“There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people.”

That’s from the opening paragraph of a major new report on our current state of pandemic preparedness. It doesn’t get much more optimistic from there.

This is the first annual report authored by the Global Preparedness Monitoring Board, an independent panel of experts convened by the World Bank and the World Health Organization “to provide the most frank assessments and recommendations possible.”

They very frankly warn that the risk of a global pandemic is growing. The next big one to hit us could be naturally occurring, deliberately created, or accidentally released. Although we’ve got new vaccines and drugs that previous generations didn’t have access to, we’ve also got new developments working against us.

Scientific advances have made it possible for disease-causing microorganisms to be engineered or recreated in labs, or to escape labs when explosions and other accidents occur. Our robust transportation infrastructure makes it easy for travelers to pick up a disease in one country, fly across an ocean, and spread the disease to another country within hours. Increased urbanization and population growth also exacerbate the spread of disease.

And then there’s climate change, which causes natural disasters that strain national health systems, weakening their ability to efficiently respond to outbreaks. Global warming is also expanding mosquito habitats, which means we’ll likely be seeing more mosquito-borne illnesses like Zika, dengue, and yellow fever — including in the US and Europe.

The convergence of these trends is making us all more susceptible to what the report calls “global catastrophic biological risks.” We’re not prepared to handle them. To change that, the report states, we need to act decisively now. But there’s a lack of political will to do that.

We need leaders to care about pandemics. That means we need to care, too.

National leaders tend to respond to health crises only when the public expresses enough panic. Unfortunately, we’ve got a habit of paying attention to pandemics only when they’re actually upon us.

“For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides,” the report says.

Our current approach is like waiting to fix a giant hole in your roof until a storm cloud actually breaks and rain starts pouring in. But in 2019, we really can’t afford to do that: The world is so interconnected that storm clouds are coming at us from all directions.

Pandemics pose risks not only to our health but also to our economies. Consider the estimated costs of past outbreaks: a loss of over $40 billion in productivity from the 2003 SARS epidemic; a $53 billion loss from the economic and social impact of the 2014-2016 West Africa Ebola outbreak; and a $45-55 billion cost from the 2009 H1N1 influenza pandemic.

If, tomorrow, we had a global influenza pandemic akin to the scale and virulence of the one that struck a century ago — in 1918, the Spanish flu killed around 50 million people — it would cost our modern economy an estimated $3 trillion. And, the report notes, “If a similar contagion occurred today with a population four times larger and travel times anywhere in the world less than 36 hours, 50-80 million people could perish.”

To avoid such an outcome, the report makes several recommendations — some scientific, some financial, some social. Here are five standout suggestions:

Heads of government in every country should invest significant sums of money in preparedness as an integral part of national and global security.

in preparedness as an integral part of national and global security. All countries should develop a system to immediately share genome sequences of any new pathogens.

of any new pathogens. Public health programs should build trust with local populations so that they will be likelier to follow instructions in the event of an outbreak.

with local populations so that they will be likelier to follow instructions in the event of an outbreak. Health officials should involve women in planning and decision-making, particularly because the majority of caregivers are women and their engagement ensures that policies and interventions are accepted.

in planning and decision-making, particularly because the majority of caregivers are women and their engagement ensures that policies and interventions are accepted. Donors should increase funding for the poorest countries to close financing gaps for their national action plans for health security.

The wisdom of some of these recommendations is easy to see if we consider recent and ongoing outbreaks. For example, one reason Ebola has proven so hard to contain in the Democratic Republic of the Congo is that there’s a trust problem: Some people don’t trust Western NGOs or health workers and have been unwilling to follow their advice. Assailants have even attacked Ebola treatment centers and health workers.

The fragmentation of trust is not only a problem in countries like the DRC. The US and Europe are at risk, too. As Ron Klain, a former White House Ebola response coordinator, wrote for Vox:

New political and social trends further increase our risk level. A rising tide of anti-vaccine sentiment in the US and Europe is raising the risk of a resurgence of once-vanquished infectious diseases (like measles), and increasing the likelihood of massive vaccine resistance in the event of an epidemic. The ability of social media to rapidly spread false information — painfully illustrated in the 2016 campaign — is another source of danger: Would the directives of public health officials be followed in a crisis? Would they be undermined by misinformation spread by misguided provocateurs or a hostile foreign power?

Preventing and stamping out outbreaks requires high-level political will and big spending. But it also requires tackling social malaise that hampers local community support. Proactively building trust with people, and reaching out to women in particular, can help us stave off the next disaster.

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