World governments did not learn the right lessons from past outbreaks of disease, and we’re paying for it now as we cope with COVID-19. We have invested too little in public health and disease prevention, particularly in poor countries, given the potential economic (as well as human) costs of pandemics.

The outbreak of the coronavirus named COVID-19 in China in December 2019 is the latest in a series of diseases— SARS, bird flu, swine flu, Ebola, and HIV/AIDS—that have moved from animals into human populations. Major outbreaks of infectious diseases are not new. The 20th century saw major disease outbreaks, such as the Spanish influenza 1918-19, Asian influenza in 1957-58 and the Hong Kong influenza pandemic of 1968-69. The emergence of a pandemic is as unpredictable as that of an earthquake. Since 1970, many countries have invested in the development of national influenza preparedness plans and building global influenza surveillance and monitoring systems. The early warning systems include a network of laboratories capable of identifying the reference strain of the epidemic.

The amount of funding that countries should invest in these efforts to prepare and respond to a pandemic is an example of decision making under uncertainty. Like other national disaster planning activities, the amount of funding should be based on assumptions of the probability of catastrophic outcomes.

In the 21st century, even though scientists have warned of the inevitability of a major pandemic, the investment in public health systems has not been sufficient to reduce the probability of a major outbreak. SARS was a timely warning. Although very few people died from SARS, compared to the great pandemics of last century, the economic costs were significant. This should have prompted governments to focus on investing vastly more on improving public health systems in the poorest countries, where a range of factors increase the probability of a major disease outbreak. Despite repeated warnings, funding for many development projects, particularly in the area of public health and disease prevention, have been cut by major governments. What is needed is significant funding for medical research and far greater funding for public health in all countries, especially in the poorest countries. It is also clear that much greater focus globally should be on the practice of better hygiene in order to reduce the spread of infectious diseases. Simple, low cost, educational interventions— the virtues of hand-washing, for instance—can have a massive impact on transmission

As part of a research program in the Centre for Excellence in Population Ageing Research (CEPAR) in the Australian National University’s Crawford School of Public Policy, my colleague Roshen Fernando and I generated seven scenarios for how COVID-19 might unfold. There were two main reasons for this approach.  First, it is not clear how a disease will evolve and spread. One technique to assist policymakers in planning responses under uncertainty is scenario analysis.  Scenarios allow policymakers to understand potential outcomes under different assumptions which capture that uncertainty to be explored. The seven scenarios in this research were shared with policymakers globally before publication. The second goal was to demonstrate how costly a pandemic could be, and therefore how much governments should be spending to respond to the current outbreak, and how much over time they should spend to minimize the probability of a major future pandemic. We understood that in publishing this research, the results might be sensationalized, but good public policy requires transparent information based on rigorous, well-documented methods. It may well be, and hopefully will be, that the more serious scenarios we published do not eventuate. It is important though, if one of the scenarios does emerge, that governments can respond with the best policies and the populations are able to take precautions to minimize the impact.

Read the rest of Warwick J. McKibbin’s article at Brooking’s