Urbanization, human societies, and pandemic preparedness and mitigation

The unprecedented urbanization experienced over the past 50 years has shaped modern societies and influenced infectious disease transmission and propagation. Pandemic preparedness and mitigation are intricately dependent on understanding the drivers of infectious disease propagation in urban areas as well as the barriers for their effective containment. This chapter identifies major determinants of infectious disease transmission and pandemic spread in urban areas, including: (a) the complexity of urban processes and the challenges they impose for developing sound public health solutions; (b) the disproportionate role of human behavior and social interactions; (c) the human–animal interface and its role in zoonotic pathogen spillover; (d) the complex political and administrative structures in cities; and (e) the role that ports of entry within cities play for pathogen introduction and circulation. Key gaps relevant for future revisions of the International Health Regulations and other policy documents governing Global Health Security and epidemic preparedness are discussed. Properly resourced and planned epidemic preparedness in cities can have significant global health benefits. We conclude that the predominance of zoonotic diseases in recent pandemics emphasizes the need for the establishment of One Health approaches within urban areas to strengthen public health surveillance and mitigate the root causes of their emergence and propagation within cities.