The Economics of Prevention: Why Biological Security Underinvests Before the Crisis

Prevention is not underfunded because nobody understands its value. It is underfunded because its costs are immediate, certain and attributable, while its benefits are probabilistic, deferred, distributed across many parties and — when prevention works — indistinguishable from nothing having happened at all.

Two outbreaks, one misleading comparison

Foot-and-mouth disease has given British policy the most quoted before-and-after comparison in animal health. In 2001 the epidemic ran for the better part of a year, more than six million animals were killed, and the National Audit Office now puts the cost at £5.2 billion to the public sector and £8.6 billion to the private sector in 2023–24 prices. In 2007 the disease returned, and the outbreak was contained quickly — WOAH cites 58 days and a cost of around £47 million — although industry estimates of the losses to farming and tourism ran to several hundred million pounds. The World Organisation for Animal Health (WOAH) used exactly this pairing in its 2026 State of the World’s Animal Health report to illustrate what preparedness buys: after 2001 the UK invested in contingency planning, traceability and emergency management, and the next outbreak was small and cheap.

The comparison is not wrong, but it is not clean either, and the way in which it is not clean is the subject of this issue.

The 2007 outbreak did not arrive the way 2001 did. The 2001 virus entered a national livestock system undetected, during a period of heavy sheep movements, and was circulating for weeks before the first report; by the time it was recognised it had already been seeded across the country through markets and dealers. The 2007 virus escaped from the Pirbright site in Surrey — contaminated effluent from a leaking drainage system, carried off site by heavy rain and vehicle movements — into a handful of neighbouring farms. The source was a known facility, the strain was a laboratory strain, and the outbreak was geographically compact from the start. Some of the difference between £8 billion and £47 million is preparedness. Some of it is simply that the second outbreak started somewhere very different, in a very different way.

And there is a second complication, one that the comparison usually leaves out. Sir Iain Anderson’s review of the 2007 outbreak did commend the government’s handling of it; many of the lessons of 2001 had been learned. But the investigations into the escape pointed to the condition of the site’s effluent drainage, and the same review described a long history of ambiguous departmental leadership and a lack of long-term sustainable funding for Pirbright. The outbreak that is now held up as the dividend of preparedness investment was itself caused by a failure to invest in the maintenance of biological-security infrastructure.

That is the economics of prevention in miniature. The value of prevention is real. The stories used to demonstrate it are frequently confounded. And the same institutions that learn expensively from one crisis can, at the same time, be underinvesting in the unglamorous capability whose failure produces the next one.

The central thesis

The argument of this article is that biological security underinvests before the crisis for structural reasons, and that those reasons are identifiable, persistent and, at least in part, correctable.

It is not an argument that decision-makers are ignorant or careless. Almost every official review of a major biological emergency in the last twenty-five years has concluded that prevention and preparedness were underfunded beforehand. The UK Covid-19 Inquiry’s first report put it plainly in 2024: proper preparation involves preparing for an event that may never happen, and it costs money, but the cost of not doing so is vastly greater. Nobody seriously disputes the proposition in the abstract. The puzzle is why a proposition everyone accepts after the crisis is so consistently under-funded before it.

The answer begins with an asymmetry in how the two sides of the prevention ledger present themselves.

The cost of prevention is immediate: it falls in this financial year. It is certain: the invoice for a surveillance programme or a laboratory upgrade is known to the pound. It is attributable: it sits on a named budget line belonging to a named organisation, and a named minister will be asked to defend it. And it is visible: it competes, openly, with other claims on the same budget.

The benefit of prevention has none of these properties. It is deferred, arriving — if it arrives at all — in some future year. It is probabilistic: it consists of a reduction in the likelihood or severity of something that might not have happened anyway. It is distributed: the avoided losses fall on farmers, processors, exporters, health systems, insurers, households and other governments, most of whom did not pay for the prevention. And it is counterfactual: when prevention succeeds, what is produced is an absence. There is no outbreak, no invoice, no inquiry and no headline. Success is observationally indistinguishable from good luck.

Any budgeting system that compares an immediate, certain, attributable, visible cost against a deferred, probabilistic, distributed, counterfactual benefit will tend to underfund the second. That is not a failure of individual judgement. It is what the comparison is set up to produce.

