The Cost of Epidemic Preparedness: Public Health Watch

The Boy Scout motto is “Be prepared.”

Now, when it comes to epidemics of infectious diseases, we have a sense of the price of not taking that axiom to heart. An analysis posted recently by Wellcome suggests that these worst-case scenarios cost an excess of $60 billion annually in both direct and indirect costs.

Conversely, setting up systems to hopefully prevent and/or control large disease outbreaks, the organization estimates, would cost a fraction of that—or $4.5 billion a year. Indeed, Wellcome notes that “not preparing for epidemics costs far more than putting the systems in place to prevent infectious diseases from spreading around the globe.”

And, “if anything some costs are under-estimated,” Robert F. Garry, PhD, a professor at Tulane University School of Medicine, told Contagion®, referring to the economic toll of epidemics. Garry leads a consortium of scientists developing countermeasures against Lassa virus, Ebola and Marburg viruses, and other deadly pathogens in West Africa.

According to Wellcome, 4 years ago, when Ebola struck the region, it lost in excess of $2 billion in economic growth. Of course, more importantly, the epidemic also caused more than 11,000 deaths.

Furthermore, Wellcome estimates that more than 17,000 children in Guinea, Liberia, and Sierra Leone—the 3 countries hardest hit by Ebola—lost 1 or both parents to the virus. And, hundreds of “learning hours” went by the wayside because school closures mandated by the epidemic response.

The long-term implications for countries in which educational resources are already stretched are significant.

“In Sierra Leone, where I spend several months a year, children lost much more than about 100 days of school,” Garry noted. “A whole generation, particularly girls, lost critical years of education or were lost to the education system altogether. The already low literacy rate in the Ebola generation has decreased substantially.”

To illustrate the importance of preparedness—and allocating funds for such efforts—Wellcome essentially tells the tale of 2 Ebola outbreaks: The aforementioned crisis, which occurred in 2015, and the more recent outbreaks in the Democratic Republic of the Congo (DRC) and India, which began in 2018. The disease, while still devastating, has been effectively contained in the DRC in particular.

“Containing these events took a series of overlapping measures: global leadership working side by side with national governments and local health workers, adequate funding for research, and private-sector commitment,” Wellcome writes. “Indeed, we’re still witnessing how a coordinated response to the current Ebola outbreak in the DRC can overcome the challenges presented by the instability of a conflict zone.”

Of the estimated $4.5 billion in preparation costs, Wellcome suggests that $3.4 billion would fund upgrades to public health infrastructure and capabilities in low- and middle-income countries, with the remaining $1 billion-plus earmarked for research and development for epidemic diseases—within the World Health Organization’s (WHO) R&D Blueprint and under the auspices of groups such as the Coalition for Epidemic Preparedness Innovations.

“This is very dear to our hearts [and it] states the direction we are all headed and no one would disagree,” said Dale Fisher, MD, an infectious disease specialist at National University of Singapore and a member of the steering committee of the WHO’s Global Outbreak and Alert Response Network (GOARN) told Contagion® of Wellcome’s report. “That said, the fact is that it is easier said than done. And the need for response never goes away. Preparedness efforts need to be very deliberate and partitioned off from other demands or they fall to the bottom of the priority list. That list resides with donors, countries, WHO and nongovernment organizations with pressing needs including emergencies always taking precedent. Right now the world’s most developed countries with sophisticated health systems are preparing themselves against the novel coronavirus from Wuhan. But how much support is being offered to less developed countries which neighbor China?”