Few natural hazards threaten more loss of life, economic disruption, and social disorder than large-scale infectious disease outbreaks. An influenza pandemic or similarly transmissible disease1 could infect billions, kill millions, and reduce trillions of dollars from global economic output. Even a more localized epidemic could lead to a catastrophic loss of life, GDP, and cost millions to contain (Commission on a Global Health Risk Framework for the Future 2016). The economic effects occur by closing businesses, schools, public offices, and often, the healthcare system itself. Further, effects of disease outbreaks include interruptions in transportation (of goods), trade, and travel. While most disease outbreaks are localized to a region, they can quickly become global, as we have seen with Ebola, Severe Acute Respiratory Syndrome (SARS), and Zika. With other related challenges, such as the rise in antimicrobial resistance (AMR) and deliberate human-engineered threats, we must ensure that a preparedness program is in place to combat these risks.
Compared to the resources devoted to mitigating other global risks such as terrorism, climate change, or war, the world invests strikingly little in infectious disease outbreak preparedness. The problem is not a lack of knowledge, as the public health community knows what steps are needed to mitigate risk. However, preventive measures are rarely prioritized. In fact, the typical pattern of infectious disease preparedness today can be characterized as a cycle of panic and neglect: a flood of resources during outbreaks followed by lack of interest and diminished investments. The resulting dependence on crisis-response is both costly and ineffective (in preventing the next outbreak).
The most recent Ebola outbreak in West Africa is a good example. Governments and response agencies poured more than $3.6 billion into containment, 11,000 lives were lost, 28,000 were infected, and the regional economy lost $2.2 billion in GDP in one year (Centers for Disease Control and Prevention 2016). Three years post-Ebola, funds to reduce future outbreaks have dwindled, and Ebola has all but disappeared from the news. Since 1976, dozens of Ebola outbreaks have struck Africa, and the next one is merely a question of time.
In addition to Ebola, we have a long and costly history with other infectious disease outbreaks. Just over the past 15 years, Zika, MERS-CoV, SARS, cholera, tuberculosis, HIV/AIDS, and various strains of the influenza virus have affected hundreds of millions of people around the world. One could argue that we have been lucky in avoiding a major pandemic, such as that of the 1918 influenza, which resulted in an estimated 50-100 million lives lost or 3-5% of the global population at that time, which today would be the equivalent of more than 200 million people.
Why do we fail to adequately invest in the prevention of disease outbreaks? We know that major disease outbreaks have an expected economic cost of tens of billions of dollars annually; yet, little preventive action is taken (Commission on a Global Health Risk Framework for the Future 2016). Indeed, following the Ebola outbreak in West Africa, more than 40 expert reports were written, each of which outlined, in strikingly similar ways, significant failures in the response of the international community and what needs to change to avoid the same mistakes. The Commission on the Global Health Risk Framework estimated that the costs of implementing robust measures would cost the world less than $5 billion annually, which is far less than the cost of a major disease outbreak or pandemic (Commission on a Global Health Risk Framework for the Future 2016). A new course of action is needed. We must act to ensure the world is better prepared.