A note on scope. “Prevention” in this issue covers more than primary prevention in the narrow epidemiological sense — stopping a pathogen from ever entering a population. It includes early detection, which does not stop introduction but limits its consequences; preparedness, which reduces the cost and duration of response; and the maintenance of the systems on which all three depend. These are different things with different economics, and later pieces in this issue distinguish between them. What they share is the property that matters here: the money is spent before the crisis, and the return is measured against a crisis that did not happen, or happened less.

Five mechanisms of underinvestment

1. The invisible return

The first mechanism is the one already described: successful prevention produces no evidence of its own success. A vaccination programme that keeps rabies out of a dog population leaves behind no bite injuries, no post-exposure prophylaxis bills and no deaths — and therefore no data point with which to demonstrate that it worked. An import-control regime that intercepts contaminated pork generates seizure statistics, but no one can observe the African swine fever outbreak that the seizure prevented.

This produces a characteristic failure in how prevention is evaluated. Programmes are judged on outputs that can be counted (inspections completed, samples tested, animals vaccinated) rather than outcomes that cannot (outbreaks avoided). Over time the outputs look like cost without consequence, and the programme becomes a candidate for efficiency savings precisely because it has been effective. The epidemiologist Geoffrey Rose identified a related paradox in population health forty years ago: a measure that brings large benefits to a population may offer little visible benefit to any individual in it. Biological security has a temporal version of the same problem. A measure that brings large benefits over a decade may offer no visible benefit in any given year.

The difficulty of valuing a non-event is the subject of the third article in this issue, The £0 Outbreak, which examines how avoided-cost claims are constructed and why the most quoted of them deserve caution.

2. The misaligned ledger

The second mechanism is distributional. The organisation that pays for prevention is rarely the organisation that receives most of the benefit.

When a national veterinary service funds scanning surveillance, the benefits flow to livestock keepers whose herds are not culled, to processors whose supply is not interrupted, to exporters whose markets are not closed, to retailers, to rural businesses dependent on footfall, and — for zoonotic disease — to the health service. When a country invests in controlling an endemic zoonosis, part of the benefit accrues to its neighbours and trading partners. Biological surveillance has, in the language of public economics, a strong weakest-link component: the protection it provides to everyone depends heavily on the least capable participant, and each participant’s incentive to invest is weaker than the collective interest in their doing so.

The result is that an intervention can have a strong economic case for society as a whole while offering a weak financial return to the body asked to fund it. That gap — between the social value of prevention and the private or departmental value to whoever holds the budget — is where much underinvestment lives. It is the subject of The Prevention Paradox: Who Pays When Prevention Works?, the first supporting analysis in this issue.

Issue 001 of this publication has already shown one consequence. In Paying for Cooperation, the Danish compensation model and the British one were compared as instruments of behaviour, not merely of fairness: where the costs of reporting fall on the farmer and the benefits of early reporting fall on everyone else, reporting is delayed. In After the Cull, the same logic was traced through the 2001 epidemic. The misaligned ledger is not an abstraction. It changes what people do.

3. Political time

The third mechanism concerns how credit is allocated. The most cited evidence comes from outside biological security. In a 2009 study of American disaster policy, Andrew Healy and Neil Malhotra found that voters rewarded incumbents for disaster relief spending but not for disaster preparedness spending — even though, on their estimates, a dollar of preparedness was worth around fifteen dollars in mitigated future damage. That ratio deserves the same scepticism this article applies to prevention ratios elsewhere; the finding that matters here is the asymmetry in how voters rewarded the two kinds of spending, not the precise multiple. The authors’ conclusion was that the electoral incentive systematically pushes governments towards relief and away from prevention, at considerable cost to public welfare.

There is no reason to believe biological security is exempt. Response is visible and heroic: vets in protective suits, ministers at press conferences, compensation announced, emergency funding approved. Prevention is invisible and administrative: a maintenance contract, a data system, a vacancy filled, an ear-tag regime harmonised across devolved administrations. A minister who funds prevention pays the political cost of the spending during their tenure and, if the prevention works, receives no credit for the crisis that did not occur — which may in any case have fallen in a successor’s term.

Political time also shapes what is learnt. The period immediately after a major outbreak is when the case for prevention is most persuasive and most fundable. It is also the period in which institutional memory is strongest. Both fade. Issue 001 described this as the Recovery Gap: epidemiological recovery arrives long before preparedness recovery, and the political attention needed to close the second is usually exhausted by the first.

4. Budget architecture: how response crowds out prevention

The fourth mechanism is the least discussed and, in the UK, the best documented. It concerns the plumbing of public finance. Where the fifth mechanism below describes capability decaying on its own, this one describes capability being actively consumed.

