PANDEMIC. THE word can spread fear to billions overnight. One of the few public-health terms that gives Hollywood nightmare plotlines. Literally meaning "all people," a pandemic is an extraordinary global health event in which an epidemic of infectious disease spreads across regions and, potentially, the entire planet. Ebola, avian flu, SARS-each had the potential to spread rapidly and each received extraordinary attention during the past several years. Though they did not result in mass casualties, all wrought worldwide fear.
Throughout the course of human history, pandemics have wreaked havoc. The 1918 flu pandemic may have killed over 20 million people. Even then, 50 percent of the mortality difference among countries can be attributed to a single factor: per capita income. Thus, the poorest country hit, India, suffered the most, while Denmark suffered the least. That differential, however, has not yet made for compelling public policy. After all, science made landmark breakthroughs in the twentieth century, often applying scientific insights from previous centuries in innovative ways to control and, in the case of smallpox, eradicate disease. But in the days of porous borders and unprecedented global travel, viruses and other pathogens may once again have the upper hand. One key question on the table is: will the next pandemic be worse than the ones we currently face?
Viewed from where I live in Rwanda, it's clear that the sheer neglect of health of poor people has set an ideal foundation for pandemics to spread for years under the radar, evade surveillance and, as has been the case with HIV/AIDS, enter our airspace and bodies at a startling rate. The history of global health demonstrates that wealthy nations respond best to dramatic, fast-moving outbreaks like Ebola or avian flu. Unfortunately, today wealthy and poor nations alike face pandemics that move slowly and don't necessarily show symptoms during the first few years of infection.
