China was completely unprepared when the virus now known as SARS emerged in the late autumn of 2002. Among other deficiencies, the government had almost no medical or administrative infrastructure in place to identify, monitor and respond to an epidemic, much less to notify the rest of the world of the impending danger. As a result, thousands of people were infected, almost 800 died, and the global economy suffered at least $40 billion in losses.
China is now facing another emergent disease, 2019n-CoV, which appears to have originated in a wet market in Wuhan. So far, the death toll is in the single digits, with hundreds of people infected, and hundreds more illnesses potentially undetected. Like SARS, this virus can be transmitted between humans and, worse, it's spreading just as hundreds of millions of Chinese begin traveling for the Lunar New Year.
The good news is that China has spent two decades improving its ability to respond to disease outbreaks. Although the response this time has been far from perfect, it's considerably better than the deadly coverup that ensued during SARS.
The bad news is that infectious diseases don't respect borders. US officials reported Tuesday that a person traveling from China to Washington state was infected with the virus. Since China first reported the new virus at the end of December, imported cases have also appeared in South Korea, Japan and Thailand. Worse, neither China nor most of the world is prepared for the worst-case scenario: a global pandemic capable of killing many times the number of people infected by SARS.
Global pandemics aren't anything new. Bubonic plague wiped out 50 million Europeans in the 14th century, and the 2009 H1N1 "Swine Flu" may have killed as many 570,000 people globally in its first year alone.
What's new is the quickening pace of infectious disease outbreaks. Between 2011 and 2018, the World Health Organization tracked 1,483 epidemic events in 172 countries. Some were relatively minor, but others — like H1N1, Ebola and Middle East Respiratory Syndrome — cost thousands of lives and billions of dollars. And there are always more emerging: The World Health Organization identifies two disease outbreaks per week in the Western Pacific, home to 1.9 billion people. Due to population growth, urbanization, greater interactions between humans and wild animals, and climate change, that pace will continue and likely accelerate.
It's a threat at least as serious as a war, a natural disaster like a volcano, or the worst of all possible terrorist scenarios. Yet, rather than address the issue preemptively, the global community has largely fallen into an expensive cycle of "panic and neglect" in which resources are rushed to an outbreak, and then fall off as the illness fades into memory. That cycle leaves most countries without the resources to detect much less control and treat new infectious diseases.
In 2019, the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security released the Global Health Security Index, a comprehensive assessment of 195 countries. It reviewed dozens of criteria — such as a country's ability to prevent the release or emergence of pathogens, and its compliance with international health norms — and came to a profoundly troubling conclusion: "National health security is fundamentally weak around the world." Unsurprisingly, higher-income countries scored better than lower-income countries, but "no country is fully prepared for epidemics or pandemics." Specific results are alarming. Only 19% of countries received top marks for detection and reporting, fewer than 7% got top marks for their ability to prevent the release or emergence of pathogens, and fewer than 5% qualified for the top tier of countries capable of rapid response to the spread of an epidemic.
Many of these findings have been known for decades, and little has been done to address them. This most recent outbreak is a good opportunity to reassess that inaction, and take a hard look at the many plans, recommendations and road maps that have been drawn up by experts over the years to boost global preparedness. Among the most important are ideas for providing funding to emerging markets that lack resources to improve health infrastructure, such as the establishment of a global health security matching fund. The National Academy of Medicine estimates that global spending of $4.5 billion a year would be sufficient to prepare the world for the next pandemic. The alternatives — tremendous loss of life, and economic losses that could total in the trillions of dollars — are far more costly. Wealthy, developed countries should view that number as a bargain, and rush to fund it.
Of course, forging global consensus on any issue is difficult, but especially when it requires long-term planning and financial sacrifice — no matter how limited — on the part of the well-off. Policy makers seeking to address climate change know it well. But if there ever was an issue that should unite interests at loggerheads over the future, it is the protection of global health. China's latest emergent virus should be the occasion to take action, finally.