Emergency response has a characteristic funding route. When an outbreak is severe enough, money is found: through reserves, supplementary estimates, reprioritisation, or the simple fact that no government will decline to pay for culling and compensation in the middle of an epidemic. Prevention has no equivalent route. It competes each year within a departmental budget that is itself under pressure — and, crucially, it competes with response for the same staff, the same laboratories and the same management attention.

The Public Accounts Committee’s November 2025 report on resilience to animal disease describes what happens next. The Department for Environment, Food & Rural Affairs and the Animal and Plant Health Agency (APHA) told the Committee that they had been in semi-permanent response mode for several years, dealing with continuous outbreaks of avian influenza since November 2020 and bluetongue since August 2024. The consequence was not only cost. Surveillance activities were reduced. Specific control strategies for high-risk diseases went without updating. Modernisation of paper-based field systems was delayed because the people who would have done it were deployed on outbreaks. The Committee concluded that the UK was not adequately prepared for the most severe outbreaks, or for serious concurrent ones, and that the department had no overarching long-term strategy for animal-disease resilience.

That is the crowding-out mechanism stated in an official record. A surge-capacity model — in which the same staff switch from routine work to outbreak response — means that every outbreak is paid for partly in prevention that does not happen. Response consumes the capacity that would reduce the need for response. Under continuous pressure the system does not reach an equilibrium; it drifts.

The physical infrastructure tells the same story over a longer period. The National Audit Office reported in 2022 that investment to update the Weybridge site — the UK’s primary laboratory capability for animal disease — had largely stopped following the 2008 financial crisis; that a 2021 review had found more than a thousand single points of failure on the site, meaning assets or systems whose loss would cause major catastrophic disruption to operations; and that Defra had estimated in 2019 that the site’s continuing decline could lead to a total loss of capability within five to ten years. Defra now puts the cost of the redevelopment programme at £2.8 billion over fifteen years, ending in 2036 — revised upward from an initial £1.2 billion once the scope was widened and costed in detail. HM Treasury has approved £1.2 billion of that and has not formally agreed to fund the programme at the revised estimate. A decade of deferred maintenance was not a saving. It was a liability recorded nowhere, which has since been converted into a much larger capital programme, a decade of interim operational risk, and a funding gap that is still unresolved.

It is worth being precise about what this evidence shows. It does not show that the UK spends too little in aggregate on animal health, or that any particular budget line is too small. It shows something more structural: that the public-finance system has no mechanism for protecting preventive capability from being consumed by response, and no mechanism for recognising deferred maintenance of biological-security infrastructure as a growing liability rather than a saving. Public accounts record assets and expenditure. They do not record risk carried forward.

5. The decay of successful capability

The fifth mechanism compounds the others, and differs from the fourth in an important way: crowding out is a diversion of capacity that someone chose, whereas decay happens to capability that nobody is actively harming. Prevention capability, once built, is not self-sustaining. Laboratories age. Trained staff leave — the Public Accounts Committee heard that APHA’s veterinary vacancy rate peaked at 24% in 2023–24, equivalent to 108 full-time posts, and still stood at 20% in April 2025 — and their tacit knowledge goes with them. Contingency plans that are not exercised go stale. Data systems are superseded. Relationships with farmers, private vets and industry bodies, which are what make reporting happen, weaken if they are not maintained.

Because the benefit of the capability is invisible, its decay is invisible too. There is no signal that a surveillance network has become less sensitive until it fails to detect something. There is no signal that a response plan is out of date until it is used. The first reliable measurement of eroded prevention capability is often the outbreak it failed to prevent.

This is why the capability, not the absence of outbreaks, must be the thing that is measured and reported. A biological-security system that has had no major outbreak for a decade may be well defended, or may simply have been lucky while its defences decayed. From outcome data alone, it is not possible to tell which.

The wider picture

The UK is a useful case because its audit institutions have documented the mechanisms in unusual detail. It is not an outlier.

WOAH’s 2026 State of the World’s Animal Health report makes the global version of the argument. Animal health receives roughly 0.6% of global health spending. More than a fifth of global animal production is lost to disease each year. WOAH estimates that bringing Veterinary Services in every country up to international standards would cost approximately US$2.3 billion a year, and that the countries it has assessed would need, on average, a 52% budget increase to meet the actual cost of effective Veterinary Services. The report’s framing — that the choice is between planned investment and unplanned loss — is the argument of this article in institutional language.

