flu becomes infected with of which there are 15 subtypes, avian flu. The two viruses could swap genetic material, creating H1 to H15. The "N" stands for neuraminidase, of which there are a new strain that allows easy human-to-human transmission.
nine subtypes, N1 to N9. All of the Health officials have a number of specific worries about the H and N subtypes have been found H5N1 virus, including the following: in birds; but only the H1, H2, and H3subtypes are known to have shown  Because there is little existing immunity in humans to the the ability to transmit freely among H5N1 strain, the spread of a mutant form could be rapid humans over the past 100 years.
Thus, one of the red flags of thepresent avian flu virus, H5N1, is that  Some antiviral medications may not be effective. According it is a subtype to which humans have to the Centers for Disease Control and Prevention (CDC), tests had no exposure. And since immunity of the genetic sequence of H5N1 viruses from human cases is built through exposure, there is no natural immunity in the human in Vietnam and Thailand have shown resistance to two of the population should H5N1 mutate most commonly used antiviral medications—amantadine and into a strain easily transmitted from rimantadine—used to treat influenza (see sidebar on page 12).
person to person.
 Developing a vaccine would take months following the appearance of the virus.
A Global Threat
A human influenza pandemic represents the extreme end ofwhat risk managers call low-frequency/high-severity events. Aswith hurricanes, tsunamis, and earthquakes, we know the risk of apandemic exists. And as with those catastrophes, we won't knowthe severity of a pandemic until it is over. But unlike hurricanes,tsunamis, and earthquakes, a pandemic will not limit its damageto one or a few countries or a single geographic region. A pandemic's worldwide consequences could include: Volume V, Issue 1, January 2006 5  more than 7 million deaths from even a mild pandemic, United Nations Conference
according to the WHO (death estimates vary wildly—some Develops Action Plan
top 350 million—and will ultimately depend on the virulence International agencies and individual of a pandemic strain); governments have been increasingly  between 89,000 and 207,000 deaths in the United States, sounding the alarm over avian flu. In early November 2005, the United according to the CDC; Nations sponsored a conference thatdrew participants from more than  25 percent or more of countries' workers needing to take 100 countries aimed at preventing or between five and twenty days of sick leave, according to the minimizing damage from a human United Kingdom Department of Health; pandemic caused by a mutation ofthe avian flu strain H5N1.
 $800 billion in worldwide economic damage, according to The conference ended with release The World Bank; and of a broad six-point plan focused on  major disruptions to every industry, particularly those with the following areas: strong ties to travel, tourism, sports and entertainment,  Control measures: Improve
lodging, and health care.
veterinary services, emergency preparedness, and control measures such as culling of The hardest hit companies in any industry are likely to be those diseased or potentially diseased with worldwide operations, global supply chains, and/or inter- birds and vaccinations.
national customers. Already, some local, state, and national  Surveillance: Strengthen the
governments are setting in place plans to curtail travel, close early detection and rapid response schools, quarantine individuals and communities, and ban systems for animal and human flu,and enhance laboratory capacity.
public gatherings. Such steps were taken during the epidemic of SARS—Severe Acute Respiratory Syndrome—in 2003, especially  Rapid containment: Train investi-
gators of animal and human in Asia, where the disease was most prevalent. Such measures— cases. Plan and test rapid- while necessary to help slow the spread of the disease and allow time for medical efforts to ramp up—impede commerce.
 Pandemic preparedness: Build
and test national pandemic Even a relatively mild pandemic could "slow or halt economic preparedness plans; conduct a growth in Asia and lead to a significant reduction in trade, global response exercise; andenhance health systems.
particularly of services," according to analysis by the AsianDevelopment Bank.
 Integrated country plans:
Develop national plans across allsectors as the basis for coordinated Lessons Learned From SARS
technical and financial support.
 Communications: Develop
In late 2002, SARS began to work its way around the world. By and use factual and transparent the time the outbreak ended in July 2003, about 800 people in 26 countries had died from the disease, just under 10 percent of Source: United Nations Web site,
those believed to have been infected. The vast majority of SARS cases were reported in Asia, although 38 people in Canada alsodied and 75 cases were reported in the United States. Concernsabout the disease led to severe travel restrictions in some countries,closure of premises by government authorities, quarantines, and other business disruptions. The Asian Development Bankestimated the total lost business revenue at about $60 billion.
SARS was not an influenza virus, but rather a coronavirus,so named for its appearance when viewed under an electronmicroscope. SARS is a droplet infection, meaning that it spreadswhen a relatively large droplet containing the virus is coughed For businesses with
or sneezed by an infected person and then inhaled or otherwise employees working
ingested by another. Influenza, on the other hand, typically spreadsmore quickly; as it is an aerosol infection involving smaller or traveling overseas,
droplets able to suspend in the air and travel greater distances.
particularly in Asia,
The SARS experience is on many people's minds as they consider some of the "lessons
a potential avian flu pandemic. For businesses with employees learned" from SARS
working or traveling overseas, particularly in Asia, some of the"lessons learned" from SARS could be relevant should an avian could be relevant
flu outbreak occur. The following are some steps to bear in mind: should an avian flu
 Maintain regular communication between the home office and other operations, with frequent and detailed updates about theunfolding situation. It's critical to give employees consistentguidance, thus avoiding confusion.
 Work closely with your office building's management to get complete and updated information on any containment, safety,or other measures implemented, and any incidents involvingother building tenants. If necessary, press them hard to revealthe true situation—they will be in direct contact with civilauthorities on these issues. Good information from the building's management will help reassure employees.
