Monkeypox, Marburg and miserable heat: How the world should respond to intersecting crises

The World Health Organization’s recent declaration of monkeypox as a global health emergency underscores a disconcerting reality: The world is beset by interlocking and intersecting crises. Deadly heat waves are sweeping the globe, sparking wildfires and causing crop failure. Conflicts in the Horn of Africa, Afghanistan, Ukraine and elsewhere have led to a record 100 million people being forcibly displaced. The return of polio in a number of countries and the first-ever outbreak of Marburg virus in Ghana shows that disease threats continue to emerge against the backdrop of the COVID-19 pandemic, which is now fueled by omicron subvariants. 

These crises, and those looming on the horizon, are exposing the fragility of advances in human health and development. Crises shock global systems and roll back gains, with the world’s most vulnerable people bearing the brunt. Driving continued progress and preventing backsliding in the face of challenges requires thinking bigger and urgent action. But the problems can seem too enormous, numerous and widespread to tackle. 

So, where do we start? By investing in more resilient systems for health and prioritizing those investments even when resources are scarce, including in times of crisis.

Restoring advancement toward the United Nations’ Sustainable Development Goals and future-proofing progress requires agile, collaborative, well-resourced and equitable systems for health that leave no one behind when crises inevitably strike. To do this, there are three key steps we should take as an international community.

First, we must ensure that delivery of essential services can continue uninterrupted, and that equity is never sacrificed in the rollout of new innovations. This requires prioritizing development and strengthening health systems, especially in resource-restricted settings. COVID-19 exposed the fault lines of top-down systems, which can fail to support vulnerable populations. These failures have global repercussions: The inequitable rollout of COVID-19 vaccines has crippled the global response and likely prolonged the pandemic. Responses originating within local communities and at country level are crucial to meeting the needs of vulnerable populations, and closing the health equity gap between and within countries. Most low- and middle-income countries have developed expertise over decades of dealing with HIV, tuberculosis, malaria and other serious infectious diseases — know-how that must not go unutilized.

Agility is also key. When lockdowns began, the global health community alongside national and local health providers proved resourceful, implementing multi-month dispensing of ARVs, telemedicine and self-testing diagnostic tools to allow patients to access care from home. Adaptations like these are critical for ensuring continuity of care, especially in displaced populations. In Afghanistan, for example, the United Nations Development Programme (UNDP) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) rolled out an innovative digital intervention allowing health care workers to maintain records for mobile populations.

Second, we must foster an even greater ethos of collaboration.In our increasingly interconnected world, threats to health disrupt economic and political security, and vice versa. Meeting these challenges requires working outside of national and global siloes.

A careful balance is needed, as one-size-fits-all approaches can neglect local realities and the needs of key and vulnerable populations. We must elevate the voices and priorities of vulnerable people — including refugees, key populations, survivors of gender-based violence and more — to drive more equitable progress. The UNDP-Global Fund partnership operates in difficult and complex settings, and the people we serve are disproportionately vulnerable to crises. Organizations like ours are most effective when we collaborate closely with national governments and other trusted partners to strengthen the local, community-driven systems for health.

Finally, we must ramp up ambition and investments now to prepare for crises we know will come. Work done today to build resilient systems for health underpins future achievements. Every dollar invested in fighting HIV, tuberculosis and malaria results in $31 USD in health gains and economic returns, further contributing to the achievement of the overall SDG agenda. The upcoming Seventh Replenishment of the Global Fund has a target of $18 billion USD. This is just the minimum required to get the world back on track toward ending HIV, tuberculosis and malaria, as well as safeguarding against future threats.

Being only reactive has devastating consequences. The International Monetary Fund estimates that by 2024 the economic impact of COVID-19 will amount to $12.5 trillion. Investing around $10 billion per year in pandemic preparedness would significantly reduce the probability of another catastrophe of this magnitude. By leveraging the synergies between investments in fighting existing diseases and investments to prevent, detect and respond to new threats, we can build pandemic preparedness on a marginal cost basis.

Yet, it is dangerous to assume that the next health crisis will be a replica of the COVID-19 pandemic. While the spread of monkeypox and the response to date bears some disturbing similarities to the early days of COVID-19, a broader crisis, driven by food and energy shortages resulting from the Ukraine war, is now rippling across the globe. In addition to the awful threat of mass starvation, we face the prospect of even greater numbers of people being made more vulnerable to existing infectious diseases by being inadequately nourished.

Extreme weather events caused by climate change have a similar impact, often leading to upsurges in malaria and other infectious diseases.

In a world confronted by a cascade of overlapping crises, we must strive to build more resilient systems for health, able to withstand a variety of shocks. We must also intensify international collaboration, enhancing adaptability and agility.

When it comes to pandemics, the world has a pattern of losing interest before the fight is truly won, while neglecting the need to prepare properly for the next threat. We need to kick these habits and commit to protecting everyone, everywhere from the deadliest infectious diseases, whether HIV, tuberculosis, malaria or COVID-19, or future threats. What’s at stake is millions of lives.

Peter Sands is the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

Achim Steiner is the administrator of the United Nations Development Programme.