The same asymmetry appears in pandemic financing. After Covid-19, the G20 and the World Bank established the Pandemic Fund as the first multilateral mechanism dedicated to prevention, preparedness and response. It has received pledges of a little over US$2 billion, against a WHO–World Bank estimate of an annual international financing need of around US$10.5 billion within a total requirement of about US$31 billion. At the level of academic estimates, Bernstein and colleagues calculated in 2022 that a package of primary pandemic-prevention measures — spillover surveillance, wildlife-trade management and reduced deforestation — would cost around US$20 billion a year, a small fraction of the annualised value of lives and output lost to emerging viral zoonoses. The World Bank’s 2012 Economics of One Health report reached a similar conclusion a decade earlier.

Two things are notable about these figures. The first is that, whatever their precision, they describe a large gap between what is spent in advance and what is spent, or lost, afterwards. The second is that emergency spending is not merely larger than preventive spending; it is also less efficient. The UK Covid-19 Inquiry’s procurement report, published in July 2026, found that of roughly £14.9 billion spent on personal protective equipment during the pandemic, almost £10 billion was wasted — a consequence, in the Inquiry’s analysis, of an inadequate stockpile and untested plans that forced improvisation at scale. Money spent in a crisis buys less, because it is spent under time pressure, in a seller’s market, with degraded governance. There is a crisis premium, and it is paid by whoever failed to buy before.

The case against: is prevention really underfunded?

A publication that argues for prevention should take seriously the people who argue that its case is overstated. There is a serious version of that argument, and it has become more prominent in 2026.

A group of researchers at the University of Leeds, working under the REPPARE project, has argued in a series of reports and peer-reviewed papers that the international pandemic-preparedness agenda rests on weak evidence. In an article published in Health Economics, Policy and Law in August 2026, Brown and colleagues re-examined the WHO and World Bank return-on-investment case for pandemic preparedness and concluded that it relied on improbable assumptions — including full mitigation of a pandemic’s economic impact — on crude baselines, and on comparisons that undervalued the burden of existing high-mortality diseases such as tuberculosis and malaria. Their wider argument is that the claim of rapidly rising pandemic risk partly reflects improved detection and reporting rather than more frequent spillover, and that diverting scarce health funding to preparedness carries real opportunity costs for diseases that are killing people now.

The REPPARE project’s funding from the Brownstone Institute is declared in the published work and has been noted by its critics. The arguments should be judged on their merits, and some of them have merit.

What should a prevention-minded analyst concede?

First, that many headline return-on-investment figures are not credible as stated. A ratio that assumes a programme would have eliminated the whole cost of a pandemic, or that treats every avoided pound as attributable to a single intervention, is advocacy dressed as analysis. The 2001/2007 foot-and-mouth comparison at the start of this article is a milder example of the same problem: a real effect, presented with more confidence than the underlying comparison supports.

Second, that opportunity cost is real. A pound spent on preparing for a hypothetical pandemic is a pound not spent on an endemic disease with a known and present burden. Prevention spending is not automatically virtuous; it has to earn its place against alternatives.

Third, that risk estimates derived from outbreak databases are sensitive to reporting, and that “rising risk” is harder to demonstrate than it is to assert.

What the critique does not establish is that the structural bias described in this article is absent. The five mechanisms operate whether the true expected value of prevention is large or modest. Even if every published ratio were halved, the facts would remain that preventive costs are immediate and attributable while their benefits are distributed and counterfactual; that response crowds out prevention within fixed organisational capacity; that deferred maintenance of biological-security infrastructure accumulates as unrecorded liability; and that political credit flows to relief rather than to avoidance. Those are claims about institutions, and the UK evidence for them does not depend on any pandemic-risk model.

The useful conclusion is that two claims are routinely run together and should be separated. There is a structural claim: that decision systems are biased against prevention relative to its expected value, for identifiable reasons. And there is a quantitative claim: that a particular prevention investment will return a particular multiple of its cost.

The first claim is well supported. The second is often poorly supported, and the prevention community has damaged its own credibility by leaning on it. One Health Security makes the first claim. It treats the second with suspicion — including when it is made on behalf of causes this publication supports. The way to rebuild the second is not to produce better-sounding ratios. It is to show the working.

What would correct the bias

If the causes of underinvestment are structural, exhortation will not fix them. Five changes would address the mechanisms directly. None requires a grand new institution.

