New pandemics could kill billions and outweighs nuclear war

By the end of 2022 SARS-CoV-2 had infected most of humankind and directly or indirectly killed perhaps 20 million people – an effective global fatality rate of 0.25% inclusive of reinfections.8 Many viruses are far more lethal. Variola major, the causative agent of smallpox, killed approximately 30% of patients while maintaining high transmissibility (estimated R0=3.5-6);9 the virus was responsible for the deaths of 500 million people in the century before its eradication.10 The 1971 Aralsk outbreak, which involved a potentially weaponised strain, was transmitted by vaccinated individuals and exhibited 100% lethality in the three unvaccinated patients.11 More devastating pathogens exist in other animals that live in tight-knit groups: rabbit haemorrhagic disease virus (RHDV) is highly contagious, transmitted asymptomatically in young animals, and 80-100% lethal in adults.12 If such a virus were to sweep the world anywhere near as quickly as the Omicron variant of SARS-CoV-2, billions would perish.

Even at the height of the Cold War, a city-targeting nuclear exchange would not have seriously threatened the viability of most nations in the southern hemisphere.13 Given humankind’s demonstrated failure to reliably contain the moderately transmissible SARS-CoV-2 virus and the dearth of large-scale subsequent investments aimed at halting pandemic transmission by any government, a sufficiently severe pandemic-class agent would threaten the stability of every unprepared nation. Today, this includes every country in the world. Thankfully, most of the technologies required to mount a reliable defence already exist. With dedicated preparations, many nations could become highly resistant to catastrophic pandemics – but only if they anticipate more severe threats than a reprise of COVID-19.