Ruger reminds us that authoritarian regimes suppress political competition and tend to have an interest in preventing human development, because improved health, education, and economic security mobilizes citizens to advocate for greater participation and more resources.6 Public health protections are literally invisible to populations; they are often taken for granted and applauded as great successes serving as propaganda ploys in public speeches.7 Although there has been scant investment in public health infrastructure and protections in all parts of the world, those countries suffer the most under autocratic regimes, especially where they have failed to keep pace with population growth and density.8 Currently, both the urban and rural environment of the 21st century are being defined by deficient dwellings, aged and inadequate infrastructure, and insufficient capacity to respond to crises, especially in ensuring access to safe water, food, sanitation, and energy. Public health surveillance, the “continuous, systematic collection, and analysis of health-related data serve as an early warning system for impending public health emergencies, but compliance differs remarkably from one country to another.”6,8 Indeed, the direct and indirect mortality and morbidity resulting from these tragedies are the responsibility of the government in power, but are often the first to be ignored. Ecological and environmental protections and preservations, such as the continuous surveillance mandated by the World Health Organization (WHO; Geneva, Switzerland) of wet markets in China that launched SARS (severe acute respiratory syndrome) in 2008, is an example of a critical monitor that was ended prematurely. Only the reporting of three diseases (yellow fever, plague, and cholera) are currently binding under the International Health Regulations, and then some countries are unwilling to notify WHO fearing economic and political consequences.9