 Anticipate that the anxiety among your work force may be driven by concerns over being sent to a quarantine camp—as was done in China during the SARS epidemic—should infections be discovered in your office building.
 Be ready to permit staff to work from other cities or from home.
 Anticipate that companies will respond to government instructions and refuse to accept visits or meetings. Again,this was true in China during SARS.
 Maintain close contact with clients by phone. Respect any requirements they may have limiting or eliminating physicalcontact, such as in-person meetings.
Volume V, Issue 1, January 2006 7  Be prepared that if you or your employees are coming from an infected area, your own head office and firms you intend tovisit in North America may require you to spend a week ormore in a hotel before coming into the office.
Although SARS provides a recent case study to which risk managers can look for ideas in planning for avian flu, they should An outbreak of avian
keep in mind that SARS was mild compared to the potential flu will severely test
impact of an influenza pandemic.
even the best-laid
Corporate Preparedness and
plans, and businesses
are well-advised to
Many businesses, particularly large multinational corporations, review and revise their
have established avian flu/pandemic planning committees.
plans in the light of
According to media reports, some are creating task forces com- bining their strategic planning, operations-continuity procedures,human resources, and health services to adopt event-specificmeasures in anticipation of an avian flu pandemic. Others—primarily in parts of the food industry that use poultry—arepreparing marketing campaigns aimed at allaying fears about the use of their products—and thus protecting their brands—should an avian flu pandemic occur.
It's also likely that many companies are not making any specialpreparations in advance of what they see as the slim likelihoodof an avian flu pandemic; instead operating with the belief that should one occur, either it will not affect them, or they will respond as the need arises.
An outbreak of avian flu will severely test even the best-laid business-continuity plans, and businesses are well-advised toreview and revise their plans in the light of this threat. In theory,business-continuity management (BCM) should already be inplace to identify, respond to, and recover from a broad range of potential interruptions. Pandemic influenza, however, isn't a "normal" business risk. Some of a pandemic's unique character-istics include:  an international impact with no demarcation by culture, industry, or geography;  the potential to escalate quickly and last for many months;  a projected infection rate of 25 percent or more of the world's population, according to many public health experts;  extreme taxation of health care facilities, public health agencies, and their work forces; and  a macro impact on regional and global economies that could result in a significant shift in the way that companies conducttheir businesses and their ability to continue operations.
There are a number of steps companies should be taking andissues they should be considering before an outbreak, during anoutbreak, and after an outbreak. The following guidelines do not present an exhaustive picture of such preparations, but areintended to foster discussion.
If avian flu does not emerge, the time spent on planning andpreparation will not have been wasted. After all, avian flu is agood proxy for other potential pandemics; pandemics are a goodproxy for potential bioterrorism; bioterrorism is a good proxy forother forms of terrorism. Corporate preparedness is a transferableskill—even if the risk emerges from a totally different direction or source than anticipated.
Before an Outbreak
Risk managers and other executives with risk managementresponsibilities should consider the following before a pandemicbegins:  Understand the nature of the disease and the potential means by which it could directly and indirectly affect their operations,resources, reputations, and financial fitness.
 Review existing corporate-preparedness plans, procedures, and policies, including business-continuity plans, risk managementcontrols, human-resource policies, communications capabilities,critical suppliers and vendors, and potential sales impacts. Allexisting plans should be reviewed, updated, and tested basedon the threat posed by a pandemic. For example, companiesshould ask themselves, "Will my plan work in the event of having fewer people, losing certain critical people, or havingstaff working from remote locations? Will the real or perceivedfear of an infection affect sales? How can we position the company to respond positively to this negative event?" Volume V, Issue 1, January 2006 9  Regularly contact governments, international agencies, and industry groups about the availability of guidance from whichthe company and its staff could benefit.
 Companies should also ensure they know what to do and whom to inform should they identify a suspected case of avianflu among their employees. Agree internally on what circum- During a pandemic, the
stances relative to avian flu would trigger invocation of a BCMplan—what are the key risk indicators? ability of an organization
 Re-examine the supply chain, and assess what additional risks to identify problems and
avian flu presents to the continuation of service from suppliers respond quickly and
and vendors. Consider the increased risk presented from usinginternational versus regional suppliers, particularly from areas effectively will make a
already infected.
significant difference to
 Review or develop employee health procedures to minimize the the success or failure of
potential for transmission of infectious diseases to other workers.
protecting staff, profits,
 Issue periodic "news releases" to employees to educate them about the disease and what health care precautions they need and reputation and,
to take at home and in the workplace.
ultimately, to the
 Test operations-continuity plans regularly. If a company believes that avian flu presents a significant risk, it should consider running a rehearsal using various outbreak scenariosto test the plan's effectiveness.
 Try to ensure that senior managers have the skills to manage such an event before it becomes a crisis.
During a pandemic, the ability of an organization to identifyproblems and respond quickly and effectively will make a signifi-cant difference to the success or failure of protecting staff, profits,and reputation and, ultimately, to the company's survival.
Companies should consider structuring their corporate-prepared-ness plans for a pandemic crisis into four to six escalating actionthresholds that would provide warning information in advanceand allow individual facilities, regions, and businesses to detectan emerging event and respond appropriately at each escalatedthreshold. Tiered planning should provide applicable guidancepertaining to:  allocation of company resources; health and safety issues and procedures; operations responses; human-resource/benefits involvement; internal and external communications; financial-resource allocation and impact analyses; government involvement; and product, facility, information technology (IT) and intellectual property security controls.
Companies should review their existing preparedness plans andconsider how—and if—they will be able to answer the followingquestions during an outbreak: Information and Communication Concerns
 What is the nature of the disease? How is it transmitted, what are its symptoms, and what health care precautions are appropriate?  Do employees know what to do and whom to contact if they are infected or may have been exposed to the virus?  How will the company communicate with its employees if they are not at work?  At what point do managers need to communicate to upper management that there is a potential problem?  How will potential problems be communicated to employees  Have call centers been set up to maintain contact with suppliers, clients, and employees?  What is the company's position if an employee wants to  What happens if an infected employee comes to work? What if a non-native employee wants to be temporarily transferred to another region? What about his/her family?  Is or should the company be prepared to provide family death Volume V, Issue 1, January 2006 11  Can the company operate with 25 percent or greater absenteeism? Vaccines: Every year, millions of
 Can the company have employees work remotely? What infra- people around the world receive a structure support is needed to support a shift to an at-home vaccination against the flu type(s) determined to be the most likely in acoming flu season. The vaccines work  How does the company know that supply resources are by triggering an immune response, not contaminated? bolstering the body's ability to fightoff a virus.
 How will clients be assured that products are not contaminated? There is currently no available  Will there be a disruption to the company's supply chains? vaccine for the H5N1 influenzastrain, although efforts are under  What are the procedures to decontaminate the facility and way in several countries, including its heating, ventilation, air-conditioning systems, electronic the United States, to produce one.
equipment, and soft materials (blankets, curtains, and so on)? These efforts do not aim to yield aready-for-production vaccine because  What assurances need to be provided to the facility staff that a vaccine must closely match the they are safe at work? actual strain of virus it is meant toprotect against. Large-scale produc-  At what point does the company prohibit staff from traveling tion, therefore, cannot begin until a to certain geographic areas? virus mutates into a form that causesa pandemic to be declared. The trials  How will traveling employees be brought home, particularly if currently under way are meant to lay the groundwork that will allow forrapid development of a bird flu  Are there escalation procedures to get additional resources? vaccine should one be needed.
 Is there a trained crisis-management team that includes Antivirals: Medications that help
reduce the duration and severity
on-call staff? Do the team members know what is expected of of the flu are called antivirals. At them? Are the correct personnel—management and others— present, only two classes of antivirals designated to participate on the team? are known to show an ability to combat avian flu— adamantanes and neuraminidase inhibitors. The adamantanes have not beeneffective against some of the avian  Are executives ready and capable of delivering the right messages? viruses isolated and they also canhave side effects such as seizures.  Have press releases been prepared that can be adapted to fit The second class of antivirals are known as neuramindase inhibitors  Are mechanisms in place for managing internal and external and contain the drugs oseltamivir(sold as Tamiflu) and zanamivir (sold as Relenza). Both need to be  What if the current means of communication fail? administered within 48 hours of theonset of symptoms to be of help;  Are there trained spokespeople for dealing with the media and and clinical data on their use againstavian flu is, of course, limited.
other stakeholders? (continued on page 13) During an Escalating Pandemic
Businesses looking to ensure continued operations during thepandemic and in its immediate aftermath may find the following (continued from page 12) questions critical: Manufacturers are working toincrease their ability to produce  Is the business-recovery team operating effectively? Does it these drugs, particularly Tamiflu, as have the necessary and readily available resources to support countries are increasingly turning to stockpiling them.
its activities? Where will the team and its support resourcesstay if they have to travel or relocate to a facility? Many medical experts advise individuals not to attempt to  Has the team initially identified and monitored changes of stockpile antivirals, as, like any the recovery-time objectives for each of the critical business prescription medicine, they need tobe monitored closely and adminis- processes that may be interrupted? tered correctly. However, newsreports indicate that many people  Have continuity strategies been developed for each process? and businesses have been purchasing Have they been integrated in an effective manner or prioritized, the drugs over the Internet. This has particularly if multiple facilities and regions are affected? created the additional problem ofscam artists selling what turn out  Have supply-chain dependencies been identified and alternative not to be the drugs people think channels identified and secured in case of disruption? What they are buying.
happens if the backup fails? The American Medical Associationissued a statement advising against  Are there alternative premises and facilities within and outside stockpiling: "Stockpiling of antivirals, of an affected region that can be used? Are transport links likely such as Tamiflu, to have on hand‘just in case' is not recommended to be sufficient to get people and resources to the alternate sites? for individuals because of the riskthat symptoms not related to avian Timing of Corporate Responses
flu will prompt people to initiateunnecessary treatment. In addition, As stated earlier, the foregoing questions are meant only as a these drugs are needed to confrontthe real risk of human flu-related general starting point for companies. The actual timing and severity illness and deaths that occur annually of a pandemic, the nature of a particular business or industry, and in the elderly and other high-risk other variables will all come into play during an actual incident and subsequently as the spread of the disease progresses.
