Emerging ‘dis-ease’: US foreign assistance needs to focus on the root causes of pandemics

The U.S. Agency for International Development has been investing in the fight against pandemics for more than 15 years.

In fact, I worked on the first such project the government helped create in 2005, focused on H5N1 avian influenza, wherein we looked at the roles of wild birds versus poultry in the global spread of this zoonotic disease. 

There were important questions related to where and how one could intervene to stop the spread of this viral scourge, and we very much took a “One Health” approach, which recognizes that the health of people, wildlife and domestic animals are all inextricably linked and impacted by how well — or not — we steward environmental and socioeconomic policies. 

Since that time, much important work has been supported by USAID’s Emerging Pandemic Threats (EPT) program. Nonetheless, here we are in the midst of a global pandemic despite at least $1 billion invested to date, and it seems prudent to ask ourselves if we should be looking at other approaches to prevent such catastrophes based on lessons that have been learned. Rather than emphasizing virological research in places where people and wildlife come into dangerously close contact, investments should be dramatically shifted to focus on making such human-wildlife contact much less likely in the first place. 

We know enough to act boldly, but we need a much broader mix of disciplines at the table. Preventing pandemics is ultimately a numbers game in terms of how easy — or not — we make it for new viruses to find us.

As one of the veterinarians behind the One World, One Health movement launched in 2004, I cannot overstate how important I think it is that our approach to pandemic prevention be much more holistic, more ambitious and more focused on root causes than our foreign assistance programs have been to date. The majority of emerging infectious diseases (EIDs) are zoonotic and more than 70 percent of those zoonoses find us through wildlife. On land and in the seas, there are millions of types of viruses. Finding them all could keep virus hunters busy for decades, but it’s important to keep in mind that despite the fact that mammals alone host hundreds of thousands of viruses, there are really only three main sets of human behaviors that bring those viruses into our bodies: we eat or trade the body parts of wild animals; we capture and mix wild species together to trade them in markets; we destroy what’s left of wild nature through activities like deforestation, greatly enhancing our encounter rates with new pathogens along the way.

Think about that. Hundreds of thousands, even millions, of viruses yet to be catalogued, but only three basic types of activities people undertake that allow viruses to lead to pandemics.

We need to be squarely focused on changing risky behaviors that have been found to increase the likelihood of future pandemics. The root causes behind the three types of behaviors described above relate largely to poverty, food insecurity, inadequate food systems, cultural traditions, poorly regulated extractive industries, the international trade in wildlife and the demand and corruption that support it. While these root causes ultimately lead to zoonotic viral jumps and the potential for pandemics — from HIV/AIDS to Ebola to SARS to COVID-19 — the core issues of concern are not primarily grounded in the biomedical sciences where USAID has made most of its pandemic-related investments to date.

That is why we need to take a step back as we make new investments overseas to prevent the next pandemic — we must make sure our toolbox is big enough to represent a truly “One Health” approach.

How should the U.S. government be spending such funds? It is one thing to be improving countries’ capacity to detect disease emergence; it’s quite another to decrease the likelihood of diseases actually emerging in the first place. Fundamentally, the U.S. and the international Global Health Security Agenda need to be working around the world to develop sound and safe food systems so that the millions of people who currently consume groups of animals that contribute significantly to the zoonotic virus pool no longer want or have to. We need to be working at the highest levels of international diplomacy and engagement to permanently shut down the enormous international trade in wildlife. We must also be able to constructively engage China, if at all possible, given that it has been at the center of wildlife trade and viral emergence.

We need to be working at higher levels of national governments and through multilateral agencies to change behaviors that put all of humanity at risk. Household-level education is of course important, but we need to be doing much more to achieve the society-wide, tidal wave-sized shift in human behaviors needed to mitigate pandemic risk. We need to incentivize governments to address the real root causes of pandemic risk and we need to be prepared to utilize international sanctions when governments continue to condone those behaviors and activities that put all of us in harm’s way. This needs to be among the U.S. State Department’s highest priorities around the world and will require sober diplomatic engagement.

We are at one of the most important tipping points in human history and we must not squander this crisis by simply relying on improved disease surveillance. We need to work with those countries of highest risk to fundamentally alter economies and food systems and even help incentivize cultural shifts, building upon encouraging attitudinal changes across generations, where that will lessen the demand for wildlife as food and medicine.

Human history has shown that empires fall when they fail to adapt to changing conditions and new knowledge. The entire world is sharing the experience of COVID-19-induced pain, loss and grief. We must think big if we are to have any chance of preventing the next pandemic. 

Steve Osofsky, DVM, is a wildlife veterinarian and the Jay Hyman professor of Wildlife Health & Health Policy at Cornell University’s College of Veterinary Medicine, and led the drafting of The Manhattan Principles on One World, One Health in 2004. He directs the Cornell Wildlife Health Center and is also a Cornell Atkinson Center for Sustainability Faculty Fellow. He was an American Association for the Advancement of Science Science & Diplomacy fellow at USAID from 1996-1998.