Disease Y - Prevention is cheaper than cure

The massive shock of the coronavirus pandemic and the shutdown measures taken to contain it may cost the global economy over $15 trillion by mid-2021 according to the World Economic Outlook Update, June 2020.

"This current pandemic must now be the wake-up call for us to abandon the ‘panic and forget’ cycle that has blighted earlier efforts..."

The phrase 'prevention is better than cure', attributed to the Dutch philosopher Erasmus (1466–1536), is a well-understood and agreed principle of modern healthcare, reflecting the desire to keep people healthy, happy and independent for as long as possible. But while there is nothing new about the concept, the idea that ‘prevention is cheaper than cure’ is taking longer to establish itself.

In 2018, the WHO identified several infectious diseases, for which there are few - if any - treatments or vaccines, with the potential to cause a serious threat to global public health. It referred to one as ‘Disease X’, a future unknown disease that would cause a serious global pandemic, and we are currently living out that prediction. The emergence of many of the recent global disease is closely linked to changes in land-use and changing interactions between humans and wildlife in highly biodiverse regions of the world. This has led to the increased appearance of zoonotic diseases, those that are caused by a pathogen such as a bacterium or virus that has jumped from a non-human animal to a human.

As we are seeing in the current crisis, one of the most effective means of limiting the spread of infectious disease and halting a pandemic is the development of vaccines. There has been a huge effort from academic and commercial organisations working together, often funded by massive government investment, to develop effective vaccines. While no-one is doubting the value of the vaccines currently under development, it has historically been hard to estimate the true value of vaccines. In developed countries, routine vaccination has led to control or complete eradication of several infectious diseases and estimates from the US CDC suggest that vaccination of children born 1994 - 2018 has saved the country over $400 bn in direct medical costs, and significantly more in total societal costs. And across the world vaccines contribute substantially to a reduction in overall disease burden and associated mortality, saving millions of lives each year.

However, of the millions of viruses in the world, many with the potential capacity to infect humans, scientists have a reasonable understanding of perhaps a few hundred. In many ways we have been fortunate in that this pandemic is caused by a coronavirus, a well-understood human pathogen. But COVID-19 will not be the world’s last health emergency, and there is an urgent need for sustainable action and emergency preparedness to deal with the next one, Disease Y.

Two major factors have emerged as primary drivers of emerging infectious disease: destruction of natural habitats (particularly in the tropics) and the wildlife trade. The most effective way to limit the development of zoonotic diseases will therefore be through limiting unsustainable land management practices, developing alternatives for food security that do not destroy habitats, controlling trade in wildlife, and identifying key drivers of emerging diseases in animal husbandry.

It has been estimated that the annual cost of preventing future outbreaks through such measures would equate to just 2% of the estimated financial damage caused by COVID-19, roughly comparable to a few percent of global military spending - clearly demonstrating how cost-effective prevention can be. This current pandemic must now be the wake-up call for us to abandon the ‘panic and forget’ cycle that has blighted earlier efforts, and to focus on developing effective health emergency preparedness right across our planet. 

Author: Dr Nigel Whittle is Head of Medical & Healthcare at Plextek