Gathering pressures are straining health systems on many fronts. The 2020 Global Risks Report, produced by the World Economic Forum in partnership with Marsh & McLennan and Zurich Insurance Group, discusses long-standing challenges as well as the next generation of health pressures that health systems are now confronting.
There is no guarantee that health systems will continue to improve health, and clear signs of strain are apparent. Despite historic, hard-won success against diseases such as smallpox, some of humanity’s most formidable global health threats still linger — and other threats, thought to have been quashed, are resurgent.
Thirty years ago, polio was endemic in 125 countries, causing 350,000 clinical cases per year. After an extraordinary international effort and USD 20 billion in investment, today there are 99.9 percent fewer cases and polio remains endemic in only Afghanistan, Pakistan and possibly Nigeria — where geopolitical challenges have complicated eradication. (1) Polio could potentially be eradicated in the next four years — but the estimated cost to make that happen would be another USD 4.2 billion. (2) The last mile is proving the hardest, for reasons including persistent political instability and community resistance — which often stems in part from a perception that investments in polio eradication come at the expense of other health priorities. (3) Letting up is not an option because the short- and long-term benefits of eradicating this enduring scourge would be massive.
Similar stories can be told about HIV/AIDS, tuberculosis and malaria. After years of remarkable progress as a result of sustained political commitment and funding via the Global Fund, ambitions to end these epidemics by 2030 are being undermined by factors such as diseases’ increasing resistance to drugs. (4)
The World Health Organization (WHO) considers reluctance or refusal to vaccinate to be among the top 10 threats to global health. (5) Growing vaccine hesitancy has led to outbreaks of measles worldwide, including in developed countries where it had largely been eliminated. (6) New York City spent USD 6 million in 2019 responding to a completely preventable measles outbreak. (7) Making fewer headlines than the massive Ebola outbreak in the Democratic Republic of Congo, that country also recently saw the world’s largest measles outbreak, affecting over 200,000 people in less than a year. (8) The resurgence of measles is a symptom of complacency and recklessness.
Antimicrobial resistance (AMR)
As measles and other infectious diseases strain health systems by siphoning off limited resources and attention, overuse of antibiotics poses a direct threat to health and healthcare. AMR makes antibiotics less effective at treating illnesses. Surgeries that have become routine, infections we now think of as easily treatable, and some common illnesses could again become life threatening. (9) The WHO estimates that AMR could result in 10 million deaths by 2050. (10)
Considerable progress has been made since the Ebola epidemic in West Africa in 2014–2016, but health systems worldwide are still under-prepared for significant outbreaks of other emerging infectious diseases, such as SARS, Zika and MERS. A recent first-of-its-kind comprehensive assessment of health security and related capabilities across 195 countries found fundamental weaknesses around the world: no country is fully prepared to handle an epidemic or pandemic. (11) Meanwhile, our collective vulnerability to the societal and economic impacts of infectious disease crises appears to be increasing. (12)
Serious as these risks are, it can be argued that health systems nonetheless have a blueprint to mitigate them, and success requires only adequate attention. The same cannot be said for new health risks.
- WHO (World Health Organization). 2018. Review of Polio Endemic Countries. Report of the Independent Monitoring Board of the Global Polio Eradication Initiative on Progress in Afghanistan, Nigeria and Pakistan. September 2018. https://www.who.int/ immunization/sage/meetings/2018/october/4_Review_Polio_Endemic_Countires_Report_IMB_Final_revised.pdf
- WHO (World Health Organization). 2019. Proposed programme budget 2020–2021. 13 May 2019. https://apps.who.int/gb/ebwha/ pdf_files/WHA72/A72_INF3-en.pdf
- Razum, O., D. Sridhar, A. Jahn, S. Zaidi, G. Ooms and O. Müller. 2019. “Polio: From Eradication to Systematic, Sustained Control”. BMJ Global Health 2019; 4:e001633. https:// gh.bmj.com/content/4/4/e001633
- The Global Fund. 2019. “Global Fund Donors Pledge US$14 Billion in Fight to End Epidemics”. Press Release, 10 October 2019. https:// www.theglobalfund.org/en/news/2019-10-10global-fund-donors-pledge-usd14-billion-infight-to-end-epidemics/
- WHO (World Health Organization). 2019. “Ten Threats to Global Health in 2019”. https:// www.who.int/emergencies/ten-threats-toglobal-health-in-2019
- CDC (Centers for Disease Control and Prevention). 2019. “Global Health: Global Measles Outbreaks”. https://www.cdc.gov/globalhealth/measles/globalmeaslesoutbreaks.htm
- Soucheray, S. 2019. “US Measles Cases Hit 1,234 as Brooklyn Outbreak Called Over”. CIDRAP News. 03 September 2019. http://www.cidrap.umn.edu/news-perspective/2019/09/us-measles-cases-hit-1234brooklyn-outbreak-called-over
- UNICEF. 2019. “As Measles Deaths in the Democratic Republic of the Congo Top 4,000, UNICEF Rushes Medical Kits to Health Centers and Vaccinates Thousands More Children”. Press Release, 09 October 2019. https://www.unicef.org/press-releases/ measles-deaths-democratic-republic-congotop-4000-unicef-rushes-medical-kits-health
- Wellcome. 2019. “Q&A: What Are Drug-Resistant Infections?” Wellcome News. 09 September 2019. https://wellcome.ac.uk/news/what-are-drug-resistant-infections
- Review on Antimicrobial Resistance. 2016. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. May 2016. Wellcome Trust and UK Government. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
- NTI (Nuclear Threat Initiative). 2019. “Global Health Security Index: Inaugural Global Health Security Index Finds No Country Is Prepared for Epidemics or Pandemics”. NTI. Press Release, 24 October 2019. https://www.nti.org/newsroom/news/inaugural-global-health-security-index-finds-no-country-prepared-epidemics-or-pandemics/
- World Economic Forum. 2019. “Outbreak Readiness and Business Impact Protecting Lives and Livelihoods across the Global Economy”. White Paper, in collaboration with Harvard Global Health Institute. https://www.weforum.org/whitepapers/outbreak-readiness-and-business-impact-protecting-lives-and-livelihoods-across-the-global-economy