A green reboot for cities: Strategies for post-COVID growth

In the case of pandemics, billions of dollars in prevention are worth trillions of dollars for the cure. But how do we translate that simple insight into effective action that saves lives? 

Countries, influential stakeholders and institutions have largely failed to take preventative action, despite clear evidence of need following the SARS and avian influenza outbreaks. The consequences are clear, and the world is now paying the price for failing to take advantage of past opportunities to make prevention a priority.

In March 2021, 26 heads of government and the director-general of the World Health Organization (WHO) called on other global leaders to build a robust international health architecture to protect the world from future pandemics and other health crises.

At the core of their appeal is the establishment of a new treaty intended to commit countries to better tackling diseases such as COVID-19, Ebola, influenza and SARS — and whatever new health threats lurk beyond the horizon. We must foster an inclusive approach that brings together governments and society to respond to future crises more effectively.  This includes championing the ‘One Health’ concept, which underscores the interdependence of animals, humans and their environment when it comes to health.

Some 75% of emerging infectious diseases come from animals and most of them are driven by human activities and their impact on the environment. Applying the One Health lens is therefore critical: it drives stakeholders from all sectors to better understand emerging infectious diseases and address the root causes.

The proposed treaty would represent a much-needed signal of high-level political commitment to protect the world from health crises. It would be more effective still, if the treaty explicitly endorsed prevention and harnessed significant financing to that end—including controlling health risks at the animal source.

Estimates from the avian flu crisis and the fight against antimicrobial resistance make a compelling case for investing in prevention, with returns on investment in the range of 44% to 88%, which is well above the returns available on nearly all other public spending and in private capital markets.

Recent estimates of prevention costs, including the monitoring and prevention of disease spillover driven by the loss and fragmentation of tropical forests and the wildlife trade, range between $18 billion and $27 billion per year over 10 years. According to the Bank’s January economic forecast, the global economy contracted by 4.3% in 2020 due to COVID-19. That amounts to about $3.6 trillion worth of goods, services and other output lost. This does not include the many different ways people suffered the downturn, through death, illness, loss of livelihood or disruption of schooling, for example.

In other words, the annual cost of prevention is less than 1% of the cost of the current pandemic!

Yet —somehow —the economic argument, while compelling, has failed to convince the international community to mobilize sustained financing.

What would effective prevention look like?

Veterinary Services, from the local community level to the World Organisation for Animal Health (OIE), have a key role to play in addressing pandemic risks at the source.  By improving animal health and welfare, they fulfill the fundamental mission of protecting human populations from animal diseases, and vice-versa. This responsibility is increasingly shared by the broader community because emerging diseases are, to a large extent, driven by numerous factors, such as climate change, land use, agricultural expansion, food systems, urbanization, conflicts.

Today, leaders are seeking solutions through different initiatives. A One Health High-Level Expert Panel, initiated by France and Germany, was launched in November 2020. The G7 aims to build back better, learning from what worked well to be better prepared for future pandemics and threats to public health. The European Council backs the idea of a strong pandemic treaty. Under the Italian presidency of the G20, countries are reflecting on the need to align their foreign policy to their domestic One Health approaches, offering incentives for other countries to take up the same steps. We must ensure that these multilateral proposals are coordinated and provide equitable and inclusive approaches. Success is only possible with sustainable financing.

In order to have real teeth, the treaty proposed by world leaders should come with the establishment of a Global One Health Support Facility. The facility, as part of a broader ecosystem of financing mechanisms, could increase, and most importantly sustain, public spending, private investments, and leverage financial resources for disease prevention, serving everyone’s best interests and protecting lives and livelihoods at a global scale. Because an effective global One Health system is only as strong as its weakest link, this fund should strengthen prevention capacities in the countries that need help the most, typically low- and middle-income countries.  

Pandemics don’t recognize borders; investing in prevention is the ultimate global public good.  We left the job unfinished when we failed to take action during past outbreaks. If we don’t learn from our missteps in the aftermath of previous pandemics then we will pay the price when—not if—the next pandemic hits. Coordinated action by the international community is a non-negotiable need. The Bank and the OIE, along with other key partners, are exploring options for a financing architecture that will provide sustained support for effective One Health actions across the world for zoonotic disease prevention.

In a few weeks, the G20 will hold the Global Health Summit, an opportunity for concrete multilateral agreements on the prevention of future global health crises. It is time to act decisively and take a proactive, preventative approach in the face of emerging diseases to build a strong global One-Health system.  This is the only way we can break the cycle of panic and neglect. The only way we can undermine the effects of future pandemics.

Let’s seize this opportunity to make zoonotic disease prevention a priority, and commit to the building of a healthier, safer, fairer and more sustainable world.