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 incubator for diseases. Since 2000, a series of epidemics, including severe acute respiratory syndrome (SARS), H1N1, Zika, and Ebola, have taken a significant toll, prompting experts to call for increased investment in global health security—efforts to help prepare 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.
U.S. government support for global health security has varied over the past two decades, often increasing in the immediate aftermath of health crisis, but declining again over time. Notably, after an outbreak of Ebola killed eleven thousand and infected twenty-seven thousand in West Africa in 2014, the United States invested $1 billion in building capacity to detect and respond to dangerous disease outbreaks in low-income and weak states. Those investments have helped countries make measurable improvements in their preparedness, but significant gaps and risks remain. The coordination and funding of the U.S. and international response to outbreaks has remained largely ad hoc, which limits its effectiveness. Without a robust, predictable, and well-coordinated international counteraction, 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 respond and control outbreaks, such as fragile or failed states, countries that are mired in civil war, or those experiencing a significant influx of refugees.