2.1 The Issue
The number of infectious disease outbreaks has been rising for several decades. As populations grow and expand into previously forested areas, more people are contracting zoonotic diseases—infections that can be passed from animals to humans. Given increasing trade and travel to and within lower-income countries, outbreaks of infectious diseases such as Ebola and Zika viruses in remote rural villages are more likely to reach crowded cities with limited health systems, which are the ideal incubators for diseases. Since 2000, a series of epidemics, including severe acute respiratory syndrome (SARS), H1N1, Zika, and Ebola, has taken a significant toll, prompting experts to call for increased investment in global health security—efforts to help countries prevent, detect, and respond to epidemic and potentially pandemic diseases. Despite these calls, progress toward increased pandemic preparedness has been insufficient, a fact painfully underscored by the ongoing coronavirus disease 2019 (COVID-19) pandemic.
The coordination of international responses to outbreaks has remained largely ad hoc, which limits their effectiveness. Notably, after an outbreak of Ebola killed eleven thousand and infected twenty-seven thousand in West Africa in 2014, international agencies and countries around the world invested in building the capacity to detect and respond to dangerous disease events globally, especially in low-income and weak states. Those investments have helped nations make measurable improvements in their preparedness for dangerous disease events, but significant gaps and risks remain. Without a robust, predictable, and well-coordinated international response, an emerging and lethal infectious disease could devastate the country where it emerges, that country’s neighbors, and potentially the world. These risks are compounded in countries without the capacity to control outbreaks, such as fragile or failed states; countries that are mired in civil war; or those experiencing a significant influx of refugees.