"Needlessly taking an antiviral may contribute to the problem of For example, at what point should a college or university with resistance to that antiviral drug,which would then make the drug a large number of students living on campus decide to cancel less useful in the event of an actual classes and/or shut down the campus? In that situation, a avian flu outbreak. Responsible use balance will need to be struck between acting too soon, which of antivirals for flu is critical to thehealth of Americans—and the health could mean canceling school unnecessarily, and acting too late, of people throughout the world." which could force students to attempt travel in a time of major Likewise, a professional services company may have a significantnumber of employees traveling overseas. At what point should itcurtail overseas travel? How much of its resources should it be Volume V, Issue 1, January 2006 13 dedicating to increasing its ability to conduct business throughteleconferencing? A manufacturer may be able to mitigate worker exposure byinstituting mandatory hygiene practices and providing workerswith protective clothing—gloves, masks, hand disinfectants, andso on. At what point should it move to do so? What thresholds While companies in
would trigger a shift of manufacturing operations to another many other industries
location and a complete plant shutdown? will be able to tell their
It is not clear that the H5N1 avian flu will mutate into a human- workers to work from
to-human disease this season, or ever. However, it is widelybelieved that in the near term the global population will have to home or take time off,
face a pandemic. It is incumbent on corporate officers to ensure care providers in most
that their companies have evaluated the risks and implementedthe appropriate steps to mitigate those risks.
instances will not only
be expected to show
up, but also to work
Immense Challenges for the
Health Care System
A pandemic will touch every business sector, but few will be asheavily involved as the health care industry, from the frontlinedoctors, nurses, and others treating patients to the companiesthat will eventually handle a potentially massive number ofinsurance claims. While companies in many other industries willbe able to tell their workers to work from home or take time off,care providers in most instances will not only be expected toshow up, but also to work longer hours.
Yet they will be under the same stresses as others, having familymembers become ill and require care, getting sick themselves,and facing the fear—a heightened fear—of being exposed to thevirus at work.
Numerous government agencies and other industry groups have prepared guidelines for health care facilities and workers to help them prepare for a pandemic. Patient-education material,planning guides for health care facilities, diagnostic-testingguidelines, infection-control guidelines, and more are availablefrom the CDC, the Department of Health and Human Services,and others (see Web sites on page 25) Pandemic Poses Potential to Stress U.S. Health Care Delivery
Low impact
High impact
Total number infected Outpatient hospital visits Estimated economic impact The number of patients U.S. hospitals and clinics could see duringa pandemic is staggering and should figure into the planning forany health care facility. The CDC's FluSurge software programaims to help hospitals and public health experts estimate thepotential for increased hospital usage during a pandemic. Theprogram estimates the number of hospitalizations and deathsthat would occur during an influenza pandemic and comparesthe number of people hospitalized, the number requiring treat-ment in the intensive care unit (ICU), and the number requiringventilators to a community's existing supplies. Users can plug ina number of variables, including the severity of the virus.
As an example, the CDC used a scenario involving the Atlantametropolitan area during a hypothetical eight-week pandemicwith a 25 percent infection rate. Based on those numbers andavailable information about Atlanta's hospitals, the CDC said thedemand on resources would peak in the pandemic's fifth week,during which an additional:  2,013 people would be hospitalized; 583 of whom would need ICU treatment; and 292 of whom would need ventilators.
For the Atlanta metro area, that represents:  28 percent of hospital beds; 77 percent of ICU capacity; and 42 percent of ventilators.
Volume V, Issue 1, January 2006 15 Over the eight-week course of such a pandemic, the CDC said,the Atlanta area could expect 13,918 hospital admissions and2,516 deaths. "These sample results from FluSurge illustrate howthe next influenza pandemic may overwhelm existing hospitalresources, given that hospitals increasingly operate at nearly fullcapacity," CDC officials wrote in the FluSurge manual.
As was the case with
The potential stress on the health care system can be expected to the SARS virus, many
be just as significant in other parts of the United States and theworld—and it could be more severe in areas where health care is claims stemming from
not as modern or effective. Clearly, health care industry workers a flu pandemic are likely
need to be prepared to be at ground zero during a pandemic.
to lead to disputes.
Insurance Coverage Questions
In the event of a pandemic, businesses around the world couldsuffer severe economic damage, the extent of which will dependon the severity of the outbreak. Whenever businesses suffer aloss, owners naturally look to their insurance policies for help. Aswas the case with the SARS virus, many claims stemming from aflu pandemic are likely to lead to disputes. Although the outcomeof any claim is dependent on its facts and the legal rules in theapplicable jurisdiction, there are some generalizations that canbe drawn. Experience derived from the SARS outbreak may alsobe instructive.
The following is a brief discussion of pandemic-related issues thatmay arise under several common types of coverage. Understandingthese issues and potential responses may assist in planning and preparation.
The commercial general liability (CGL) policy provides coverageagainst a broad range of liabilities alleged to result from the actsor negligence of the insured. It also provides a defense againstclaims actually or potentially falling within the coverage. Somevariation of this coverage is held by almost all businesses and is,therefore, likely to be at issue in any avian flu-related event.
The standard policy typically responds to bodily injury, sickness,or death allegedly caused by the insured. Insurers are, therefore, likely to closely scrutinize the alleged causal connection betweena claimed infection or exposure and the actions of the insured.
Because insurers take the position that the policy extends only toactual injuries, they are also likely to look closely at the nature ofinjuries alleged by third parties and may reject claims based onfear of exposure, exposure without actual symptoms, or other Because of the varied
mental or emotional injuries. However, under the "bodily injury"and/or the "personal injury" language of some policies and the law wording of CGL policies
of some jurisdictions, such emotional injuries may be covered, so and the varied legal
careful review is necessary.
interpretations of the
The policy also responds to third-party property damage, butrequires physical injury or destruction of tangible property; so policy language, cases
insurers may take the position that certain types of claimed potentially falling within
damage are not covered or that the mere presence of the virus the reach of the coverages
in or on property does not constitute physical injury.
need to be reported to
The standard policy contains coverage for "personal injury"—anumber of specified wrongs, including wrongful eviction. Policy the primary and excess
language varies, as does applicable law; but in some situations, it insurers as soon as there
might be possible to argue that the actions of a landlord or other is knowledge of a claim.
similar insured that result in closure of a building or evacuationof premises fall within the reach of this definition.
