Dengue, Urbanization and Globalization: The Unholy Trinity of the 21st Century Duane J. Gubler Abstract: Dengue is the most important arboviral disease of humans, affecting over half the world's population. The frequency and magnitude of dengue epidemics have increased dramatically in the past 40 years due to the geographic expansion of the virus and its mosquito vector, Aedes aegypti. The main drivers of this increase are urbanization, globalization, and the lack of effective mosquito control. Dengue viruses have adapted to a human-Aedes aegypti-human transmission cycle in large urban centers, where crowded populations live in close association with large mosquito populations. These cities have modern airports, facilitating the spread of the virus to new regions. The result is epidemic dengue. This paper discusses the three main drivers, disease burden, prevention, and control, and future prospects. Key words: Dengue, urbanization, globalization, Aedes aegypti The last half of the 20th century taught many lessons about infectious diseases. The 1950s-1970s saw victories over diseases like smallpox, malaria, and dengue, leading to a period of apathy and complacency. This period saw the deterioration of public health infrastructure and the rise of global trends like urbanization and globalization, which contributed to the re-emergence of infectious diseases. Dengue fever is an ideal case study of how urbanization and globalization influence infectious disease emergence. Before World War II, dengue viruses were globally distributed in the tropics, but epidemics were sporadic. World War II planted the seed for the current dengue pandemic. The war led to the movement of viruses and Aedes aegypti to many areas, leading to hyperendemicity. Post-war economic growth led to urbanization, which increased the frequency and magnitude of dengue epidemics. Dengue hemorrhagic fever (DHF) first emerged in the 1950s and became a leading cause of hospitalization and death in Southeast Asia by the 1980s. Dengue re-emerged in the Pacific Islands in 1964 and again in 1971. The global geographic expansion of dengue coincided with urban growth and globalization. Currently, 3.6 billion people in 124 countries live in areas at risk for dengue. The disease burden is difficult to measure due to misdiagnosis, poor surveillance, and lack of cooperation. Dengue is the most important vector-borne virus disease affecting humans. If current trends continue, dengue incidence and spread will increase. Factors influencing dengue incidence and spread include apathy, decay in public health infrastructure, changing lifestyles, and misguided mosquito control. The main drivers are urbanDengue, Urbanization and Globalization: The Unholy Trinity of the 21st Century Duane J. Gubler Abstract: Dengue is the most important arboviral disease of humans, affecting over half the world's population. The frequency and magnitude of dengue epidemics have increased dramatically in the past 40 years due to the geographic expansion of the virus and its mosquito vector, Aedes aegypti. The main drivers of this increase are urbanization, globalization, and the lack of effective mosquito control. Dengue viruses have adapted to a human-Aedes aegypti-human transmission cycle in large urban centers, where crowded populations live in close association with large mosquito populations. These cities have modern airports, facilitating the spread of the virus to new regions. The result is epidemic dengue. This paper discusses the three main drivers, disease burden, prevention, and control, and future prospects. Key words: Dengue, urbanization, globalization, Aedes aegypti The last half of the 20th century taught many lessons about infectious diseases. The 1950s-1970s saw victories over diseases like smallpox, malaria, and dengue, leading to a period of apathy and complacency. This period saw the deterioration of public health infrastructure and the rise of global trends like urbanization and globalization, which contributed to the re-emergence of infectious diseases. Dengue fever is an ideal case study of how urbanization and globalization influence infectious disease emergence. Before World War II, dengue viruses were globally distributed in the tropics, but epidemics were sporadic. World War II planted the seed for the current dengue pandemic. The war led to the movement of viruses and Aedes aegypti to many areas, leading to hyperendemicity. Post-war economic growth led to urbanization, which increased the frequency and magnitude of dengue epidemics. Dengue hemorrhagic fever (DHF) first emerged in the 1950s and became a leading cause of hospitalization and death in Southeast Asia by the 1980s. Dengue re-emerged in the Pacific Islands in 1964 and again in 1971. The global geographic expansion of dengue coincided with urban growth and globalization. Currently, 3.6 billion people in 124 countries live in areas at risk for dengue. The disease burden is difficult to measure due to misdiagnosis, poor surveillance, and lack of cooperation. Dengue is the most important vector-borne virus disease affecting humans. If current trends continue, dengue incidence and spread will increase. Factors influencing dengue incidence and spread include apathy, decay in public health infrastructure, changing lifestyles, and misguided mosquito control. The main drivers are urban