Dense urban living facilitates the spread of infectious diseases. Particular vulnerabilities exist in countries where rapid urbanization results in informal settlements that make it difficult to control transmission and can therefore increase the risks of mosquito-transmitted epidemics, such as malaria, tuberculosis, dengue and yellow fever.
Various examples highlight the impact of urbanization on pandemics. In the Democratic Republic of the Congo, 83% of people with tuberculosis live in cities (around 40% of the population lives in urban areas). In 2009, Mexico City shut down schools, libraries, museums and nightclubs to halt the spread of H1N1 flu. A 2009 cholera epidemic in Zimbabwe heavily affected Harare city, Chitungwiza and Kadoma, also stressing the influence of slums and the lack of urban infrastructure as key igniting factors for the speed and severity of disease outbreaks.
In today’s hyperconnected world, it is easier for pathogens to be carried from one city to another and quickly scale up the impact of most outbreaks. The presumed introduction of the virus to the informal settlements of Kenema and Freetown in Sierra Leone has undoubtedly augmented its spread. Sierra Leone is urbanizing at a rate of 3% each year, and in 2005 more than 97% of its urban population lived in slums. The economic impact of Ebola is enormous for the affected countries and their neighbouring countries. The estimated economic cost is $32 billion in the worst-case scenario.
Another aggravating factor to the 2014 Ebola crisis was the lack of a governance mechanism that would allow an effective link between what was being observed at the country and city levels and the alert mechanisms necessary to trigger an emergency response. Looking into the future for an adequate response across geographies, the existence of such a governance mechanism would: (i) allow collaboration between local and national governments, civil society and the private sector across borders; (ii) coordinate the surveillance, collection, sharing and analysis of infectious disease data in real time; (iii) incentivize the private sector to develop and scale up the production and distribution of affordable drugs, vaccines and diagnostics; (iv) establish a network of centres for research into microbial threats; and (v) promote international standards for best laboratory, regulatory and ethical practice.
The vulnerability of urban centres to pandemics points to the need for strong public-private coordination involving organizations beyond the traditional healthcare sector. The ability to mobilize a response from sectors as diverse as food production, telecommunications and corporate supply chains will determine how epidemics are fought in the future. Local, national and cross-border government agencies need to build bridges with all stakeholders and learn from what worked in the past to shape systems with the capacity to respond to pandemics and build the resilience to bounce back afterwards. Coordinating responses and developing global governance mechanisms are critical to contain future outbreaks, which will inevitably occur.
Authors: Arnaud Bernaert is the Head of Global Health and Healthcare at World Economic Forum. Vanessa Candeias is Associate Director of Healthy Living at the World Economic Forum.
Image: Christmas shoppers flock to a market despite concerns over Ebola in Monrovia December 23, 2014. REUTERS/James Giahyue