For its first report, the Global Preparedness Monitoring Board (GPMB) reviewed recommendations from previous high-level panels and commissions following the 2009 H1N1 influenza pandemic and the 2014–2016 Ebola outbreak, along with its own commissioned reports and other data.
The result is a snapshot of where the world stands in its ability to prevent and contain a global health threat. Many of the recommendations reviewed were poorly implemented, or not implemented at all, and serious gaps persist. For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. The GPMB will advocate at the highest levels so that continued, sustained commitments – political, financial and social – are high on the political agenda and will increase accountability for follow-through.
While disease has always been part of the human experience, a combination of global trends, including insecurity and extreme weather, has heightened the risk. Disease thrives in disorder and has taken advantage - outbreaks have been on the rise for the past several decades and the specter of a global health emergency looms large. If it is true to say “what’s past is prologue”, then there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5% of the world’s economy.
A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared. Outbreaks hit lower-resourced communities much harder given their lack of access to basic health services, clean water and sanitation; this will aggravate the spread of any infectious pathogen.
Disease amplifiers, including population growth and resulting strains on the environment, climate change, dense urbanization, exponential increases in international travel and migration, both forced and voluntary, increase the risk for everyone, everywhere.
Leaders at all levels hold the key. It is their responsibility to prioritize preparedness with a whole-of-society approach that ensures all are involved and all are protected. The world needs to proactively establish the systems and engagement needed to detect and control potential disease outbreaks.
These acts of preparedness are a global public good that must meaningfully engage communities, from the local to the international, in preparedness, detection, response and recovery. Investing in health emergency preparedness will improve health outcomes, build community trust and reduce poverty, thereby also contributing to efforts to achieve the United Nations Sustainable Development Goals.
The report highlights actions all countries must take to build strong systems:
Heads of government must appoint a national high-level coordinator with authority and political accountability to lead whole-of-government and whole-of-society approaches, and routinely conduct multisectoral simulation exercises to establish and maintain effective preparedness.
They must prioritize community involvement in all preparedness efforts, building trust and engaging multiple stakeholders (e.g. legislators; representatives of the human and animal health, security and foreign affairs sectors; the private sector; local leaders; and women and youth).
Progress indicator(s) by September 2020
· At a minimum, the 59 countries that have completed a NAPHS identify a national high-level coordinator (board, commission or agency) to implement national preparedness measures across all sectors, and to lead and direct actions in these sectors in the event of a public health emergency.
· WHO, the World Bank and partners, working with countries, develop and cost packages of priority interventions to increase preparedness capacity that can be financed in current budget cycles and map these interventions to expected results in the near term.
· There are fewer, but better harmonized coordination mechanisms, global, regional and country networks, institutions and initiatives for preparedness and readiness and for research and development (R&D). Countries, donors and multilateral institutions must be prepared for the worst. A rapidly spreading pandemic due to a lethal respiratory pathogen (whether naturally emergent or accidentally or deliberately released) poses additional preparedness requirements.
Donors and multilateral institutions must ensure adequate investment in developing innovative vaccines and therapeutics, surge manufacturing capacity, broad-spectrum antivirals and appropriate non-pharmaceutical interventions. All countries must develop a system for immediately sharing genome sequences of any new pathogen for public health purposes along with the means to share limited medical countermeasures across countries.
Progress indicator(s) by September 2020:
· Donors and countries commit and identify timelines for: financing and development of a universal influenza vaccine, broad-spectrum antivirals, and targeted therapeutics. WHO and its Member States develop options for standard procedures and timelines for sharing of sequence data, specimens, and medical countermeasures for pathogens other than influenza.
· Donors, countries and multilateral institutions develop a multi-year plan and approach for strengthening R&D research capacity, in advance of and during an epidemic.
· WHO, the United Nations Children’s Fund, the International Federation of Red Cross and Red Crescent Societies, academic and other partners identify strategies for increasing capacity and integration of social science approaches and researchers across the entire preparedness/response continuum.
To mitigate the severe economic impacts of a national or regional epidemic and/or a global pandemic, the International Monetary Fund (IMF) and the World Bank must urgently renew their efforts to integrate preparedness into economic risk and institutional assessments, including the IMF’s next cycle of Article IV consultations with countries and the World Bank’s next Systematic Country Diagnostics for International Development Association (IDA) credits and grants. Funding replenishments of the IDA, Global Fund to Fight AIDS, TB and Malaria (Global Fund), and Gavi should include explicit commitments regarding preparedness.
