Note: this article was originally written and published in 2016, three years before the outbreak of COVID-19 in Scenario magazine, a Copenhagen Institute for Future Studies publication. Authors: Kyle Brown and Simona Arminaite.
The achievements of modern medicine and improvements in public health and hygiene make it difficult to comprehend the possibility of a fatal outbreak of disease in today’s societies. Especially in the developed world, many see pandemics – widespread epidemics of infectious diseases – as a threat of the past. Diseases like the black Death in the Late Middle Ages seem to be regarded as historical concerns and relics of past times. However, in a world more connected than ever, the perceived confidence found in many developed regions is just a false sense of security.
Take for instance the 2014 Ebola outbreak in West Africa, which killed over 10,000, or the 2009 H1N1 flu virus that killed 250,000 to 600,000. Or consider the older but graver example of the Spanish flu of 1918-1919, which killed millions worldwide. Though much progress has been made in medicine since then, what made the Spanish flu so deadly was precisely that it arrived in a time of massive global transportation of people and goods, carrying the disease to all corners of the world. What would the consequences be if we were hit by a similar pandemic in today’s hyper-globalised world?
A severe pandemic is typically viewed by international organisations as a top global catastrophic risk – one that is higher than the risk of terrorism due to the widespread impact. While the casualties of more recent outbreaks generally pale in comparison to historical pandemics, we are much more vulnerable to future pandemics than we’d like to think – in spite of the numerous advances in modern medicine. A future pandemic represents a wildcard scenario – a low-probability, but high impact future that will have wide-ranging consequences for societies and economies across the globe.
Mutant bugs
Despite the many uncertainties about the location, timing of onset, attack rate, morbidity, and mortality of the next pandemics, most professionals in public health, medicine, and epidemiology consider future pandemics to be inevitable. Experts agree that the most likely type of disease to reach pandemic proportions will be a novel form of influenza virus, to which there is little or no immunity in the human population, and which spreads easily from person to person.
In addition, the possibility of global pandemics arising from known diseases such as HIV/AiDS, SARS, Ebola, smallpox, and other viruses still exists. The threat not only arises from the inherent danger of viruses themselves in an era of globalisation, but from evolving mutations. The Centre for Disease Control and Prevention and the World Health Organisation both recognise growing multidrug, antibiotic, and antimicrobial resistance among some of the most prevalent and harmful viruses.
Globalisation and cities
Our world is changing rapidly, and with it, so are the conditions for a future outbreak of a global pandemic. At the same time, the interdependence and fragility of our modern, underlying socioeconomic systems are raising the stakes. A growing number of trends are increasing the risk of a pandemic outbreak, challenging the resilience of our current progress in health and medicine.
Firstly, calculations show that there is a strong correlation between the risk of pandemic and human population density. A growing global population and increased urbanisation mean that the spread of disease within populations will be accelerated. The population growth projected by the United Nations is expected to reach 9.6 billion people by mid-century, and 11.2 billion by 2100. Likewise, the global urban population is expected to increase from 54 per cent in 2014 to 67.5 per cent by 2030. The emergence of megacities, megacorridors, and massive metro-regions in many places of the world will also likely facilitate the spread of communicable diseases should an outbreak occur.
Secondly, not only is the overall level of urbanisation rising, but the rapid growth has been disproportionate and particularly dramatic among low-income countries. This has led to the explosion of slums – squalid and overcrowded urban areas inhabited by very poor people. Some call areas such as these social ‘time bombs’ ready to explode, as their development is unplanned and they often lack basic infrastructure such as water and waste management. According to a World Economic Forum report, almost 700 million urban dwellers currently lack adequate sanitation. This problem is particularly urgent in Sub-Saharan Africa and South-Central Asia, where 62 per cent and 43 per cent, respectively, of the urban population live in slums. In such conditions, infectious diseases can easily flourish and spread to neighbouring regions.
Lastly, in our hyper-connected world, it is easier for pathogens, which cause disease or illness, to be carried from one place to another and quickly scale up the reach and impact of infection. Modern air travel means that an outbreak of infectious disease in one country could spread worldwide in a matter of days, instead of taking months or years. The outbreak of severe acute respiratory syndrome (SARS) in the early 2000s is illustrative of the potential for bugs to travel and the challenges of containment. On February 21, 2002, a medical professor from Guangzhou checked into the Metropole hotel in Hong Kong for one night. He brought with him the SARS virus, infecting other guests, who subsequently spread the disease to Vietnam, Singapore and even as far as Toronto. The growing sophistication of transport networks, connecting not only people but also goods in the global value chain, could make the spread of infectious disease extremely quick and limit our ability to contain the spread.
The cost of a cold
When speaking about the effects of pandemics, we tend to measure the outbreaks of a disease on the number of infected, the severity of the disease caused by a virus, the vulnerability of affected populations, and the effectiveness of preventive steps. However, pandemics alter not only a population’s health and well-being, but societal structures as well.
In the event of a severe epidemic, political power would likely funnel upwards, with local and state authorities dictating a public response programme, suggesting closure of schools and limiting public gatherings to reduce the threat of transmission. Health service providers, police or even military personnel would likely be involved to manage the chaos, if not civil unrest, especially if the centres of the disease could be identified. The fallout would certainly create national and even international security concerns, requiring a coordinated response.
The size of the workforce would also shrink in a time of such crisis. A pandemic would result not only in direct economic costs, but in indirect costs including absenteeism or shortages in the labour force and associated productivity losses. Moreover, a pandemic would significantly disrupt supply networks and reduce demand in transport, trade, communication, payment systems and major utilities, leading to an overall economic decline. According to the World Bank, a single severe flu pandemic could cost upwards of USD 3 trillion.
As we can learn from historical pandemics, unmanageable catastrophes not only affect the daily life in the short term, but also bring forth a general reorientation of society in the long term. Of course, research interests will shift, preventive measures will be put in place, and products and services will be created in the aftermath and rebuilding following a pandemic, but there will also be more significant, lasting changes. It is difficult to outline precisely how this will take place, though in a new period of political turmoil, globalisation and the existing socio-economic order will likely be challenged both philosophically and pragmatically. New values, belief systems, and paradigms will emerge and become reflected in new socio-economic and political structures that seek to safeguard humanity from future pandemics and other catastrophes.