Most liability policies also contain a broadly worded pollutionexclusion, which applies to, among other things, all "solid,liquid or gaseous…contaminants or irritants." Although there are grounds to argue that this language should apply only to industrial chemicals and waste, insurers have used the broadlanguage to deny claims for damage caused by substances ascommon as smoke, grease, and mud. Courts have split on thisargument, with some holding the exclusion applies only toindustrial chemicals and others holding that it must be readbroadly to apply to anything that is potentially an irritant or contaminant. It is, therefore, possible some insurers will arguethat viruses constitute a "contaminant" within the meaning ofthe exclusion and use that as a basis to deny claims.
Because of the varied wording of CGL policies and the varied legal interpretations of the policy language, cases potentiallyfalling within the reach of the coverages need to be reported tothe primary and excess insurers as soon as there is knowledge ofa claim. Umbrella policies are generally broader than the primary Volume V, Issue 1, January 2006 17 coverage, so it is important to make sure that the umbrella insur- International Travel to
er is also on notice for the types of employers liability claims Avian Flu-Affected Areas
noted in the following section.
During the outbreak of SARS—SevereAcute Respiratory Syndrome—in 2003, many companies restricted travel to affected areas. It's important for Workers compensation will undoubtedly be an issue in the event companies to keep their employees of an avian flu pandemic. As with any insurance coverage issue, well-informed about travel restric-tions and precautions, especially the facts of individual cases will vary, as will the coverage afforded those who may be traveling to under various policies according to state and federal laws and the areas known to harbor avian flu.
terms and conditions of policies that provide coverage beyond that The Centers for Disease Control which is mandated by law. Exposure falls into three categories: and Prevention (CDC) recommendsthe following precautions regarding  potential exposure in the U.S. workplace; Before travel to areas affected
 short-term or temporary assignments outside the United by avian flu:
States and Canada; and  Visit http://www.cdc.gov/travel for  long-term work assignments outside the United States  Check with your doctor or health care provider to be sure all vacci- Exposure inside the United States: Depending on the language
nations are up to date.
in each state's statute relative to occupational disease, workers  Put together a traveler's health kit, including thermometer and compensation could be the mechanism to cover medical bills alcohol-based hand gel.
and reimburse lost wages for avian flu-related disability as  Identify health resources before long as the exposure meets the jurisdictional compensability entering the country.
standard. The definition of injury is consistent within the majority  Check your health insurance of states, requiring it to be "…arising out of and in the course coverage for medical evacuationcoverage.
of." employment.
During travel in an affected area:
Occupational disease is defined more narrowly in some states,  Avoid all direct contact with which use language such as "hazards in excess of those ordinarily poultry and handling of surfacesthat have been in contact with incident to employment in general and/or…peculiar to the occu- poultry feces or secretions. Avoid pation in which the employee is engaged." Some states list those visiting poultry farms or live poultry markets.
occupational diseases that are "covered"; still others considerwhether the risk of exposure is greater on the job than it would  Cleanse hands often with soap be to the general public.
 Ensure all poultry-based foods are thoroughly cooked.
No state specifically references avian flu in its workers compen-  If you become sick with symptoms sation law. However, claims for disability related to avian flu by that include fever, cough, sore employees on work assignments in geographic areas where the throat, or difficulty breathing, a risk is identified should file claims under the appropriate policy.
U.S. consular officer can assist youin locating medical services and If avian flu reaches the United States, the workers compensation contacting family and friends.
issues will be different from those posed by overseas exposure.
(continued on page 19) Overseas exposure: Workers compensation coverage for employees
International Travel to
injured while working temporary assignments outside of the Avian Flu-Affected Areas
United States will depend on the extraterritorial coverage provi- (continued from page 18) sions of the applicable state law. Many states extend benefits tothose injured outside their borders (whether in another state or After return from an affected
area
:
outside the country), provided that the contract of hire was made  Monitor your health for 10 days.
in the state or the principal location of employment is in the state.
 If you become ill with a fever, However, circumstances can arise under which such employees cough, sore throat, or difficulty would not be entitled to state workers compensation benefits.
breathing during the 10 days, consult a health care provider. Be The other coverage that might apply is employers liability, also sure to alert the provider beforeyour visit that you have been in a covered under the standard workers compensation policy used known avian flu area. Also, inform in most states. But while employers liability coverage applies to him/her if you have had contact injuries to employees temporarily outside of the United States or with poultry during that visit.
Canada—as long as the employer is legally liable for damages as  If ill, limit travel and contact with others as much as possible.
a result—many employers prefer to address this exposure byarranging for a foreign voluntary compensation benefits endorse-ment or a separate, standalone policy for this coverage. Thisendorsement or policy provides voluntary coverage for the workerscompensation benefits of a given jurisdiction to employees notcovered by state workers compensation law.
Because U.S. nationals assigned to work outside of the UnitedStates for an extended period or indefinitely may not have pro-tection under domestic workers compensation policy, coverageunder a foreign voluntary workers compensation policy orendorsement is generally preferable. The language is usually very similar to that of the National Council on CompensationInsurance (NCCI) voluntary compensation endorsement plus language providing coverage for endemic disease—such as avianflu—and repatriation expense.
An endemic disease is one that is peculiar to a particular country.
