A pandemic is a global disease outbreak that represents a top global catastrophic risk. Influenza (flu), for example, transmits readily and can spread fast. Every year, up to 500,000 people die from flu. In years when pandemic flu occurs, the toll can rise well into the millions. The 1918 pandemic flu, the most severe of the four flu pandemics in the last 100 years, infected up to 40% of some national populations and killed 50–100 million people.

Pathogens with pandemic potential continue to emerge, and most of them are of animal origin (zoonotic).  They include, for example,  Ebola,  H5N1 avian flu, H7N9 avian flu, HIV/AIDS, and two kinds of coronavirus: severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS). In 2008, the World Bank estimated that a severe flu pandemic could result in $3 trillion in global economic losses, equivalent to 4.8% of gross domestic product (GDP).  Most of the losses would not be caused by disease directly, but rather by consumer reactions, labor shortages and cascading failures in economic and financial sectors.

The U.S. government has warned of the potential for a severe flu pandemic to impact global security and stability. Every year, 2.3 billion human infections occur in developing countries by zoonotic diseases.  The burden on the poor is formidable, as they tend to live close to animals in communities with inadequate veterinary and human public health services. Such diseases diminish livelihoods, nutrition, food security, trade, and assets of poor households.  Reducing this burden is a global development imperative. Increasing global pandemic prevention and preparedness is essential to achieving the global goals of ending extreme poverty by 2030 and boosting shared prosperity.

Managing pandemic risk is important for all countries, but especially so for poor and fragile states, where a severe pandemic would result in significant harm to population health, economies, and communities.. Pandemic prevention requires health systems with strong core public health functionality (veterinary and human) to detect contagion early, ensure correct diagnoses, and respond rapidly to stop the contagion from spreading.

The World Bank has estimated the cost of this essential, permanent, global infrastructure at $3.4 billion per year in all developing countries.  The expected benefit of better preparedness is at least $37 billion per year, making such infrastructure a profitable use of public funds. The economic rates of return to investments in public health and strong health systems range from 50% to 123% per year, depending on disease risk.

Yet, even as the threat posed by avian flu and other zoonotic diseases remains, country and donor investments in pandemic prevention and preparedness have decreased markedly in recent years.  The 2013-15 Ebola crisis is a reminder of the price of neglect of core public health functions (both veterinary and human).

Last Updated: Sep 10, 2015

WBG supports countries in their efforts to strengthen veterinary and human health systems, as well as the bridges between them to prevent pandemics.   This approach is in line with World Health Organization (WHO) and World Organisation for Animal Health (OIE) standards.

Since 2005, WBG has contributed to the international response to the avian and pandemic influenza threat through a multisectoral approach to disease control and prevention that encompasses human health, animal health, analytical and technical support, disaster risk management and development communications. This was key to effective, integrated country-led programs.

A major lesson from the current Ebola epidemic is that the world must be better prepared and respond much more quickly to future disease outbreaks. With WHO and other partners, including the private sector, the World Bank Group is developing a global Pandemic Emergency Financing Facility (PEF), to enable a rapid response in the event of a disease outbreak before it becomes a pandemic. The PEF will mobilize and leverage resources from the private sector (reinsurance and capital markets) and the public sector, and disburse them rapidly to governments, multilateral agencies, NGOs and other agenciesto finance the response to dangerous epidemic outbreaks before they turn into pandemics. In addition to providing rapid financing, the PEF will support the creation of a new market for pandemic insurance in developing countries, and drive national and international players to work together more effectively to ensure better crisis preparedness and response readiness.

In June 2015, as new cases of Ebola continued to emerge in West Africa, the World Bank Group commissioned a survey in the U.S., U.K., France, Germany and Japan to gauge public opinion and understanding in developed countries about future outbreak preparedness and global health security. The survey of 4,000 citizens found that most people are not convinced that the world is prepared for another global epidemic like Ebola. Respondents also indicated strong support for investments in developing countries to reduce the threat of infectious diseases.

Previous Work on Pandemics

In addition, from 2006-2013, a multidonor trust fund, Avian and Human Influenza Facility (AHIF), received $127 million from ten donors, led by the European Commission. AHIF helped developing countries tackle avian flu and other zoonotic diseases and prepare responses to a pandemic. The World Bank financed 72 projects in 60 countries under a fast-track approval mechanism, totaling $1.3 billion (of which $0.1 billion was from AHIF and other trust funds). The mechanism still serves as the model for rapid global response operations. The World Bank also organized knowledge-sharing session on key topics in the global response. This experience and the impact of its contributions put the WBG in a strong position to help shape future pandemic prevention and control efforts.

One Health

In 2008, the WHO, OIE, and the Food and Agriculture Organization (FAO), coordinated by the World Bank and UN System Influenza  Coordinator (UNSIC), prepared a global strategy for using “One Health” approaches to reduce health risks at  animal-human-environment interfaces. Ministers of health and agriculture from across the world have welcomed this strategy and urged that it be implemented. The World Bank supported development of WHO-OIE tools for assessing country systems in the veterinary and human public health areas, and the bridges between them. These tools are available from April 2014, but in the absence of funding, they have not been implemented.

Based on these tools, country systems can be strengthened to meet international standards, including the International Health Regulations (IHR).  Robust systems will work to prevent pandemics (such as flu), reduce the costs of ongoing and emerging health crises such as antimicrobial resistance, zoonotic diseases like Ebola and rabies, and other diseases. 



Last Updated: Sep 10, 2015

  • The response to H5N1 avian flu and the H1NI pandemic was the largest global health security program to date.  It reduced risk through prevention and preparedness; assistance was delivered quickly to over 100 developing countries, thanks to emergency procedures and strong leadership at all levels. Preparedness and response capacity in countries improved, but large gaps remain.
  • H5N1 avian flu was controlled in most of the 63 countries in Africa, Asia, and Europe where it appeared, but still circulates.  Other strains, like H7N9, have emerged. Thus, the achievements are partial and fragile, despite the death from disease and disease control measures of over 600,000 poultry. This imposed high costs on poor farmers in developing countries. 
  • Preparedness for pandemics has increased, as demonstrated by responses to the 2009 H1N1 flu pandemic. Sustaining these gains requires high-level commitment, contingency planning, and periodic exercising of multisectoral plans, but this has become increasingly neglected.

The Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI) emphasized investments in prevention and preparedness, before a disease outbreak. Results include:

  • Increased capacity to assess and respond to influenza and other pandemic risks, including stronger preparedness to address health risks at the animal-human-environment interface
  • Strengthened multisectoral partnerships to diagnose and respond to public health threats and other potential disasters
  • Supported national action plans and intersectoral coordination to respond to avian and human influenza outbreaks in more than 50 countries
  • Strengthened communications on animal and human disease risks, and on pandemic responses, including to poor and marginalized communities

Last Updated: Sep 10, 2015

The World Bank has worked closely with developing countries, donors, the United Nations System Influenza Coordinator (UNSIC), World Health Organization (WHO), Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE), and others.


UN System Influenza Coordinator (UNSIC)

Toward a Safer World TASW

World Health Organization (WHO)

World Organisation for Animal Health (OIE)

UN Food & Agriculture Organization (FAO)

USAID Avian and Pandemic Influenza Preparedness and Response

European Commission

US Centers for Disease Control & Prevention (CDC) One Health Page

Global Risk Forum Davos - One Health

One Health Network

One Health Talk

One-Health Initiative

One Health Approaches Facebook Group

U Minnesota CIDRAP

The Bank has supported the international community by analyzing issues such as financing needs and gaps, poultry sector bio-security, and compensation schemes.


Last Updated: Sep 10, 2015

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