The current H7N9 avian influenza (bird flu) that has infected 108 cases and claimed 22 lives, and that has just spread outside People’s Republic of China (PRC) as of 24 April 2013 should be a stern reminder that global (and regional) health threats continue to loom large. As global economic integration forges ahead, the consequences of interdependence on health status also deepens. Accelerated cross-border transmission of disease (influenza, HIV, dengue, etc.) and international transfer of behavioral and environmental health risks (road traffic accidents, human trafficking, bad consumption habits such as poor diet, tobacco, and alcohol) are exacerbated by enhanced international linkages in trade, migration, and information flows. Likewise, environmental health threats are propelled by intensive pressure on limited, shared global resources of air and water as well as by climate change (food security, natural disasters, and disease vectors).  Globalization is not simply accelerating long-term trends rather it is ushering in contextual changes that substantially alter disease risk, health vulnerability, and policy response. 

The threat of the current outbreak becoming a pandemic is real and this would have potential adverse implications for economic growth in the region.

Although there is currently no evidence of sustained H7N9 human-to-human transmission, Keiji Fukuda, WHO’s assistant director-general for health, security and the environment warned that H7N9 is an “unusually dangerous virus for humans” and that “the virus is more easily transmitted from poultry to humans than H5N1” referring to the bird flu virus that has circulated in poultry in Asia for a decade, occasionally causing human fatalities.

The threat of the current outbreak becoming a pandemic is real and this would have potential adverse implications for economic growth in the region. Taking previous communicable disease experience as an example, severe acute respiratory syndrome (SARS) in 2003 was the first severe and transmissible disease that emerged in the 21st century. Globally, SARS is estimated to have infected 8,096 people, killing 774.  Fan (2003) and ADB (2003) estimated that the economic impact of SARS was around $18 billion in East Asia, around 0.6% of GDP. Bloom et al. (2005) estimates of H5N1 avian influenza in 2004-2006 show that the cost of such a pandemic would be $100 billion–$300 billion (2.6 to 6.8 percentage point reduction in GDP) for Asia and the Pacific region (excluding Japan). Pandemic H1N1 influenza in 2009-2010 claimed over 18,000 lives with 3,600 in Asia and the Pacific. ADB has “proven successes” in supporting infection disease outbreak response (SARS and Indonesia, Malaysia, and Philippines) and continues to support communicable disease control (Viet Nam, Cambodia, and Laos). Still, a strong commitment to avert other public health threats is needed.

One of the main goals for health operations identified at the annual ADB Health Community of Practice (CoP) retreat is to support regional public goods in health. The Health CoP collectively identified three concrete actions for regional public goods in health: (i) prepare the third phase of the communicable disease control project; (ii) adjust the pandemic preparedness plan; and (iii) draft a social and health education/governance strategy (e.g., trafficking, HIV, road safety, essential medicines) among workers and beneficiaries who are excluded from project evaluations. At the same time, the group recognized that there were a few constraints to achieving this, namely lack of coordination, and less interest in and lack of understanding of health as a public good and prioritizing it in regional country partnership strategies.

In order to draft and implement a strategy on regional public goods in health towards action (iii) and overcome the constraints raised, regional cooperation within the health field and between the health sector and other development sectors is essential. For the Asian region, ADB can marshal strategic leadership and its unique position as a platform for developing member countries and stakeholders to spearhead collective action towards cooperation in health. This can be achieved in threefold:

1. resource mobilization: ADB facilitates development financing and adequate resource levels in support of these efforts. 
2. systems of regional governance: ADB supports activities to develop and reinforce a model of regional health governance toward awareness, research, and collective action. Where constraining resource is knowledge or capacity, technical assistance can be provided.
3. creation of institutional space for organizational renovation and innovation; ADB facilitates new, and reinforces existing, cooperation among government, intergovernmental regional agencies (ASEAN, SAARC, CAREC, etc.), technical agencies (WHO, FAO, WFP, IOM, etc.) and private actors. The areas of focus include communicable disease control as well as other regional health threats such as disaster management, road traffic accidents, human trafficking, food security, climate change, and macroeconomic growth (poverty and social safety nets) where ADB leverages expertise in respective development sectors.

Global and regional health increasingly demonstrates cross-border externalities. As a public good, health risks and responses are increasingly interdependent. As Chen et al. (1998) emphasized, “No individual or nation state can fully guarantee its own health,” thus addressing health challenges requires the involvement of all and improved coordinated responses at all levels: individual, family, community, national, regional, and global. With ADB in a key leadership role, in coordination with other stakeholders, it is timely to take action on cross-border and multi-sectoral regional public goods in health.