Global Health Threats of the 21st Century

The world’s health greatly improved in the past century. Major killers such as smallpox and polio have been eliminated or contained. A large part of the world’s population has access to clean water and better sanitation. Medicine can cure or improve many conditions that crippled or killed people only decades ago.

Nonetheless, human health continues to confront serious threats, as demonstrated by the recent outbreak of the Ebola virus.

Pandemic Risk

Among policymakers who worry about it at all, optimists think a severe pandemic is a once-in-a-century event.

But before the onset of the 2014 Ebola epidemic, most people, including policymakers, seldom thought about pandemics (worldwide epidemics)—which explains why the risk of contagion is undermanaged and the Ebola crisis is here at all.Â

The global community continues to confront serious threats from infectious diseases, as demonstrated by the ongoing Ebola crisis. Ebola is still largely confined to three small west African countries, where the human, social, and economic damage is already high. If the crisis is not contained, damaging health and economic impacts would be replicated in other developing countries and even on a global scale in the case of a pandemic.Â

Contagion surprises and then worsens because the authorities and the public are unaware of the risk and implications of exponential spread. Even without a global spread, disease outbreaks can be very costly. They occur with unnerving frequency. Recent years saw Severe Acute Respiratory Syndrome (SARS) and H5N1 and H7N9 avian flu—and now we face the Ebola crisis. With current policies, one of these, or another pathogen, will cause a pandemic.Â

According to economist Lawrence Summers, awareness of pandemic risks is much too low, and “every child should learn about the 1918 flu pandemic,” when 100 million died, out of a world population of less than 2 billion people. Although a recent World Bank report identified pandemics as one of the three major global risks—together with climate change and financial crises—most official discussions, reports, and communications take no notice of pandemic risk.Â

As a result, governments do little to reduce the risk, even though the measures are known and the costs are low—involving mostly strengthening veterinary and public health systems to detect and control outbreaks. After all, contagion does not start in a vacuum. A staggering 2.3 billion animal-borne infections afflict people in developing countries every year. Uncontrolled livestock diseases and exposure to pathogens from wildlife can periodically spawn widespread contagion because weak veterinary and human public health systems fail to stop outbreaks and allow them to spread.Â

Policies thus shape the onset of contagion. Chronic neglect of veterinary and human public health is both a disastrous policy choice and the prevailing practice in most countries and donor programs.Â

The economic imperative is compelling. Fear—which can spread faster than disease—changes consumer, business, and government behavior. Though it was quickly contained in 2003, SARS cost $54 billion, a toll driven by shocks to business and consumer confidence. The Ebola outbreak has severely disrupted trade, production, and health care in the most affected countries. In a pandemic, similar effects would cascade globally, with outcomes that the U.S. Department of Defense has characterized as the equivalent of a “global war.”

A 4.8 percent drop in global GDP is a realistic outcome in a severe flu pandemic, equivalent to $3.6 trillion (based on global GDP in 2013). Even if the optimists are right that the probability of a pandemic is just 1 percent a year, the risk to the global economy is $36 billion annually over a century. The world is spending about $500 million now to prevent pandemics, so it’s a safe bet that $36 billion a year would more than eliminate the risk. Spending up to that amount is warranted.Â

Fortunately, defenses against pathogens cost a fraction of this amount. A World Bank study (2012) found that spending $3.4 billion annually would bring veterinary and human public health systems in all developing economies to performance standards set by the World Health Organization and the World Organization for Animal Health. The standards cover capacity for early detection, correct diagnosis, and prompt and effective control of contagion. (None of the countries that experienced the 2014...