The endemic disease coverage language of a foreign voluntaryworkers compensation endorsement establishes that coverageapplies to injury or death arising out of endemic disease even ifthe disease is not covered under the workers compensation oroccupational disease law of the designated state. The repatriationexpense coverage provides for the cost of bringing the employeeor his/her remains back to the United States.
It is important to note, at this juncture, that foreign voluntarycompensation coverage—whether by endorsement or standalone Volume V, Issue 1, January 2006 19 policy—is not a standard coverage. There is wide variation in theterms and conditions of coverage from one insurer to the next.
Policy forms and endorsements should be analyzed in detail tobe sure that coverage will apply as expected.
Infection from returning employees: Exposure within the United
States to employees who may have been infected with avian flu
If an employee alleges a
outside of the United States and Canada presents additional workplace exposure to
coverage questions. Most state workers compensation statutes donot view illness contracted due to exposure to fellow employees avian flu, the employer
as a compensable occurrence, as the exposure to illness is not should report the
usually limited to the workplace. The exposure to avian flu wouldhave to be proven to be solely a result of a workplace exposure incident to its claims
to be considered for coverage under a standard workers compen- administrator and
sation policy in any jurisdiction.
cooperate in any
If an employee alleges a workplace exposure to avian flu, the employer should report the incident to its claims administratorand cooperate in any investigation. Compensability of each casemust be determined on the merits of the situation and the law ofthe jurisdiction.
Insureds may also have separate coverage for damage arising out of pollution. These policies may provide a basis for seekingcoverage, but it is important to be aware of potential issues andpossible insurer responses.
A typical pollution policy provides coverage for "pollution condi-tions," which must result from a "discharge, dispersal, release,seepage, migration, or escape." The term "pollution condition"is usually defined broadly and includes, as a general category,both "contaminants" and "irritants." However, insurers have often resisted attempts to recover for nonindustrial pollution.
The insurer response to widespread mold claims included revis-ing policy definitions so that they now contain exclusionary or limiting language. Policies now often exclude "naturally occurringsubstances" or "microbial matter." Insurers may argue that thislanguage also applies to viruses. In some policies, the definitionof "microbial matter" is quite broad and may encompass viruses.
In addition to these changes to policy wording, insurers have argued that the mechanism by which the virus spreads does notconstitute "discharge, dispersal, release, seepage, or migration." Some insurers have also argued that the broad definition of "pollution" was intended to apply only to industrial pollution andchemicals, rather than to any substance that could be consideredan irritant or contaminant; and in some states, there is case lawthat will support this argument.
Finally, pollution policies often contain a provision requiring thatexpenses be incurred only in response to a government order andthat the order be issued in accordance with a law or regulationgoverning and setting standards for the remediation of the pollu-tant. The likely purpose of this language is to protect the insureragainst voluntary acts or cleanups or governmental overreaching,but it can create difficulties. In the avian flu situation, insurers maytake the position that governmental closure or decontaminationorders are not supported by specific authority, that no standardsexist, that governmental directives are not orders, that the entityissuing the order does not constitute the government, or thatcosts are voluntary. It is, therefore, important to consider theseprovisions when dealing with and responding to local healthauthorities or other governmental or quasi-governmental entities.
Real property may potentially be contaminated in an avian fluoutbreak. The government may close or quarantine a building oran entire neighborhood. Such events could give rise to claimsunder an insured's first-party property coverage.
Insurers begin every analysis of a claim under a property policy,whether for direct damage or time-element loss, by askingwhether insured property (or property of the type insured) hassustained physical loss or damage from an insured event or peril.
Generally, unless the insured's policy provides specific time-element coverages for "infectious disease outbreaks," coverage is unlikely to be triggered. In regard to avian flu, the two mostlikely scenarios resulting in a time-element loss are:  fear that the virus may be present in or near the vicinity where the insured's property is located, thereby leading to employeeabsences and diminished customer traffic to the site; and Volume V, Issue 1, January 2006 21  the actual contamination of the site by the virus, resulting in Fears That Bird Flu Will
governmental or voluntary closure.
Follow Flaws of Swine Flu
With respect to the first scenario, insurers providing coverage In the winter of 1976, a small number under a standard property policy may argue that there is no of soldiers at Fort Dix developed astrain of the flu that had not been coverage for losses arising out of people's fear of entering a seen in humans before. Only one of premises. Insurers may argue that a mere suspicion that avian them died, but the incident caught flu may be present is not sufficient to trigger coverage because the eye of health officials and trig-gered a national response, one largely there is no direct physical loss or damage to insured property.
viewed as a failure of overreaction.
In the second scenario, where there is an actual closure because Epidemiologists found that some ofthe sick soldiers—and the dead the avian flu has been detected, it may be more difficult to argue one—were infected with a strain of there was a lack of physical impact; although insurers may contend influenza found in pigs. Fearing that the mere presence of viruses does not constitute physical that a new strain of flu was about tosweep through the population like damage. They may also point to the "contamination" exclusion the 1918 Spanish flu pandemic—and found in most property policies and the "virus" exclusion found that it might even be the same strain within the "mold" exclusions under some more recent forms.
as that killer disease—some called fora national immunization campaign.
The term "contamination" is not defined in most policies. Courtsinterpreting it have reached varying conclusions as to its meaning.
Despite mounting evidence that theswine flu was not a serious threat, It is likely some insurers would argue it applies to contamination preparations for a massive vaccina- by the avian flu virus.
tion program were undertaken. Soonafter the vaccination program began, Civil authority: The "Civil Authority" extension is commonly
though, critics of the effort emerged.
