The World Knows an Apocalyptic Pandemic Is Coming

But nobody is interested in doing anything about it.

By , a former senior fellow for global health at the Council on Foreign Relations and columnist for Foreign Policy.
A Chinese U.N. soldier prepares a truckload of Ebola relief aid after it was airlifted by the United Nations Children's Fund (UNICEF), on August 23, 2014 in Harbel, Liberia.
A Chinese U.N. soldier prepares a truckload of Ebola relief aid after it was airlifted by the United Nations Children's Fund (UNICEF), on August 23, 2014 in Harbel, Liberia. John Moore/Getty Images

A new independent report compiled at the request of the United Nations secretary-general warns that there is a “very real threat” of a pandemic sweeping the planet, killing up to 80 million people. A deadly pathogen, spread airborne around the world, the report says, could wipe out almost 5 percent of the global economy. And we’re not ready.

The ominous analysis was compiled by an independent panel, the Global Preparedness Monitoring Board (GPMB), which was assembled last year in response to a request from the office of the U.N. secretary-general, and convened jointly by the World Bank and World Health Organization (WHO). Co-chaired by the former WHO head and former Norwegian Prime Minister Gro Harlem Brundtland and the head of the international Red Cross, Elhadj As Sy, the GPMB commissioned expert studies and issued a scathing attack on the political, financial, and logistical state of pandemic preparedness affairs.

“Preparedness is hampered by the lack of continued political will at all levels,” read the report. “Although national leaders respond to health crises when fear and panic grow strong enough, most countries do not devote the consistent energy and resources needed to keep outbreaks from escalating into disasters.”

With no intention of degrading the GPMB’s effort, I must sadly say that this core message has been shouted from the rafters many times before, with little discernable impact on tone-deaf political leaders, financial enterprises, or multinational institutions. There’s no reason to think this time will be any different. It’s hard to know what, shy of a genuinely devastating pandemic of killer influenza or some currently unknown microbe, will motivate global leaders to take microscopic threats seriously.

In May 1989, Nobel laureate Joshua Lederberg gathered fellow Nobelists and a roster of extraordinary virus-hunters for a three-day meeting in Washington to consider a then bold hypothesis that viruses, far from being vanquished by modern medicine, were actually surging worldwide in animals and people, often in forms never previously seen. And air travel increasingly meant that an outbreak in an obscure location could spread to large cities, even make its way around the world. At the time, the exploding HIV/AIDS epidemic focused collective attention: If the incurable virus could claim millions of lives, what other threats might lurk? During the gathering I felt tensions rise by the hour, as the volume of evidence grew in support of the dire hypothesis.

The National Academy of Sciences’ Institute of Medicine was sufficiently shaken by the meeting that it delved further, beyond the kingdom of viruses to all microbial threats, and in 1992 published a call to arms—a report that drew sufficient interest at U.S. President Bill Clinton’s White House to prompt the formal classification of emerging diseases as national-security threats in 1996.

In 1994 I published my book on the subject, The Coming Plague: Newly Emerging Diseases in a World Out of Balance, arguing that human disruption of the global environment, coupled with behaviors that readily spread microbes between people and from animals to humans, guaranteed a global surge in epidemics, even an enormous pandemic. And in 2000, my book Betrayal of Trust: The Collapse of Global Public Health demonstrated that outbreaks were aided and abetted by inept health systems, human behavior, and the complete lack of consistent political and financial support for disease-fighting preparedness everywhere in the world.

So what has changed?

An enormous number of previously unknown viruses, such as the one that caused the 2003 epidemic of severe acute respiratory syndrome (SARS), have claimed the lives of people and animals around the world. In just seven years (from 2011 to 2018), for example, the WHO did battle with 1,483 epidemics.

And the costs of containment, coupled with the disruptions’ general economic impact, have worsened, according to a GPMB study commissioned by the World Bank. The 2003 SARS epidemic exacted a toll of about $40 billion on the global economy, the 2009 swine flu epidemic reached about $50 billion, and the 2014-16 West African Ebola epidemic cost nearly $53 billion. An influenza pandemic akin to the 1918 flu would today cost the world economy $3 trillion, or up to 4.8 percent of global gross domestic product (GDP).

Economically, wealthy nations have proven the most resilient in recent outbreaks, and the GPMB predicts that countries such as the United States and Germany could get through a devastating epidemic with less than 0.5 percent loss of GDP. But poorer nations—from India and Russia down to the countries of Central Africa—could lose up to 2 percent of their GDPs from the same hypothetical pandemic. The West African Ebola epidemic directly cost the hardest-hit countries—Liberia, Sierra Leone, and Guinea—$2.8 billion, knocking Sierra Leone’s GDP down a whopping 20 percent in 2015.

And risks are increasing. Climate change favors outbreaks, as rising heat and humidity spawn surges in populations of disease-carrying mosquitoes, allow water surfaces to suffocate under toxic algae, fill hospitals and agricultural fields with deadly fungi, and change the migratory patterns of birds and animals—which, in turn, carry their microbial hitchhikers to new geographies.

