THE THREAT of a disease disaster has arisen in the past two decades in an unfortunate cycle of panic followed by neglect. The panics have been real: the anthrax letters; severe acute respiratory syndrome and Middle East Respiratory syndrome, both coronaviruses; the swine flu pandemic; the Ebola virus disease outbreaks in Africa, taking thousands of lives. These events should be taken as warnings, but they have not been.

That is the conclusion of a globe-spanning survey of 195 nations, looking closely at their readiness to combat infectious disease outbreaks, either natural or man-made, including those of high consequence, meaning they could overwhelm the national and international capacity to manage them. The study, the Global Health Security Index, was carried out by the Nuclear Threat Initiative and the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, with help from the Economist Intelligence Unit. It plumbed each country with 140 questions about readiness in the fields of disease prevention, detection and reporting, rapid response, adequacy of existing health systems, meeting international standards and the overall risk situation.

The world flunked. The index shows that “no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak.” The average national score was 40.2 of a possible 100. Only 19 percent of countries received top marks for detection and reporting; fewer than 5 percent of the nations scored in the highest tier for being ready to respond rapidly to an epidemic. The United States ranked at the top overall, with a score of 83.5, but fell to 19th place in the category of overall risk environment and vulnerability to biological threats. This was the first year of the index; hopefully it will spur progress that will show up in future editions.

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National boundaries don’t stop infectious disease, but how nations are governed remains an important factor in preparing and fighting sickness, and there are a host of reasons that they fall down on the job. The most significant is a lack of political will and a failure to make preparedness a priority, including by chronically underfunding public health. But the problem does not stop there. The current Ebola outbreak is being fought with an effective experimental vaccine and with benefit of lessons drawn from the 2014 outbreak, yet the struggle faces new hurdles, such as how to overcome fear, suspicion and distrust in a war zone. Nations need to prepare for old problems, and new ones. They need to not lapse back into neglect after each panic.

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