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The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment

BMJ 2009; 339 doi: (Published 20 November 2009) Cite this as: BMJ 2009;339:b4571
  1. Richard D Smith, professor of health system economics1,
  2. Marcus R Keogh-Brown, research fellow in economic modelling1,
  3. Tony Barnett, professorial research fellow and honorary professor12,
  4. Joyce Tait, professor and scientific adviser3
  1. 1Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2London School of Economics and Political Science, London WC2A 2AE
  3. 3ESRC Innogen Centre, University of Edinburgh, Edinburgh EH1 1LZ
  1. Correspondence to: R D Smith richard.smith{at}
  • Accepted 2 November 2009


Objectives To estimate the potential economic impact of pandemic influenza, associated behavioural responses, school closures, and vaccination on the United Kingdom.

Design A computable general equilibrium model of the UK economy was specified for various combinations of mortality and morbidity from pandemic influenza, vaccine efficacy, school closures, and prophylactic absenteeism using published data.

Setting The 2004 UK economy (the most up to date available with suitable economic data).

Main outcome measures The economic impact of various scenarios with different pandemic severity, vaccination, school closure, and prophylactic absenteeism specified in terms of gross domestic product, output from different economic sectors, and equivalent variation.

Results The costs related to illness alone ranged between 0.5% and 1.0% of gross domestic product (£8.4bn to £16.8bn) for low fatality scenarios, 3.3% and 4.3% (£55.5bn to £72.3bn) for high fatality scenarios, and larger still for an extreme pandemic. School closure increases the economic impact, particularly for mild pandemics. If widespread behavioural change takes place and there is large scale prophylactic absence from work, the economic impact would be notably increased with few health benefits. Vaccination with a pre-pandemic vaccine could save 0.13% to 2.3% of gross domestic product (£2.2bn to £38.6bn); a single dose of a matched vaccine could save 0.3% to 4.3% (£5.0bn to £72.3bn); and two doses of a matched vaccine could limit the overall economic impact to about 1% of gross domestic product for all disease scenarios.

Conclusion Balancing school closure against “business as usual” and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself. Prophylactic absence from work in response to fear of infection can add considerably to the economic impact.


  • Contributors: RDS conceived the idea of a computable general equilibrium application for influenza, advised on the modelling and scenarios, and contributed to the drafting of the paper. MRK-B was responsible for the modelling, the underlying dataset, construction of modelling scenarios and shocks, and drafted the paper. TB and JT conceived the idea of the transition point based on social networking theory, advised on the scenarios and vaccination strategies, and contributed to the drafting of the paper. MRK-B is guarantor for the study.

  • Funding: No specific funding for this study.

  • Competing interests: None declared.

  • Ethical approval: Not required for this study.

  • Data sharing: Model output data are available on request from MR Keogh-Brown marcus.keogh-brown{at}

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