A global epidemic far worse than the Ebola outbreak is a real possibility and could kill many millions if the world does not become better prepared to deal with the sudden emergence and transmission of disease, the UN has said in a hard-hitting report.

The report has emerged in draft form, as experts rally to deal with the rapid spread of the Zika virus across Latin America, which has been linked to thousands of cases of brain damage in babies.

Countries in the region have again been caught off-guard because of the lack of scientific knowledge about the virus and the absence of good data on microcephaly, a condition in which babies’ heads fail to grow properly in the womb.

The report comes from the high-level panel on the global response to health crises, set up by the UN secretary general in April 2015, as the Ebola epidemic that killed more than 11,000 people finally waned. Several other inquiries into what occurred, and the slow and inadequate response by the World Health Organisation (WHO), have reported and fed into the UN panel’s conclusions.

Too often, global panic about epidemics has been followed by complacency and inaction UN report

“The high risk of major health crises is widely underestimated, and … the world’s preparedness and capacity to respond is woefully insufficient. Future epidemics could far exceed the scale and devastation of the west Africa Ebola outbreak,” says the panel’s chair, Jakaya Mrisho Kikwete from Tanzania, outlining their findings in the preface.

“Too often, global panic about epidemics has been followed by complacency and inaction. For example, the 2009 influenza pandemic prompted a similar review of global preparedness, but most of its recommendations were not addressed. Had they been implemented, thousands of lives could have been saved in west Africa. We owe it to the victims to prevent a recurrence of this tragedy.”

The report, which has been posted online in advanced, unedited form in the UN’s Daily Journal, is not just about the mishandling of Ebola, but about the crucial need for the world to put in place systems to detect and fight new disease threats.

“Notwithstanding its devastating impact in west Africa, the Ebola virus is not the most virulent pathogen known to humanity,” says the report. “Mathematical modelling by the Bill and Melinda Gates Foundation has shown that a virulent strain of an airborne influenza virus could spread to all major global capitals within 60 days and kill more than 33 million people within 250 days.”

Other diseases that have recently caused widespread suffering include four major outbreaks of Middle East Respiratory Syndrome (Mers) in Saudi Arabia and the Republic of Korea, the pandemics of avian and swine flu and severe acute respiratory syndrome (Sars). “These all serve as stark reminder of the threat to humanity posed by emerging communicable diseases,” says the report.

The panel says surveillance and response to outbreaks must be led by the WHO, but the key role should be played by a centre for emergency preparedness and response. The centre “must have real command and control capacity”, says the report, and it should have the best technology available to identify, track and respond to an emerging threat.

The report also says countries must report on their state of compliance to WHO every year and must be regularly reviewed.

All countries must give the WHO more money, says the report – an increase of at least 10% in their funding. In addition, they must put $300m for a contingency fund for emergencies, not $100m as recently set up. A further fund worth $1bn must be set up for the development of vaccines, drugs and testing equipment.

Prof Jeremy Farrar, director of the Wellcome Trust, said: “Epidemic and pandemic diseases are among the greatest of all threats to human health and security, against which we have for too long done too little to prepare. After four inquiries into the preventable tragedy of Ebola, there is now a strong consensus about what must be done. The WHO’s leadership and member states must make 2016 the year of decision and act now to build a more resilient global health system.



“As the UN panel and the other inquiries recommend, the cornerstones of better health security must be a strong, independent WHO centre to lead outbreak preparedness and response, new mechanisms and financing for developing vaccines, drugs and diagnostics for potential epidemic threats, strong community engagement and investment in basic health infrastructure in every country, not just those that can afford it.”