A framework for stimulating economic investments to prevent emerging diseases

Over the last decade, the global community has experienced the repeated burden of emerging diseases, including pandemic influenza, Ebola, and Zika virus epidemics. Other pathogens, such as influenza A (H7N9), Middle East respiratory syndrome coronavirus, and Nipah virus, have demonstrated their capacity to become global threats. The increasing incidence of multidrug-resistant pathogens has become a pressing global health threat that challenges both the human and animal health sectors. The prospect of a post-antibiotic era prompted a high-level consultation on antimicrobial resistance at the 2016 United Nations General Assembly. Infectious disease emergence and multidrug-resistant pathogens are among this century's defining global health challenges. The magnitude of their present and potential impact is sobering. In addition to the disease burden and social impact on families and communities, economic losses due to epidemics and pandemics are often more significant than the direct immediate and longer-term medical expenses. The World Bank estimates the global cost of the 2003 severe acute respiratory syndrome pandemic at 30 billion United States dollars. The 2013-2016 Ebola virus disease outbreak was associated with 2.2 billion in lost economic growth for Guinea, Liberia, and Sierra Leone alone. Total costs attributable to both income loss and premature mortality from a moderately severe influenza pandemic are projected at 570 billion annually, which is within the range of the annual cost associated with global climate change. Without intervention, the cumulative economic impact of antimicrobial resistance through 2050 is anticipated to exceed 100 trillion, two-thirds of which would be in low- and middle-income countries, substantially more than current annual global economic output. Increasingly, the evidence base suggests that the accelerated rate at which infectious diseases of pandemic potential and antimicrobial resistance are emerging is strongly correlated with anthropogenic change on the planet. Rapid population growth and demographic shifts, coupled with soaring demand for animal-sourced nutrition, changes in food-production systems, global travel and trade, and an increasing remodelling of our natural landscapes, are opening new pathways to emerging and re-emerging diseases. The World Bank and health and development institutions have made the case for investing in proactive, preventive measures that directly address these drivers, and for enhancing capacities that can contribute to averting the worst of their consequences. A yearly investment of 1.9-3.4 billion to strengthen animal and human health systems would yield an estimated global public benefit of over 30 billion annually, because it would avoid the economic damages associated with pandemics.