Record prevention as a distinct category of spending. At present, it is difficult to answer a basic question: how much does the UK spend on preventing biological emergencies, as opposed to responding to them? Other parts of the public sector have begun to answer the equivalent question for their own domains. The Scottish Government has piloted a Preventative Budgeting Tool that tags budget allocations as preventative or responsive across portfolios and health boards, and CIPFA has published an approach to evaluating preventative investment across the public sector. A biosecurity equivalent — a published, annual tagging of preventive, preparedness and response expenditure across Defra, APHA, UKHSA and the devolved administrations — would at least make the balance visible. What is not recorded cannot be protected.

Separate the funding of response surge from the funding of routine prevention. The PAC’s evidence shows that a surge-capacity model silently converts outbreaks into lost surveillance and delayed modernisation. The fix is not necessarily more staff; it is a rule. Where response draws on staff or laboratory capacity normally assigned to prevention, the displaced preventive work should be recorded as a liability and backfilled from response funding rather than absorbed. Response should pay its own way, including the prevention it displaces.

Recognise deferred maintenance of critical biological-security infrastructure as a liability. The Weybridge history is a case study in how a decade of apparent savings became a multi-billion-pound programme and a decade of operational risk. Critical laboratory, containment and data infrastructure should carry a published condition assessment and a recorded maintenance backlog, reported alongside departmental accounts, in the same way that other critical national infrastructure is increasingly expected to.

Agree who pays before the crisis. Much of the misaligned ledger can be addressed only by pre-agreed cost-sharing: levies, co-funding arrangements, insurance and contingent finance negotiated in advance rather than argued over during an outbreak. This is the correction with the most working precedent, and the least excuse for inaction.

Australia’s Emergency Animal Disease Response Agreement is a legally binding deed, signed in 2002 between governments and industry, which fixes the cost split before anyone knows who will be affected — 80:20 between government and the affected industries for foot-and-mouth disease, with the industry share underwritten by the Commonwealth at the time and repaid through producer levies afterwards. New Zealand’s Government Industry Agreement goes further and shares the cost of readiness as well as response, which matters because readiness is precisely what the misaligned ledger starves. Germany’s state animal disease funds split compensation equally between keepers’ levies and the state, and Lower Saxony has begun reducing payments to keepers without a biosecurity plan — turning compensation from a pure transfer into a price on behaviour. The Netherlands caps each sector’s liability in five-year agreements and pays everything above the ceiling from public funds, so that the industry carries the frequent losses and the state carries the catastrophic ones.

England came close. A draft Animal Health Bill in 2010 proposed exactly this kind of framework; it was deferred in 2011 and never returned. The Public Accounts Committee’s findings fifteen years later — semi-permanent response, reduced surveillance, no long-term strategy — are what that deferral cost. The policy analysis in this issue, Insurance Before Emergency, sets out these arrangements in detail and proposes a layered version for the UK.

Show the chain, not the ratio. Finally, the evidence standard for prevention claims needs to change. A claim that prevention “saves £X for every £1” should be treated as incomplete unless it shows each step between the money and the benefit: what capability the spending created, how that capability changes biological risk, what outcomes are plausibly avoided as a result, what those outcomes would have cost, who would have borne those costs, and how confident the analyst is in each step — with a stated counterfactual and a range, not a point estimate.

None of these five is speculative. Each already exists somewhere: preventative budget tagging in Scotland, protected capability in jurisdictions that ring-fence it, published condition assessments for other critical national infrastructure, standing cost-sharing agreements in Australia, New Zealand, Germany and the Netherlands, and — in the resource published with this issue — a method for showing the working behind a prevention claim. What is missing in the UK is not a model to copy. It is the decision to copy one.

The OHS Prevention Ledger

That last proposal is the one this issue attempts to put into practice.

The OHS Prevention Ledger v1.0, published alongside this issue as a methodology and an Excel workbook, does not calculate the value of an outbreak that never happened. It records the chain of evidence and assumptions required to estimate the economic value of changing the probability or consequences of that outbreak. It requires the analyst to move step by step, from prevention investment to capability created, from capability to risk change, from risk change to outcomes potentially avoided, and from those outcomes to the economic consequences potentially avoided.

At each step, the analyst records the evidence and classifies it — observed, empirically estimated, modelled, transferred from another setting, or assumed. The counterfactual is stated in words and evidenced, not buried inside a formula. Results are produced for low, central and high scenarios. The headline output is a Prevention Ratio rather than a return on investment, because much of the benefit does not return to the investor; and it never appears on its own, only beside the assumptions and evidence quality that produced it. The workbook separately records who pays, who benefits, who still bears residual risk, and which material consequences — animal welfare, trust, ecological effects, professional capacity — have not been monetised at all.

