Over the past two decades, the time between fatal outbreaks of international diseases has shortened, and the human and economic cost of these outbreaks has increased. In 2002, severe acute respiratory syndrome (SARS) caused 800 deaths and $40 billion in economic losses. The 2014 Ebola outbreak in West Africa caused more than 11,000 deaths and $53 billion in economic and social losses. In early 2020, COVID-19 spread rapidly around the world and was estimated to have contributed to more than 17 million deaths, with economic losses estimated at $12.5 trillion by 2024. alerting the world to these threats has led to a wider spread and greater loss of life.
The next infectious disease threat could be even more deadly and costly. Political leaders can choose to prevent it. In May 2021, we and our colleagues at the Independent Panel for Pandemic Preparedness and Response released an evidence-based package of actions for transformative change that could make COVID-19 the latest pandemic of such devastation (see go.nature.com /3iqfqhm) . In short, we recommend a mindset shift towards faster detection and reporting of outbreaks and threats by an independent, well-funded World Health Organization (WHO). Presidents and prime ministers would lead a council to coordinate multisectoral action and promote accountability. Medical countermeasures would be available wherever they are needed. This transformed system would be supported by an international fund that funds measures to prevent and respond to new health threats.
To stop the next health threat, heads of state and government must lead, nationally and in solidarity. With some exceptions, the COVID-19 pandemic has been characterized by too many words and not enough actions, despite its clear threat to global health, economies and security. COVID-19 global summits brought welcome funding announcements and leaders spoke at WHO meetings, but action was not sustained.
We believe a global leader-level council is needed to identify gaps in preparedness and response, mobilize finances, empower public and private stakeholders, and provide leadership at the first sign of a threat. This council should be established by a political declaration negotiated by the United Nations General Assembly.
Preventing the global pandemic is estimated to cost $10.5 billion annually, a hefty sum, but a fraction of the cost of not being prepared. A new fund for pandemic prevention, preparedness and response, approved by the World Bank board in June, is too new to be adequately evaluated. However, early signs are that it is based on an outdated ‘donor-recipient’ model, with high-income countries having too much influence and not enough money pledged. Instead, we recommend a comprehensive and inclusive public investment financing model that offers low-income countries a seat at the table and disburses funds based on a country’s needs and finances.
The role of the WHO should also be considered. If it is to remain the coordinating authority for global health, member states must give it the authority, independence and funding to perform that role well. WHO was too slow in declaring a Public Health Emergency of International Concern (PHEIC) when the SARS-CoV-2 virus emerged. Work is currently underway to amend International Health Standards, which govern global responses to international public health threats, to give WHO clear authority to freely communicate on disease outbreaks, declare an evidence-based PHEIC, and investigate without obstacles. However, these amendments are not expected to be accepted until May 2024 and the changes will only come into effect later. This creates a dangerous in-between period, during which WHO must be courageous and raise the alarm about new threats. The relative speed with which he has called a PHEIC for the current monkeypox outbreak has been encouraging, although some think it should have come sooner.
The area of reform that is meeting the greatest resistance, from industry and some countries, is ensuring that adequate medical countermeasures are available where they are needed most. Vaccines and treatments are a global common good: they are meant to slow the spread of disease and protect lives during a health emergency, not be a profit opportunity. Countermeasures should be distributed equally based on public health needs and research and development should be adapted to the environments in which these products will operate: “ultra-cold chain” vaccines, for example, cannot be easily administered in hot environments , low-income countries.
Assessing the successes and failures of the Access to COVID-19 Tools Accelerator (ACT), an initiative launched in April 2020, should reveal practical next steps to bring about a fair system. The pandemic preparedness treaty currently under negotiation at WHO could also ensure an end-to-end system for medical countermeasures, from research and development to delivery, that takes into account the public health needs of countries across the globe. income levels. These considerations must include supporting manufacturing worldwide, to avoid rich countries prioritizing their populations during a health emergency at the expense of low-income nations.
These recommendations are not exhaustive. Other actions are also essential, such as building trust in public health interventions and investing in strategies to minimize the risk of pathogens transferring from animals to humans. Political leaders now have a clear choice: to watch as a new disease with pandemic potential emerges and spreads, or lay the groundwork needed to fight it. Given the damage caused by COVID-19, it’s hard to see why this is a choice.
This article is part of Nature Outlook: Pandemic Preparedness, an independent editorial supplement produced with the financial support of third parties. About this content.