Journal of the College of Physicians and Surgeons Pakistan
ISSN: 1022-386X (PRINT)
ISSN: 1681-7168 (ONLINE)
Affiliations
doi: 10.29271/jcpsp.2026.08.1085ABSTRACT
This opinion piece provides a critical examination of the new rhetoric surrounding arboviruses as potential drivers of future pandemics, particularly in sub-Saharan Africa and South Asia. Although dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV) are significant public health threats in these regions, the author contends that their reliance on arthropod vectors inherently constrains their ability to cause pandemics. Overestimating the dangers of these infections can lead to resource misallocation, promote public distrust, and dilute the impact of health interventions in already fragmented health systems, with Pakistan serving as a prime example. The piece also warns against the alarmist use of the term "pandemic", advocating a balanced approach rather than sensationalist reporting, which could divert attention from public health priorities. Instead, it promotes a balanced, evidence-based evaluation of risks proportionate to ecological realities. In short, the article calls the attention of the scientific community to the merits of building regional capacities, promoting clear communication, and resisting the temptation of sensational but unlikely global health forecasting regarding arboviruses.
Key words: Arboviruses, Epidemic, Epidemiology, Pandemic, Healthcare systems, Viral transmission, Pakistan.
The narrative that arboviruses are poised to cause the next global pandemic has gained traction in the scientific community over recent years. Recent publications contend that sub- Saharan Africa quite possibly may be the epicentre of the next arboviral pandemic due to poor surveillance infrastructure and high healthcare vulnerabilities.1 The World Health Organiza- tion's Global Arbovirus Initiative acknowledges that the threat of emergence and re-emergence of arboviruses with pandemic potential has grown as a global public health concern.2
These concerns are warranted, as the global geographical spread of dengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV) has already been documented. No less than seven arboviruses alone were responsible for 29 outbreaks in 25 African countries in 2023, with nearly 20,000 confirmed cases.1 Urban arbovirus prediction models point to how viruses such as ZIKV surprised and overwhelmed public health authorities, demonstrating the capacity for rapid geographic spread when arbo- viruses transition from sylvatic to urban cycles of transmission.3
However, this perspective is perhaps founded on incomplete analysis of arboviral biology and epidemiology. Although these agents certainly present a serious regional health threat, their intrinsic nature imposes significant constraints on actual pan- demic potential.
The most limiting constraint on arboviral pandemic potential is obligate reliance on arthropod vector transmission. Unlike respiratory viruses that attain direct human-to-human trans- mission, arboviruses need specific vector species to mediate transmission cycles.4 This imposes natural constraints on world-wide dissemination, as the geographical distribution and ecolo- gical requirements of competent vectors limit transmission.
In addition, the biological intricacy of arboviral transmission demands effective replication in both arthropod vectors and vertebrate hosts, a process that introduces several points of potential failure. The majority of arboviruses are inefficient in human-to-human transmission, precluding the exponential transmission chains of true pandemics.5 Dependence on a vector necessarily constrains transmission efficiency in comparison to directly transmitted pathogens such as SARS-CoV-2.
Through several decades, arboviruses have shown regional endemic patterns of distribution rather than true pandemic spread. In this context of discussion, the differentiation bet-ween epidemic and pandemic becomes significant, whereas epidemics can be severe in certain regions of the world, pandemics signify global, uncontrolled spread. Apart from a minority of diseases, most arboviral infections are geographi- cally limited to regions where competent vectors are present, thus forming predictable endemic boundaries but not pre- dictable global spread. According to the WHO Global Arbovirus Initiative assessment of 167 countries, arbovirus transmission is primarily localised in the tropics and subtropics, with minimal spread beyond the support of appropriate vector populations.2 This geographic limitation implies that although arboviruses can pose severe regional health impacts, their potential for true pandemic spread is limited by ecological boundaries.
Moreover, limited transmission observed with subcritical pathogens, which transmit only weakly from person-to-person and have small, self-limiting chains of transmission, is a major constraint in arboviral pandemic potential. In contrast to highly contagious respiratory infections, the majority of arboviruses are classified as subcritical, with transmission chains naturally burning out due to their inability to maintain the exponential growth required for pandemic transmission.4
Evidence suggests that functional surveillance systems can predict and control arboviral outbreaks effectively before they escalate to pandemic levels. Early warning and response systems have promise for timely prediction of outbreaks, with proven capacity to predict DENV outbreaks 3-5 weeks, CHIKV outbreaks 10-13 weeks, and ZIKV outbreaks 6-10 weeks in advance.6 This allows enough time for the implementation of focused control interventions that can stop epidemic amplification. Furthermore, the efficacy of surveillance programs such as ArboNET in the United States, where arboviral trends have been effectively monitored since 2000, indicates that properly designed surveillance systems can prevent regional outbreaks from becoming large-scale epidemics.7 These examples indicate that arboviral transmission can be effectively controlled by focused public health interventions.