The intended effect is that a spectacular 20:1 ratio built largely from transferred assumptions should look visibly weaker than a modest 2:1 ratio supported by direct evidence. That is the discipline the critics of the prevention agenda are right to demand, and the discipline its advocates need if they are to be believed.

The applied research article in this issue, What Does Prevention Actually Buy?, runs a first worked case through the Ledger: mass dog vaccination for rabies control in Ethiopia.

What would prove this wrong?

An argument about structural bias should say what evidence would undermine it.

If jurisdictions that ring-fence preventive capability — protecting surveillance and maintenance budgets from response — showed no better detection times, outbreak sizes or response costs than those that do not, the claim that the crowding-out mechanism matters would be weakened.

If well-designed ex-post evaluations of prevention programmes consistently found avoided losses close to or below programme costs, once counterfactuals were stated honestly and uncertainty was carried through, the claim that prevention is underfunded relative to its expected value would be weakened, even if the institutional biases remained.

If preventive capability, once built, turned out to be durable without continuing investment — if laboratory capacity, workforce and reporting relationships did not degrade in the absence of crisis — the fifth mechanism would not hold.

And if the balance between preventive and responsive spending, once made visible through budget tagging, turned out to be closer to the socially optimal level than this article suggests, the case for correction would be weaker than claimed. That is itself an argument for the tagging: it is how the claim could be tested.

How to read Issue 002

This article sets out the structural argument. The four pieces that follow each take one part of it further.

The Prevention Paradox: Who Pays When Prevention Works? examines the misaligned ledger: public goods, externalities, collective action, and the distribution of prevention’s costs and benefits among government, farmers, health systems, supply chains, insurers and the public.

The £0 Outbreak: How Do You Value a Crisis That Never Happened? examines the counterfactual problem, how avoided-cost claims are constructed, and why “£1 spent on prevention saves £X” should be read with care.

Insurance Before Emergency: Can Biological Risk Be Financed Before the Crisis? examines insurance, risk pooling, levies and contingent finance as ways of moving expenditure ahead of the emergency.

What Does Prevention Actually Buy? attempts the full chain for a single intervention, rabies vaccination in Ethiopia, with the uncertainty left visible.

Together with After the Cull and Paying for Cooperation from Issue 001, these pieces form the second One Health Security Topic Pathway: Economics & Incentives.

Conclusion

The case for prevention is usually made as if the problem were persuasion: if only decision-makers understood how much a crisis costs, they would spend more to avoid one. The evidence suggests otherwise. Decision-makers do understand, most vividly in the months after a crisis. What defeats prevention is not ignorance but arithmetic performed on unequal terms — a certain cost set against an uncertain benefit, a named payer set against dispersed beneficiaries, a visible budget line set against an invisible success, and a response system that quietly spends the capacity prevention depends on.

Those terms can be changed. Prevention can be recorded, protected from crowding out, paid for by the parties who benefit, and argued for with evidence rather than slogans. None of that guarantees that the next outbreak will be small. But it would mean that, when the next inquiry asks why the system was underprepared, the answer is not once again that the cost of preparing was obvious and the cost of not preparing was nobody’s line in the accounts.

Questions & Answers

References

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2. Bernstein, A.S., Ando, A.W., Loch-Temzelides, T., et al. (2022). The costs and benefits of primary prevention of zoonotic pandemics. Science Advances, 8(5), eabl4183.
3. Brown, G.W., von Agris, J., Tacheva, B. and Bell, D. (2026). An investment too good to be true?: Reassessing the World Health Organization and World Bank return-on-investment estimates for pandemic preparedness. Health Economics, Policy and Law, published online 6 August 2026.
4. CIPFA (2025). Evaluating Preventative Investments. London: Chartered Institute of Public Finance and Accountancy.
5. Healy, A. and Malhotra, N. (2009). Myopic voters and natural disaster policy. American Political Science Review, 103(3), pp. 387–406.
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11. Scottish Government (2026). Preventative Budgeting Tool: Guidance.
12. The Pandemic Fund (2026). About the Pandemic Fund.
13. UK Covid-19 Inquiry (2024). Module 1 Report: The Resilience and Preparedness of the United Kingdom. 18 July 2024.
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17. World Organisation for Animal Health (2026). The State of the World’s Animal Health 2026. Paris: WOAH.