Foreword by Her Excellency Ellen Johnson Sirleaf and The Right Honourable Helen Clark
In May 2021, the Independent Panel for Pandemic Preparedness and Response presented a package of evidence-based recommendations to the World Health Assembly that was urgent, ambitious, and practical. Our goal was to make COVID-19 the last pandemic of such devastation. At the current rate of change, it will not be.
The world now marks time as “before” and “after” the pandemic. Many want to forget the pandemic itself and block the collective trauma. Yet we cannot afford to forget.
Government leaders may have turned their attention to other issues, but they must not neglect their responsibility to act now and unite to safeguard the public and prevent future pandemics.
A pandemic threat can emerge at any time, in any country. Today dangerous disease outbreaks are occurring around the globe: for example, avian influenza A (H5N1) is infecting more mammals, including domestic cattle. There is a scramble now to diagnose human cases and to purchase vaccines in case the worst happens and H5N1 begins to transmit from person to person. A deadlier new form of mpox has led to child deaths in the Democratic Republic of the Congo, where there is no access to vaccine. A new pandemic threat, “Disease X,” could emerge at any time. Every day that preparation for a new threat is delayed is a dangerous gamble.
There is recent cause for some optimism concerning the rules for pandemic preparedness and response. On June 1, 2024, after many challenging days and nights of negotiation, the World Health Assembly adopted amendments to the International Health Regulations (IHR). These amendments won’t immediately make the world’s population safer. They will be meaningful only when Member States and the World Health Organization fully invest in and abide by them. However, in a fractious world, countries demonstrated that multilateralism could still deliver and unite us against existential threats. Member States must now prioritise negotiation and adoption of a pandemic agreement— with equity at its heart—that will complement the IHR. This should happen before the end of 2024.
Discussions in Geneva are essential but must not hold up actions to prepare for the next pandemic threat. While three years is a short time in multilateral negotiations, it is a dangerously long time to leave gaping holes in the national, regional, and international systems meant to protect 8 billion people from a new pandemic.
In our main report to the World Health Assembly in May 2021, COVID-19: Make it the Last Pandemic, we recommended a coherent and urgent package of change. Leaders, however, have too often looked the other way and towards issues of immediate interest to their electorates. They are unfortunately gambling with our future.
Today the world is not investing in pandemic preparedness and response at anywhere near the scale or speed necessary. Despite multiple initiatives and discussions, there is still no efficient, equitable, end-to-end platform for medical countermeasures on which low- and middle-income countries can rely. Based on assessments, it’s difficult to say if countries are prepared or not for the next pandemic threat. Furthermore, tools and metrics still lack the rigour and comprehensiveness to identify and address pandemic vulnerabilities and risks. There is far too little accountability within the international system. There is a dangerous gap in trust between countries, within countries, and within communities that will allow pathogens to sail through.
There is a path that political leaders can choose, however, to transform their countries and the world into a safer place for their citizens today and for generations to come. It is a matter of building reciprocal trust, and it is in the interest of every country to do so. The unpredictability of pathogen emergence means every country must both rely on and support its global neighbours to be prepared.
All governments, of all income brackets, can apply lessons from COVID-19, invest in multisectoral capabilities, and update their plans to identify and manage the next pandemic threat. Governments can work much more closely with communities to understand and address inequities, vulnerability, and risks, and to rebuild trust.
The international community can take steps to transform international financing to support low- and middle-income countries to help bridge the gaps in domestic finances. Modern digital tools in the hands of community workers can transform disease surveillance across human, environmental, and animal health. Leaders can choose to manage outbreak and pandemic tools as part of the global commons. The World Health Organization can focus its efforts on ensuring the very best technical advice and support.
Pandemic preparedness and response are not for public health experts alone. There remains an essential role for political leaders at the highest level. Such leadership has been missing, but it can be advanced through various avenues, including the United Nations General Assembly, and specifically the upcoming Summit of the Future. We also call for a group of champion leaders to emerge and advocate to close the gaps in the international system and help to activate a response in times of crisis.
The solutions lie in political will to overcome trust deficits, leadership, and accountability. Statements from the G7 and G20 are important, but they are not enough. A pandemic agreement and strengthened IHR are not enough. The world needs leadership at the highest-level to turn statements and recommendations into systems and actions that protect people.
This isn’t a problem for future governments. It is not a theoretical exercise. It is a problem for which we have direct lived experience in the most recent of pasts and for which actions need to happen now.
Lack of preparation risks the lives and livelihoods of the 8 billion people on this planet, including the children and grandchildren of leaders who today could instead make a choice to protect them. This is not the time to gamble. Inaction is a dangerous political choice.