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The frequency of infectious disease outbreaks and pandemics is rising, demanding an understanding of their drivers. Common wisdom suggests that increases in outbreak frequency are driven by socioeconomic factors such as globalization and urbanization, yet, the majority of disease outbreaks are caused by zoonotic pathogens that can be transmitted from animals to humans, suggesting the important role of ecological and environmental drivers. Previous studies of outbreak drivers have also failed to quantify the differences between major classes of pathogens, such as bacterial and viral pathogens. Here, we reconsider the observed drivers of a global sample of 300 zoonotic outbreaks, including the 100 largest outbreaks that occurred between 1977 and 2017. We show that socioeconomic factors more often trigger outbreaks of bacterial pathogens, whereas ecological and environmental factors trigger viral outbreaks. However, socioeconomic factors also act as amplifiers of viral outbreaks, with higher case numbers in viral outbreaks driven by a larger proportion of socioeconomic factors. Our results demonstrate that it is useful to consider the drivers of global disease patterns in aggregate due to commonalities that cross disease systems. However, our work also identifies important differences between the driver profiles of bacterial and viral diseases in aggregate. 

The concurrent pressures of rising global temperatures, rates and incidence of species decline, and emergence of infectious diseases represent an unprecedented planetary crisis. Intergovernmental reports have drawn focus to the escalating climate and biodiversity crises and the connections between them, but interactions among all three pressures have been largely overlooked. Non-linearities and dampening and reinforcing interactions among pressures make considering interconnections essential to anticipating planetary challenges. In this Review, we define and exemplify the causal pathways that link the three global pressures of climate change, biodiversity loss, and infectious disease. A literature assessment and case studies show that the mechanisms between certain pairs of pressures are better understood than others and that the full triad of interactions is rarely considered. Although challenges to evaluating these interactions—including a mismatch in scales, data availability, and methods—are substantial, current approaches would benefit from expanding scientific cultures to embrace interdisciplinarity and from integrating animal, human, and environmental perspectives. Considering the full suite of connections would be transformative for planetary health by identifying potential for co-benefits and mutually beneficial scenarios, and highlighting where a narrow focus on solutions to one pressure might aggravate another.