As heads of government from around the world gather at the UN in New York in the coming days, they are unlikely to make significant progress in tackling a pressing problem that so recently dominated their attention.
While conflict, climate change, and economic growth will be prominent in their discussions, the existential threat of communicable disease has largely fallen off the international diplomatic agenda — despite its lingering legacy and certainty of recurrence.
Covid-19 is a reminder that infectious disease remains a fundamental threat. The pandemic has killed millions of people, caused long-term harm to the health of many more, and triggered global economic disruption that has cost trillions of dollars.
Yet, despite prominent inquiries and ambitious proposals to enhance pandemic prevention and preparedness, much of the momentum has faded — even as new variants of coronavirus spread, mutate, and claim lives.
Policymakers’ attention is focused elsewhere. Bold ideas to allocate funding, distribute vaccines more equitably, and increase government accountability — which appeared in pandemic treaty drafts — have been significantly watered down.
“The urgency that gripped nations to be better prepared in the future has been replaced by complacency and compromise,” says Nina Schwalbe, a health consultant and adjunct faculty member at Columbia University’s Mailman School of Public Health. “If we squander the political will to fix our broken system in the wake of a pandemic, when will we ever do it?”
For years, economic growth supported by investment in public health — from improved sanitation to effective vaccines — seemed to be eliminating once prominent infectious diseases such as typhoid, polio, and smallpox. Even in lower-income countries, efforts significantly reduced the burden of former scourges like HIV and malaria. Shifting lifestyles have made cardiovascular disease, cancer, and other non-communicable threats the primary focus for health systems in both richer and poorer populations.
But the pandemic has highlighted the close connections between communicable and non-communicable disease and the need for healthcare capacity to handle infectious diseases. People with underlying conditions were more vulnerable to Covid-19, and many survivors have developed “long Covid”.
While the previous pandemic on the scale of Covid-19 began more than a century ago, newly emerging infections continue to spread. In addition to periodic epidemic threats like Mers, Sars, and H5N1 “bird flu”, some serious conditions such as tuberculosis (TB) persist and claim more than 1.5 million lives each year.
The complex, expensive, and often ineffective treatments for TB are one example of the broader and growing threat of antimicrobial resistance (AMR), which already kills 1.3 million people annually. “It’s a huge risk,” says Tom Frieden, former head of the US Centers for Disease Control and Prevention. “We could soon be in a post-antibiotic era. We’re losing them faster than we’re developing them.”
Frieden now leads the organization Resolve to Save Lives, which is working on an improved future pandemic response, along with efforts to address cardiovascular disease. “We need sustained investment in preparedness instead of the cycle of panic and neglect,” he says. He advocates for a new “7-1-7” framework: seven days to detect a suspected infectious disease outbreak, one day to notify public health authorities to begin an investigation, and seven days to complete an initial response.
However, economic pressures and populist politics have resulted in reduced foreign aid budgets in countries like the UK, undermining momentum for new pandemic initiatives and support for neglected tropical diseases such as bilharzia and trachoma.
While these conditions are primarily concentrated in rural and impoverished regions, climate change is introducing new threats to urban and wealthier areas as well. Florida recently reported the first cases of locally transmitted malaria in two decades. Other infections, from Lyme disease to Chagas, continue to spread.
Funding to combat these infections, diverted by the pandemic, is yet to recover. This is one of the reasons why UNAids, the UN’s HIV/Aids program, launched a Global Council on Inequality, Aids, and Pandemics over the summer to re-emphasize the burden, interconnectedness of diseases, and the need for more coordinated responses.