And so did evidence that the swine found in business interruption and other time-element forms flu did not pose the threat of a where coverage will need to be reviewed relative to this question.
pandemic at all.
Generally, this extension covers the actual business interruption Nonetheless, more than 40 million or other time-element loss caused by the action of civil authority people were vaccinated against the that prohibits access to the premises covered under the policy, so-called "swine flu." Any vaccinationcomes with a risk for a small percent- due to direct physical loss or damage to property other than at age of those receiving it, and swine the described premises and arising from a covered cause of loss.
flu vaccinations were no different.
Other restrictions may apply, such as a maximum time period for The vaccine was believed responsible recovery, usually three consecutive weeks after a 72-hour waiting for hundreds of people developing period. Other forms may limit the scope of coverage to a specified Guillain-Barre Syndrome, a rare neurological disease characterized distance from where the damage occurred. In addition, a sublimit by loss of reflexes and temporary may be applicable.
paralysis. Hundreds of lawsuits werefiled, resulting in about $100 million Therefore, in any claim involving this extension, the facts and in settlements and judgments.
circumstances of the loss and of the governmental action will becritical. Given possible insurer responses, governmental closurebased on suspicion may be treated differently than governmentalclosure that occurs because of the actual presence of the virus. Ineither case, it is likely that insurers will rely on the contaminationexclusion as a basis for denial. Insurers are more than likely to take an "absolutely no coverage" position if an insured evacuates orcloses voluntarily without an actual order from the civil authorities.
Physical loss or damage: Insurers may also argue that the presence
of avian flu on the premises does not constitute "physical loss or
damage" under the policy. Insurers may argue that even though it
may be dangerous to enter the premises because of the presence
Insurers may also argue
of avian flu, a property policy insures the structure and/or the that the presence of avian
property contained therein, not the health of individuals.
flu on the premises does
Some older policy forms and some manuscript forms contain not constitute "physical
variations in language that could affect these arguments. Examplesinclude forms that contain the words "from any cause whatsoever" loss or damage" under
in lieu of the more typical "from an insured peril" wording set out in the civil authority clause. Insurers may insist that such wordingrelates back to the "Perils Insured Against" clause or "Causes of Loss" form, which stipulates "physical loss or damage," andthat it must be read in conjunction with the "Perils Excluded"or "Exclusions" clauses—in other words, contamination.
Similarly, some large hotel/hospitality and entertainment com-panies have obtained programs that contain an endorsementoriginally developed in the London insurance market that coversthe time-element loss resulting from closure of the premises by a public authority after one or more guests exhibit symptoms of a contagious disease. Again, this language is outside the nar-rower scope of the standard "physical loss or damage" verbiage and, therefore, may provide a counterargument to potentialinsurer arguments.
Although it is unlikely any insurer will immediately acknowledgecoverage under a standard property policy for any of the avian fluscenarios discussed above, it is important that all such potentialclaims be reviewed. Where the insured can demonstrate that apublic authority has closed or quarantined its premises as aresult of an actual—provable—contamination by the avian flu,the potential claim should be reported to its property insurers for review.
Volume V, Issue 1, January 2006 23 The question on the tip of everyone's tongue is, "Just how worriedshould we be about an avian flu pandemic?" The answer is notsimple. Just as residents of San Francisco and Tokyo live with theknowledge they reside in an active earthquake zone, the entireworld is becoming aware that we all live in a potential pandemiczone.
Even if the H5N1 avian flu strain fails to mutate into a form easilytransmissible among humans, it will have raised awareness thatpandemics are a natural part of the world. The issue has nowbecome one that every corporate leader or board of directorsmust consider and take into account.
Coupled with the awareness is the reality that it's impossible topredict ahead of time just how severe an outbreak will be. Beyondfears over the possible loss of life, avian flu has raised concernsabout governments' and businesses' readiness to deal with a crisis of enormous scale. However, there is still time to preparefor the contingency. Now is the time to check your company'spreparedness for handling a pandemic crisis.
Web Sites of Interest
More information on avian flu can be found at the following Websites, most of which provide regular updates:  American Medical Association http://www.ama-assn.org (see page 13)  Asian Development Bank  The Centers for Disease Control and Prevention http://www.cdc.gov (see page 15)  Council of State and Territorial Epidemiologists (links to individual state avian flu/pandemic response plans)http://www.cste.org  Official U.S. government Web site for avian flu and pandemic information http://www.pandemicflu.gov  Trust for America's Health  UK Department of Health  U.S. Department of Health and Human Services http://www.un.int (see page 6)  World Health Organization Volume V, Issue 1, January 2006 25 Abbreviations and Acronyms
in This Issue

 BCM: business-continuity management  CDC: Centers for Disease Control and Prevention  CGL: comprehensive general liability  ICU: intensive care unit  IT: information technology  NCCI: National Council on Compensation Insurance  SARS: Severe Acute Respiratory Syndrome  WHO: World Health Organizations Much of the information for this report was provided by:  Dalena L. Berrett, vice president with Marsh's HealthCare Industry Practice;  Ronald L. Calhoun, managing director and practice leader of Marsh's HealthCare Industry Practice;  Paul Clifford, head of China Client Services for Marsh and Mercer Management Consulting;  Neal Drawas, managing director with Kroll's Environmental Health and Safety group;  James Edwards, assistant vice president with Marsh's Risk Consulting Practice, Singapore;  Thomas N. Falzarano, managing director and global practice leader of Marsh's Liability Claims Practice;  Stephen D. Fraser, managing director with Marsh's Property  Allen M. Gilley, managing director with Marsh's Risk Consulting Practice;  Harry S. Leff, assistant vice president with Marsh's Risk Consulting Practice;  Michael Lovdal, managing director with Mercer Management  Gary S. Lynch, managing director and practice leader of Marsh's Business Continuity Planning Practice;  Paul D. McVey, managing director and global practice leader of Marsh's Property Claims Practice;  Mark J. Noonan, managing director and North American practice leader of Marsh's Workers Compensation Practice;  Anne Tiedemann, regional managing director for Europe and the Middle East with Kroll;  Martin Vilsoe, senior consultant with Marsh's Risk Consulting Practice, Singapore; and  Robert S. Wilkerson, global practice leader with Kroll's Corporate Preparedness group.
