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From the foreword by Co-Chairs H.E. Dr Gro Harlem Brundtland and Mr Elhadj As Sy: “For its first report, the Global Preparedness Monitoring Board 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. It is well past time to act.”
EXECUTIVE SUMMARY: ACTIONS FOR LEADERS TO TAKE
Heads of government must commit and invest. Heads of government in every country must commit to preparedness by implementing their binding obligations under the International Health Regulations (IHR (2005). They must prioritize and dedicate domestic resources and recurrent spending for preparedness as an integral part of national and global security, universal health coverage and the Sustainable Development Goals (SDG).
Countries and regional organizations must lead by example. G7, G20 and G77 Member States, and regional intergovernmental organizations must follow through on their political and funding commitments for preparedness and agree to routinely monitor progress during their annual meetings.
All countries must 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).
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.
Financing institutions must link preparedness with economic risk planning. 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.
Development assistance funders must create incentives and increase funding for preparedness. Donors, international financing institutions, global funds and philanthropies must increase funding for the poorest and most vulnerable countries through development assistance for health and greater/earlier access to the United Nations Central Emergency Response Fund to close financing gaps for their national actions plans for health security as a joint responsibility and a global public good. Member states need to agree to an increase in WHO contributions for the financing of preparedness and response activities and must sustainably fund the WHO Contingency Fund for Emergencies, including the establishment of a replenishment scheme using funding from the revised World Bank Pandemic Emergency Financing Facility.
The United Nations must strengthen coordination mechanisms. The Secretary General of the United Nations, with WHO and United Nations Office for the Coordination of Humanitarian Affairs (OCHA), must strengthen coordination in different country, health and humanitarian emergency contexts, by ensuring clear United Nations systemwide roles and responsibilities; rapidly resetting preparedness and response strategies during health emergencies; and, enhancing United Nations system leadership for preparedness, including through routine simulation exercises. WHO should introduce an approach to mobilize the wider national, regional and international community at earlier stages of an outbreak, prior to a declaration of an IHR (2005) Public Health Emergency of International Concern.
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