Draft, not yet released. In stewardship review. Not indexed until the first approved release.

Health threats cross every line

Part I describes systems and their couplings. It ranks no country or operator and assesses no authority.

5 min read2 figures1 table10 notesNR-STRATEGIC-HEALTHSECURITY-GLOBAL-2026-BASELINE

Contents
  1. ·Edition home
  2. ·Executive summary
  3. 1Health threats cross every line
    1. 1.1 The questions this part answers
    2. 1.2 The argument
    3. 1.3 Twenty couplings between five systems
  4. 2Key findings
  5. 3Systems and sectors at baseline
  6. 4Risks and capability
  7. 5High-consequence outbreak that overlaps reduced financing and thin surveillance
  8. 6Readings from the other desks
  9. 7The 2027 agenda
  10. 8Systems in depth
  11. AMethodology
  12. BData appendix
  13. CReferences and record
  14. ·Complete edition, for print

1.1The questions this part answers

Key questions

  • Where is health security risk concentrated?
  • Which couplings carry health security shocks into other systems?
  • Which health security capabilities hold under compound stress?
  • What must 2027 evidence measure first?

In this part

  • Narrative
  • Headline finding
  • Lead figure
  • Five mechanism chapters
  • Twelve-domain reading
  • Sector screens
  • Dependency matrix
  • Risk objects
  • Capability ladder
  • Scenario
  • Three lenses
  • Portfolio

1.2The argument

Health security is usually reported by disease: Ebola, mpox, measles, resistant infections, bird flu. The 2025 and 2026 evidence reads them as one connected system. Animals pass infections to people, people carry them across borders, and health services decide whether a local outbreak stays local1347.

The causes repeat. Over 60% of emerging infectious diseases reported globally come from animals13. Dengue reached 14.6 million reported cases in 202411. Cholera killed 7,870 people in 47 reporting countries in 2025, the highest toll since 199910. Resistance rose across over 40% of monitored pathogen and drug combinations from 2018 to 20236.

The response base is uneven. Development assistance for health fell to USD 39 billion in 2025, 51% below its 2021 peak22. The United States left WHO in January 202621. The Pandemic Agreement annex is not agreed3. Meanwhile no licensed vaccine or specific treatment exists for Bundibugyo virus, the cause of the largest outbreak in this evidence set47.

The edition therefore asks the same four questions of every event: what was the common cause, how did it spread, what was shared, and what threshold was crossed. It makes no attribution and ranks no country or agency.

Figure 1.1How far has development assistance for health fallen? USD billion

Aid for health in 2025 stood about half of its 2021 peak, with US financing falling 67% in 2025. The estimate is preliminary22.

ItemBar, scaled to the largest valueValue
2021 peak80
2025 preliminary estimate39

Source: as cited in the note to this figure. Year 2025.

Figure ID FIG-STRATEGIC-HEALTHSECURITY-GLOBAL-2026-BASELINE-01-003

39USD billion

development assistance for health, 202522

80USD billion

record level, 202122

51%

fall from the 2021 peak22

67%

fall in US financing, 202522

1.3Twenty couplings between five systems

The health security-centred matrix types the twenty couplings between the five core systems, read for their health security content. Strengths are Nexus estimates (ESTIMATED) from the cited evidence and analogue events; they set the graph that 2027 evidence will test.

Figure 1.2Couplings between the five systems

Each line is one coupling from one system to another, drawn by the strength the edition assigns. Strengths are Nexus estimates from the cited evidence and analogue events.

  • Strong
  • Moderate
  • Weak

Source: this edition’s coupling matrix (Table 1.1); status Estimated.

Table 1.1Coupling matrix: from the row system to the column system
From, toWATENEFOOHLTBIO
WAT Water·WEAK
hydropower		MODERATE
irrigation · food safety		STRONG
cholera · safe supply		WEAK
flows
ENE EnergyMODERATE
pumping · treatment		·MODERATE
cold chain		STRONG
facilities · vaccine cold chain		WEAK
land use
FOO FoodWEAK
withdrawals		WEAK
bioenergy		·STRONG
nutrition · food safety · resistance		MODERATE
land conversion · livestock
HLT HealthWEAK
workforce		WEAK
workforce		WEAK
labour		·WEAK
residues
BIO BiodiversityWEAK
contamination		WEAK
hydrology		MODERATE
animal disease · pests		STRONG
zoonoses		·
Strength: strong, moderate or weak; a Nexus estimate (status Estimated) from cited evidence and analogue events. The scale is defined in Annex A.

Transmission paths

  1. 01

    BIO → HLT

    An animal reservoir passes a pathogen to people, and local transmission begins.

    Reported Marburg and Ebola outbreaks1947

  2. 02

    HLT → TRD

    Travel and trade restrictions follow an outbreak although WHO advises against them.

    Reported Ebola 202625

  3. 03

    FIN → HLT

    Falling aid weakens surveillance and response.

    Inferred IHME 202522

  4. 04

    WAT → HLT

    Water and sanitation failure sustains cholera.

    Reported cholera 202510

  5. 05

    FOO → HLT

    Resistance in food and clinical settings limits treatment.