Volume V, Issue 1, January 2006 27 About Marsh & McLennan Companies
Marsh & McLennan Companies (MMC) is a global professional services firm with annual revenues exceeding $12 billion. It is the parent company of Marsh, the world's leading risk andinsurance services firm; Kroll, the world's leading risk consulting company; Guy Carpenter, theworld's leading risk and reinsurance specialist; Mercer, a major global provider of consultingservices; and Putnam Investments, one of the largest investment management companies in the United States. Approximately 60,000 employees provide analysis, advice, and transactionalcapabilities to clients in over 100 countries. Its stock (ticker symbol: MMC) is listed on the NewYork, Chicago, Pacific, and London stock exchanges.
Marsh
Marsh meets the global needs of its clients through a wholly owned network of more than 400
offices in more than 100 countries. In every country, Marsh combines a deep knowledge of local
risk issues with the ability to tap global insurance and capital markets for solutions tailored to client
needs. Since its founding more than 130 years ago, Marsh has steadily built its business beyond
insurance broking to encompass a full range of services to identify, value, control, transfer, and
finance risk.
Kroll
Kroll provides corporate advisory and restructuring, forensic accounting, valuation and litigation
consulting, electronic evidence and data recovery, business intelligence and investigations, back-
ground screening, and security services. It serves a global clientele of law firms, financial institutions,
corporations, nonprofit institutions, government agencies, and individuals.
Guy Carpenter
Guy Carpenter provides reinsurance broking, financial modeling services, and related advisory
functions worldwide for insurers and reinsurers.
Mercer
Mercer provides clients with solutions linking the three most enduring dimensions of business
success—business design, organizational design, and people strategy. It does this through a unique
array of consulting expertise:
 Mercer Human Resource Consulting is the global leader in human-resource, employee-benefit, and compensation consulting.
 Mercer Management Consulting helps clients achieve sustained shareholder value through innovative business design.
 Mercer Oliver Wyman is a leader in financial-services strategy and risk management consulting.
 Mercer Delta Consulting works with CEOs and senior teams of major companies on the design and leadership of large-scale transformation.
 NERA Economic Consulting, the leading firm of consulting economists, devises solutions to problems involving competition, regulation, finance, public policy, and business strategy.
 Lippincott Mercer, the premier corporate-identity firm, helps clients create, develop, and manage their brands throughout the world.
Putnam Investments
Putnam Investments plays a key role in the financial-planning decisions of millions of individuals and
thousands of institutions. With more than 60 years of investment experience, Putnam provides
investment-management services to more than 2,700 institutional and 401(k) clients and manages
more than 14 million individual-shareholder accounts.
Collaborative Solutions
The companies of MMC work together to offer multifaceted client solutions. In so doing, they
bring to bear a unique range of perspectives on the toughest issues confronting clients, industry by
industry. Risk management is the focus for many of these collaborative services. Through the
expertise of Marsh, Kroll, Guy Carpenter, Mercer, and Putnam, the companies of MMC are uniquely
positioned to offer clients risk solutions and advice across the full range of their strategic, financial,
operating, and hazard risks.
For more information about Marsh & McLennan Companies, go to http://www.mmc.com.
The information contained herein is based on sourceswe believe reliable, but we do not guarantee its accu-racy. It should be understood to be general risk management and insurance information only. Marshmakes no representations or warranties, expressed orimplied, concerning the financial condition, solvency,or application of policy wordings of insurers or rein-surers. The information contained in this publicationprovides only a general overview of subjects covered,is not intended to be taken as advice regarding anyindividual situation, and should not be relied upon assuch. Statements concerning tax and/or legal mattersshould be understood to be general observationsbased solely on our experience as risk consultants andinsurance brokers and should not be relied upon astax and/or legal advice, which we are not authorizedto provide. Insureds should consult their own qualifiedinsurance, tax, and/or legal advisors regarding specificrisk management and insurance coverage issues.
This document or any portion of the information itcontains may not be copied or reproduced in any formwithout the permission of Marsh Inc., except thatclients of any of the Marsh & McLennan Companies,including Marsh, Kroll, Guy Carpenter, Mercer, andPutnam Investments, need not obtain such permissionwhen using this report for their internal purposes.
Marsh is part of the family of MMC companies,including Kroll, Guy Carpenter, Putnam Investments,Mercer HR Consulting (including Mercer HR Services,Mercer Global Investments, Mercer InvestmentConsulting, and Mercer Health & Benefits), and MercerSpecialty Consulting businesses (including MercerOliver Wyman, Mercer Management Consulting,Lippincott Mercer, Mercer Delta, and NERA).
Risk Alert: Avian Flu: Preparing for a Pandemic 2006 Marsh Inc. All rights reserved.
Marsh. The world's #1 risk specialist.SM
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