A hundred years ago, the so-called “Spanish Influenza”, or H1N1 virus, swept through the world. This infamous 1918 flu pandemic is estimated to have killed 50 million people globally. Despite its name, scientists now say it killed far more people in India than in any other country.

Significant advances in medicine in the last century mean that many people, including world leaders, assume that the 1918 pandemic should be confined to the history books, along with the Black Death and bubonic plague. That is a deadly assumption.

Globally, a lack of preparedness for health emergencies is putting millions of lives and international security at risk, and India could be the next ground zero for a catastrophic epidemic. Compared to 1918, India is significantly more interconnected, with denser cities and no nation-wide seasonal flu immunisation policy.

Much like natural disasters and extreme weather events, it is very challenging to predict when a disease outbreak might occur. But we can be sure that preparing ourselves for the worst will mean the difference between a true global disaster and a difficult, but not debilitating, epidemic. At their best, strong preparedness systems can even stop the spread of an epidemic-prone disease at its source before it becomes an outbreak.

Protective measures must

So, how should India prepare for the next health emergency? Government leaders must secure sustained financial investments, prioritise health system improvements and involve communities to build trust. As demonstrated in India, all of these efforts are proven to yield positive results. In May 2018, recent improvements in India’s health system helped public health officials to identify and contain a deadly outbreak of Nipah virus.

There has been similar success in Uganda, where cases of Ebola that have spread across the border from the Democratic Republic of Congo have been contained before the pathogen spread to the general populace.

While these individual examples are reason for celebration, the world as a whole still faces the threat of a pandemic, which would damage health systems, destabilise national security and hurt economies. As illustrated in the accompanying map, models show that India could suffer some of the biggest economic losses in case of a high-impact pandemic. When it comes to preparedness, the reality of our globalised world is that we are only as strong as our weakest link, and all countries need to work together to mitigate risks.

A report published last week by the Global Preparedness Monitoring Board, an independent group of experts in health, finance and security, calls for urgent action from all world leaders to tackle the threat of health emergencies. This includes building strong systems and putting in place a national-level coordinator with the authority and political accountability to lead a whole-of-society approach to preparedness.

Readying ourselves for future health emergencies is everyone’s business. Climate change and natural disasters, global migration, conflicts and humanitarian challenges are all breeding ground for future outbreaks. It is crucial for all sectors, from finance and security to humanitarian relief and conflict resolution, to collaborate on preparedness. That is why international bodies such as the G20, of which India is a key member, should be prioritising the issue of preparedness and holding each other to account for pledges made.

The Indian government has already demonstrated political leadership on this issue. Earlier this month, it contributed $2,00,000 to health emergency preparedness in South-East Asia and organised for health ministers from across the region to sign the “Delhi Declaration” on emergency preparedness.


Alongside the governments of Germany, Japan and Norway, India was also a founding member of the Coalition for Epidemic Preparedness Initiatives (CEPI), an alliance to finance the development of new vaccines against infectious diseases.

The Prime Minister must build on this great work to ensure that India meets the progress indicators set out in the GPMB report and, given that the country is home to such a large chunk of the world’s population, encourage the other BRIC countries to do the same.

Security is the number one responsibility of a government, and that includes health security. There is no avoiding the next epidemic, but by acting now, its consequences can be minimised.

The writer is Director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva and is Member of the Global Preparedness Monitoring Board. Views are personal