The answer to the question of whether the world is becoming safer from emerging health threats depends on the type of pathogen involved.
Until recently, the responses to outbreaks of viral haemorrhagic fevers were becoming more rapid and more effective and resulting in fewer lives lost in West Africa than just a decade ago. The outbreaks of the Marburg virus in Rwanda in 2024 and Ethiopia in 2025–2026, and the more common species of the Ebola virus in the Democratic Republic of Congo and Uganda in 2017, 2018, 2020, 2021, 2022 and 2025, were all brought under control with local expertise, international coordination and the rapid deployment of effective vaccines and diagnostics.
The current outbreak of the Bundibugyo virus, the largest on record, departs from that trend in several ways: there are no effective countermeasures yet for this rare species of the Ebola virus; international coordination has been disrupted with the shortfall in aid from the United States and other donors; and the outbreak is still spreading in a region marked by armed conflict, displaced populations and insecurity. The World Health Organization’s Tedros Adhanom Ghebreyesus has professed “cautious optimism” as disease transmission rates in the outbreak are reportedly declining in most affected provinces, and promising vaccine candidates are now in clinical trials.
Different pathogens, different preparedness
There is little to suggest, however, that the world is becoming safer from respiratory viruses that spread more easily and quickly. A dangerous outbreak of H5N1 avian influenza in dairy cows first discovered on a Texas farm in 2024 has spread to nearly 1,200 herds across 20 states, causing more than one hundred suspected cases, two deaths and hundreds of millions in damage. The US government appeared powerless to stop it and only half-hearted in its attempts to do so. H5N1 avian flu might never acquire the capacity to spread efficiently between humans, but it has already demonstrated again the persistent weaknesses in US health security systems that might mirror those in other democracies that cannot easily compel pro-social, health-protective behaviours in industries and people.
The risk of an accidental, natural or deliberate emergence of the next deadly virus is rising. The next one may spread more easily from human to human than H5N1. In September, Anthropic published a report of five instances when scientists used its artificial intelligence models for research that could help develop biological weapons, including one involving avian flu immune evasion.
For viral haemorrhagic fever outbreaks, the static capacities measured by existing international pandemic preparedness metrics such as the Joint External Evaluation and Global Health Security Index – laboratories, operational plans, health workforces, countermeasure production capacity and the like – may provide a fair assessment of improving readiness and response.
Where preparedness falls short
For emerging respiratory pathogens, however, the capacity to develop and deliver vaccines and diagnostic tests quickly, the existence of robust emergency plans and greater surveillance alone are not enough. More than a dozen studies and reports assessed the association between Covid-19 health outcomes and the leading country-level metrics of pandemic preparedness and found that, when income and relevant biological factors (such as obesity or age) are properly taken into account, there is no association between Covid-19 deaths and infection rates and those preparedness metrics. Even if the world achieved its goal of vaccinating its eight billion people within 100 days of an outbreak – quicker than the US fully vaccinated 100 million people against Covid-19 even after the development of an effective vaccine – it would still not have been sufficient to prevent the spread of a respiratory pathogen such as the Omicron variant.
Navigating these fast-moving disease threats will require governments, people and industries to adopt large-scale changes, often not because of the risk to themselves but because of the outsized risk to others. The success of that effort depends on state capacity, the perceived fairness of national and local governments, sustained investment in domestic public health and the ability to mobilise the cooperation of communities, even those with historical reasons to mistrust. In many democracies, that level of social trust is in short supply.
It is often said that what gets measured gets done, but the opposite is also true. Countries need to understand where their preparedness gaps against respiratory pathogens lie in order to address them and reduce the likelihood of an outbreak spreading. Aid organisations should likewise be able to identify the gaps in preparedness that exist so that they can target resources to help countries make the necessary improvements. Being able to accurately assess a country’s preparedness to detect and respond to respiratory disease threats would improve the prospects of convincing sceptical donors and policymakers to invest more in preparing for future global health security threats.
