Protecting the world from infectious disease threats: now or never

• Published in: BMJ global health 2019-08, Vol.4 (4), p.e001885
• Main Authors: Shahpar, Cyrus, Lee, Christopher T, Wilkason, Colby, Buissonnière, Marine, McClelland, Amanda, Frieden, Thomas R
• Format: Article
• Language: English
• Subjects: Disease; Ebola virus; Economics; Emergency preparedness; Epidemics; Global health; Health surveillance; Income; Infectious diseases; Outbreaks; Pandemics; Public health; R&D; Regional development; Regional planning; Research & development; Severe acute respiratory syndrome
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2019-001885

During 1997–2009, economic losses from six major outbreaks averaged $6.7 billion per year, and the cost of the 2014–2016 Ebola epidemic alone is estimated at $53 billion.3 Preparedness can prevent many outbreak-related costs, with estimated incremental worldwide expenditure of $4.5 billion per year needed to upgrade public health systems in low and middle-income countries, strengthen global institutions’ abilities to prevent and respond to emergencies, and invest in research and development of new vaccines, diagnostics and countermeasures for epidemic and pandemic-prone diseases.4 Unfortunately, preparedness, although more effective and less costly than response,5 rarely ranks high on political agendas. Of the 24 least-prepared countries,2 20 (83%) are sufficiently low income to be eligible for International Development Association (IDA18) from the World Bank.7 In these countries, there are limited resources and competing demands, with the result that public health is often a low priority.8 The World Bank has recently dedicated additional support for health security in these settings through specific IDA projects such as the Regional Disease Surveillance Systems Enhancement project.8 Regional development banks can develop similar credit or grant programmes to build public health capacity in countries and protect regions from the economic shocks of large-scale outbreaks, as the Asian Development Bank has done.9 Prioritisation Stepping up preparedness is difficult, and requires that many incremental activities be done to achieve meaningful change. Management within health systems is particularly important in low-income settings, where efficient use of limited resources is critical to accomplish health goals.11–13 Those charged with leading preparedness activities need effective tools and skills to plan, implement and report on complex multisector National Action Plans for Health Security (NAPHS) across all 19 technical areas. Handling editor Seye Abimbola Contributors All authors of this paper made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; drafted the work or revised it critically for important intellectual content; made final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions