He identifies a cluster of non-medical drivers of deadly outbreaks—war, political instability, human migration, poverty, urbanization, anti-science and nationalist sentiment, and climate change—and maintains that advances in biomedicine must be accompanied by concerted action on these geopolitical matters.
War and Pestilence ride together as two of the Four Horsemen of the Apocalypse, and there is no shortage of historical precedent to demonstrate the aptness of the allegory. The great influenza pandemic that began in 1918 was propelled, in part, by troop movements and population shifts at the end of the First World War. Both the First and the Second World Wars produced typhus epidemics. Armed conflicts cause malnutrition, poor pest control, and sanitation problems; even the soil often becomes contaminated. Medical facilities are destroyed; doctors and nurses, diverted to combat duty, are unable to provide care, and vaccination and other mass-treatment programs usually falter.