The World Health Organization (WHO) has released its list of the top 10 dangers they believe to be the biggest threats to health in 2019. On there are many of the usual suspects, including Ebola, which saw several outbreaks in 2018, and dengue, which infects around 390 million people a year, as well as the likelihood the world will face another global influenza pandemic.

Joining these hard-to-tackle threats this year is one entirely preventable. Yes, the WHO have decided to add anti-vaxxers to the list of the biggest threats to world health. 

VACCINE HESITANCY

Measles has seen a resurgence, with a global increase of 30 percent, despite vaccines to prevent measles being introduced in 1963 and the vaccine only being improved since then. An outbreak in Europe affected more than 41,000 people in 2018, up from just over 5,000 in 2016.

Rather than list the diseases themselves (although it also mentions the HPV vaccine and poliovirus) as threats to the world's health, the WHO has added the anti-vaccine movement itself as a threat. 

"Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases," they write in their release. "Some countries that were close to eliminating [diseases] have seen a resurgence.

"Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved."

As well as anti-vaxxers, the WHO outlined these nine other threats to world health (in no particular order) that they will try to tackle in 2019:

Air pollution and climate change

The WHO list air pollution as the greatest environmental risk to health. Nine out of 10 people worldwide breathe polluted air every day, with around 7 million people dying prematurely every year as a result.

Non-communicable diseases

Chronic, non-transmittable diseases such as cancer, heart disease, and diabetes are the leading cause of mortality, causing 70 percent of deaths worldwide. Of the 41 million people a year who die due to non-communicable diseases, 15 million people die prematurely (aged between 30 and 69).

The WHO say that a rise in these diseases has been driven by the use of alcohol and tobacco, unhealthy diets and inactivity, and air pollution.

Global influenza pandemic*

"The world will face another influenza pandemic – the only thing we don’t know is when it will hit and how severe it will be," the WHO write about one of the most unpredictable threats on the list.

"Global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system."

An estimated 6.2 to 7.3 million people in the US have gotten sick from the flu during the 2018/19 flu season so far, according to the Centers for Disease Control and Prevention (CDC).

*Before you all nitpick and say that all pandemics are global, this is the way it was described by the World Health Organization and who are we to argue with the WHO?

Fragile and vulnerable settings

Over 6.1 billion people live in unstable environments, where crises (such as war and mass population displacement) can leave them without adequate food, water, or basic medical care. 

Ebola and other high-threat pathogens

The Democratic Republic of Congo saw several Ebola outbreaks last year, which spread to densely populated cities, making the epidemics even more difficult to tackle.

As well as Ebola, the WHO list SARS, Zika, Nipah, and the ominously-named "disease X" as pathogens that we need to prepare properly for. Before you panic and think you have symptoms, "disease X" is a codename for an as-yet-unknown disease that could arise and spread through the population.

Antimicrobial resistance

The WHO have been quick to sound the alarm on antibiotic resistance, and this year it makes the list of biggest threats to humanity once again.

"A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century," the WHO warned in 2014. Other than a few promising studies on new types of antibiotics, not much has changed and alarming scenarios for what happens when antibiotics stop working still loom large.

Dengue

With 40 percent of the population at risk of dengue fever, it remains one of the biggest threats to world health. The mosquito-borne disease kills up to 20 percent of people with severe forms of the disease, mainly occurring during rainy seasons in countries like India and Bangladesh.

HIV

Progress tackling HIV has been enormous, but still nearly a million people a year die of HIV and/or AIDS. With more than 37 million people living with the infection, the WHO remains committed to tackling it head-on. 

One of the biggest problems in doing so is reaching groups around the world often excluded from health systems, such as "sex workers, people in prison, men who have sex with men, or transgender people". This year they warn that young women and girls are increasingly at risk of contracting HIV, citing that one-in-four HIV infections in sub-Saharan Africa occurs in this group, despite the fact they only make up 10 percent of the population. 

Weak primary health care

Many low-middle income countries around the world do not yet have adequate primary health care (the first point of contact people have with their health system) and it's putting lives at risk. In a global conference in 2018, all countries committed to improving primary health care. The WHO will work with countries and organizations to help improve this vital first port of call.