Exaggeration of arboviral pandemic risk has several detrimen- tal effects on regional health systems that can ultimately undermine public health readiness and response capabilities. The “Boy Who Cried Wolf ” effect is one of the most pertinent con-cerns, in which repeated pandemic threats that fail to materialise as anticipated erode public confidence in health authorities, resulting in pandemic fatigue and reduced responsiveness to real threats.8 Misallocation of resources is another significant consequence, with funds diverted from established health priorities such as endemic disease treatment, routine disease surveillance, and overall healthcare infrastructure enhancement. This diversion can account for up to 30% of healthcare spending, and the economic cost of health emergency disinformation is estimated to range from US$50 million to US$300 million per day during health crises.9 In addition, health crisis fatigue among health workers and populations diminishes the efficacy of public health communication and renders populations indifferent to real health hazards.
Among other countries, Pakistan serves as a compelling case study illustrating the negative effects of pandemic-related fear and hype in a resource-limited setting. Pakistan spends less than 1% of its gross domestic product (GDP) on healthcare, ranking among the lowest globally.10 The susceptibility and weakness of Pakistan's healthcare system make it particularly vulnerable to wasteful resource consumption in the face of overblown pan- demic risks. Furthermore, Pakistan's disease surveillance system is generally characterised as weak and fragmented, with fewer than 70 Rapid Response Teams operating in 154 districts, resul- ting in substantial gaps in actual pandemic preparedness.11
During the COVID-19 pandemic in Pakistan, disinformation accounted for 14% of health-related WhatsApp group messages, with false information circulating for the longest duration.12 Low levels of digital literacy in the country make populations vulnerable to the propagation of disinformation. Overestimation of arboviral pandemic potential in Pakistan has the propensity' to erode the credibility of already struggling health authorities, divert limited resources away from high-priority activities such as maternal mortality prevention, increase vaccine hesitancy against routine immunisation drives, and cause social unrest similar to previous misinformation crises regarding polio vaccines.
The framing of arboviruses as pandemic precursors also raises questions about the evolving definition of public health urgency. It seems the criteria for what constitutes a pandemic threat are expanding faster than the pathogens themselves. This seman- tic inflation is not without consequences. By categorising nearly every emergent zoonotic vector-borne virus as a pandemic candidate, there is a risk of diluting the term’s meaning and, more importantly, its strategic utility. A term once reserved for truly global, sustained, and uncontrollable spread is now increasingly applied to localised outbreaks with constrained ecology. While the democratisation of concern may reflect the post-COVID recalibration of risk tolerance, it may also contribute to a creeping desensitisation. When everything is framed as an emergency, genuine emergencies struggle to stand out. In this regard, arboviruses have become something of an academic Rorschach test, onto which concerns are projected in ways that reflect collective anxieties as much as empirical evidence. What is urgently needed is not another virus portrayed as a global threat, but rather a more precise application of risk-related terminology that aligns with the available evidence on transmission rather than prevailing narratives.
There’s something oddly theatrical about the way arboviral threats are sometimes positioned, as if Aedes aegypti were staging a covert world tour, held back only by the inconvenience of airport security and an aversion to cold weather. The sheer enthusiasm with which some predictions launch these viruses into pandemic stardom would almost be flattering, were it not for the logistical realities of vector-borne transmission. It is a curious paradox; viruses that require specific mosquitoes, standing water, and tropical humidity are somehow imagined breaching global borders with the ease of an internet signal. This hyper-anticipatory mindset transforms health preparedness into a kind of academic suspense novel, complete with dramatic projections, ominous maps, and the ever-present spectre of ‘not if, but when’. Meanwhile, routine vector control struggles to secure basic funding, and community health workers are left managing DENV outbreaks with little more than pamphlets and goodwill. In this climate, the most pressing public health interventions risk being sidelined by scenarios that are epidemiologically intriguing but operationally remote. If global health were a budget-conscious theatre production, greater investment in the stage lights rather than the smoke machines might be considered.
The author’s opinion does not undermine the value of arboviral disease control and prevention efforts in any way. Arboviruses are valid regional public health threats; however, the differen- tiation between regional epidemic risk and global pandemic potential is required to guide best resource investment and public health communication. Strong arboviral preparedness depends on prioritising the strengthening of regional surveillance systems, developing targeted vector control initiatives, enhancing clinical management capacity, and fostering international collaboration to respond to outbreaks.2 These evidence-based solutions are more likely to yield significant public health benefits than general pandemic preparedness frameworks, which run the risk of over-estimating actual levels of danger.
In short, the scientific community faces the challenge of reconciling justifiable concern about novel infectious diseases with rational risk management based on biological constraints, eco- logical realities, and demonstrated containment capability. Exaggerating pandemic risk has the unintended consequence of undermining the very preparedness efforts required to contain serious arboviral public health issues.
COMPETING INTEREST:
The author declared no conflict of interest.
AUTHOR’S CONTRIBUTIONS:
MAK: Conceptualisation, literature review, writing of the original draft, and final approval of the version of the manu-script to be published.
REFERENCES