    Inferred GLASS 20256

Notes

Numbers are the edition’s reference numbers, so a note reads the same in every chapter. The full list, with every source and its licence, is in Annex C. Annex C, references

  1. 13WHO (ed.), One Health, fact sheet (Quadripartite; over 60% of emerging infectious diseases reported globally come from animals). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  2. 47ECDC (ed.), Ebola disease outbreak caused by Bundibugyo virus, Democratic Republic of the Congo, update of 30 September 2026 (cases up to 27 September 2026: 8,116 confirmed and 3,924 deaths; seven provinces; 63 of 167 health zones; Uganda 20 confirmed cases). European Centre for Disease Prevention and Control, Stockholm. Observation year 2026. Accessed 2026-11-03.back
  3. 11WHO (ed.), Dengue and severe dengue, fact sheet of 21 August 2025 (more than 14.6 million cases in 2024). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
  4. 10WHO (ed.), Cholera, fact sheet (451,499 cases and 7,870 deaths reported from 47 countries in 2025). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  5. 6WHO (ed.), WHO warns of widespread resistance to common antibiotics worldwide, news release of 13 October 2025 on the Global antibiotic resistance surveillance report 2025 (data year 2023; 104 reporting countries). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back
  6. 22IHME (ed.), Financing Global Health 2025, news release of 15 July 2025 (development assistance for health USD 39 billion in 2025; USD 80 billion peak in 2021; US financing down 67%), read through a syndicated release. Institute for Health Metrics and Evaluation, Seattle. Observation year 2025. Accessed 2026-11-03.back
  7. 21US Department of Health and Human Services (ed.), HHS Fact Sheet: U.S. Withdrawal from the World Health Organization (Executive Order 14155 of 20 January 2025; effective 22 January 2026), hosted on the CDC site. HHS, Washington. Observation year 2026. Accessed 2026-11-03.back
  8. 3WHO (ed.), Seventy-ninth World Health Assembly daily update, 19 May 2026 (decision to continue the annex negotiations; outcome to the Eightieth Assembly in May 2027 or a special session in 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
  9. 19WHO (ed.), Marburg virus disease, fact sheet (case fatality 24% to 88% in past outbreaks; Rwanda 2024: 66 cases and 15 deaths; fruit bat host). World Health Organization, Geneva. Observation year 2024. Accessed 2026-11-03.back
  10. 25POST-CLOSE, context only: WHO (ed.), Disease Outbreak News 2026-DON607, 13 June 2026 (695 confirmed cases; risk assessment; continental response plan June to November 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back

Cite this chapter

Valadbaygi, S. (Ed.). (2026). Chapter 1: Health threats cross every line. In Strategic Systems Report 2026: Health Security, One Health and Biosecurity (Baseline Edition 2026, Report No. NR-STRATEGIC-HEALTHSECURITY-GLOBAL-2026-BASELINE) [Draft under review]. The Global Centre for Risk and Innovation (GCRI).

Every citation form of the whole report, BibTeX and RIS included, is on the edition home. Cite this report

ReportsContribute

Send evidence or a correction on Health Security, One Health and Biosecurity.

Reports is the Consortium’s quarterly publication, written by six desks. This page sits with the Global Centre for Risk and Innovation (GCRI) Systems Evidence desk. What you know about this subject can become evidence, a case or a correction in the next edition, credited to you and published under CC BY 4.0 where it is your own work. Sent to the wrong desk, it is forwarded, not refused.

GCRI Systems Evidence deskStrategic Systems

Never send personal data, sensitive infrastructure detail or anything you have no right to share. A contribution is reviewed before use; sending it confers no authorship or editorial rights, and sponsorship never buys a finding.

CC BY 4.0 Free to read. Text and figures: CC BY 4.0. Data: CC0 1.0. Authors keep copyright. Published by GCRI Canada.

Sector signature

The sectors behind Health Security, One Health and Biosecurity.

A reading aid: the sectors the findings run through and how strongly they depend on each other.

Select corners · hover lines6 / 15 relations

Signature

Health and its partners

Health gives workforce for operations to infrastructure (0.3), farm labour to food (0.3) and utility workforce to water (0.2).

W · E · I · F · H · B

Sectors
4 of 6
Relations
6 of 15
Coupling
0.42 share of total

Strongest relations in play

  • Water → Food · irrigation0.8
  • Food → Health · nutrition0.7
  • Infrastructure → Water · pipes, dams and treatment works0.6
  • Water → Health · drinking water and sanitation0.7
Teaching values for a typical city-region, not measurements for any place. Coupling is the summed strength of the relations in play, as a share of all fifteen.
The Global Centre for Risk and Innovation

Science · evidence · measurement

Not for profit

Our articles, maps and twins are free to read and free to republish. Readers and partners keep it that way.

Partner with us

Who funds us

GCRI is a not-for-profit institution. To ask who funds a piece of work, use the funding questions form.

Independence

Editors and the expert reviewers named on each article decide what we publish. Funders and partners do not review or approve articles before publication.

Corrections policy

Licence

Articles: CC BY 4.0. Figures, maps, twins and data: CC BY 4.0. Other uses: ask through the permissions form.

Privacy choices