The authors from several US institutions, led by Tiffany Bogich from Princeton University, reached these conclusions by reviewing nearly 400 serious international public health events. They found that the disruption to, or lack of, public health infrastructure was the major driving factor of infectious disease outbreaks, contributing 40% overall. In contrast, other main driving factors, such as climate and weather and war and famine had a much lesser role, each contributing less that 10% to infectious disease outbreaks.

Based on these findings, the authors argue that there is a mismatch between the drivers of infectious disease outbreaks and current trends in public health spending as shown by the current donor trend of favoring disease-specific global health programs. The authors argue that this mismatch may be at the cost of strengthening public health infrastructure and development in the long term.

They argue: "Stronger public health infrastructure, for example, expanded surveillance, better diagnostic capacity, and rapid reporting and control, in developing countries will likely help prevent localized outbreaks of newly emerged pathogens becoming pandemic."

The authors recommend a way forward. They say: "We propose a systems approach within development agencies to address pandemic prevention at the intersection of people and their environment where the risk of disease emergence is highest."

The authors continue: "To achieve this goal, mainstream development funding, rather than emergency funding, is required."

The authors add: "Not only will this better address the most significant global health threats, but it will also provide the broad scale first line of defense against the next unknown contagion."