Consider the events of the first two weeks of this month, for example. A mysterious explosion in a Soviet-era laboratory complex outside Novosibirsk, Russia, raised concerns about the safety of smallpox and hundreds of other viruses locked in the facility’s freezers. The Russian lab, known as Vector, was once one of a handful of top-security pathogen research centers in the world, but today there are more than 1,000 such so-called Biosafety Level-3 and -4 labs, in which lethal microbes are stored and studied: Many of the facilities have had leaks and safety breeches. Australia’s H3N2 influenza is still spreading as the country heads into spring. Seemingly on track to be the nation’s largest flu year—for both cases and hospitalizations—in recent history, it has sickened 279,326 Australians so far, a possible harbinger of what’s ahead in a few weeks for North America. According to the Pan American Health Organization, more than 2,384,029 people in Latin America and the Caribbean contracted dengue virus infections last week alone. The so-called TR4 fungus is suddenly wiping out bananas across Central America and recently turned up in Australia, increasing fear of the fruit’s extinction. The African swine-fever epidemic that started in China late in 2018 has spread across Asia and just turned up in the Philippines: Tens of thousands of pigs in the region have died of the incurable, usually lethal disease.

The GPMB says that the current Ebola epidemic in the Democratic Republic of Congo (DRC) exemplifies everything that is wrong with the current state of epidemic preparedness. When it first emerged on Aug. 1, 2018, according to a report commissioned by GPMB, “the fundamentals of an effective response were put in place within days of the declaration of the outbreak. The response in the first weeks of August was the fastest, best equipped, and best-funded in the history of Ebola outbreak response.” Yet despite these efforts, “the outbreak in North Kivu and Ituri persisted and spread, crossing the national border to Uganda in June 2019, and reaching Goma, the capital of North Kivu in July 2019. The outbreak now stands, [after] more than one year, [at] 3000 cases, and 2000 deaths since its declaration.”

The Ebola response has failed in the DRC so far because the country’s health system is in shambles, the outbreak is nested in a violent war zone, the local population harbors deep suspicions about it and fails to fully cooperate with health authorities, donors have left DRC humanitarian needs woefully underfunded, and the Ebola response is compelled to beg for dollars and euros.

Prospects for even deadlier, airborne microbes have also risen since the 1989 gathering of scientists in Washington because the technology to alter viral and bacterial genes is now fast, easy, cheap, and precise. Whether achieved via CRISPR or even newer genetic manipulations, it is now possible to give microbes all sorts of attributes—or make them, from the DNA up. Whether a man-made killer leaks accidentally, or is deliberately spread by malevolent individuals, no nation has the organization and technology to halt an outbreak once the germs escape their lab confines.

The GPMB provided a list of seven policy initiatives that should be implemented worldwide to improve humanity’s odds against the microbes. All of them have, in some form, been on the table for years, even decades. We have been here before.

“Preparedness and response systems and capabilities for disease outbreaks are not sufficient to deal with the enormous impact, rapid spread and shock to health, social and economic systems of a highly lethal pandemic, whether natural, accidental or deliberately released. There is insufficient R&D investment and planning for innovative vaccine development and manufacture, broad-spectrum antivirals, appropriate nonpharmaceutical interventions,” read the GPMB report. “Epidemic control costs would completely overwhelm the current financing arrangements for emergency response.”

The United Nations General Assembly that convenes in New York this week and next, and delegates will be deluged with similarly grim reports about climate change, humanitarian crises, refugees, intractable conflicts, diminishing supplies of safe drinking water, and literally dozens more crises. Every one merits attention, financing, and global cooperation.

In 1996, the Clinton administration declared that “emerging infectious diseases such as Ebola, drug-resistant tuberculosis, and HIV/AIDS present one of the most significant health and security challenges facing the global community,” and issued an eight-point plan for improving pandemic preparedness. The specifics may have changed, but the tone and recommendations in the new GPMB pandemic report are remarkably similar, if not more urgent. The GPMB insists it is possible to render microbial outbreaks to controllable, containable scale—if humanity has the political and financial will to do so.

So far, however, humanity has pushed disease threats out of its collective consciousness shortly after every epidemic ceased. The 1918 influenza pandemic killed some 50 to 100 million people—estimates vary widely. And the plague of the 14th century claimed 60 percent of the European population: roughly 50 million souls. We have already, in my lifetime, failed to stop HIV, which, since its emergence on the global stage in 1981, has sickened 75 million people, killing about 32 million of them.

We know there will be another terrible epidemic—perhaps not as large as 1918 flu or the plague, but awful nonetheless. Yet it will likely take much more than expert reports to mobilize serious collective efforts to prevent and prepare catastrophe.

Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations, a Pulitzer Prize winning science writer, and columnist for Foreign Policy. Twitter: @Laurie_Garrett