Last week, the Global Preparedness Monitoring Board (GPMB), an international panel of experts, released its first-ever assessment of the world’s preparedness for significant infectious disease outbreaks. The report identified a number of critical deficiencies in the world’s readiness for outbreaks, such as those that may be caused by novel respiratory pathogens, and calls on global leaders to take urgent action to address these threats. Given the implications for outbreak response, we review the findings of the GPMB’s ‘A World At Risk’ report. We also look at one of the background papers the GPMB commissioned the Johns Hopkins Center for Health Security to draft, which informs the findings and recommendations contained within the GPMB report. 

The 2013-16 West Africa Ebola epidemic demonstrated the necessity of global health preparedness and highlighted the economic and health consequences of poor health infrastructure. Over the years, numerous initiatives and expert panels have been founded to identify gaps and provide recommendations for strengthening global health security. One such recommendation from the UN Secretary-General’s Global Health Crises Task Force in 2017 called for establishing an autonomous body to monitor global preparedness efforts and ensure their continued priority at both the national and international levels. As a result, the GPMB was launched in 2018 to “assess the world’s ability to protect itself from health emergencies, identify critical gaps to preparedness across multiple perspectives, [and] advocate for preparedness activities with national and international leaders and decision-makers.” The GPMB is co-convened by the WHO and the World Bank Group, and its board is chaired by Dr Gro Harlem Brundtland, the former Prime Minister of Norway and former WHO Director-General, and Mr Elhadj As Sy, the Secretary-General of the International Federation of Red Cross and Red Crescent Societies.

‘A World At Risk’

The GPMB’s first annual report, titled ‘A World At Risk,’ offers a snapshot of where the world currently stands in regards to our ability to prevent and control disease outbreaks and other health emergencies. This report provides an independent assessment and comprehensive overview of the international state of preparedness for health threats along with 7 high-level recommendations.

As part of the process, the GPMB commissioned 7 thematic reports to inform the analysis, findings, and recommendations included in their first annual report. These thematic reports provide further detail on the challenges of preparedness and response through various lenses including:

  • Governance and coordination (University of Oxford and Chatham House)

  • Country preparedness capacities (WHO)

  • Research and development (Wellcome Trust)

  • Financing (World Bank Group)

  • Building community engagement (International Federation of Red Cross and Red Crescent Societies)

  • Preparing for a high-impact respiratory pathogen pandemic (Johns Hopkins Center for Health Security)

  • Lessons learned from recent Ebola outbreaks (the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme)

The GPMB report finds that the world is facing a high risk of regional and global disease outbreaks with the possibility of causing devastating social, political, public health, and economic consequences. A pandemic may originate from a naturally occurring outbreak, an accidentally released pathogen, or a deliberate event. While the likelihood of a global pandemic is increasing, institutional trust, a key necessity for an effective response, is diminishing. In addition, the report remarks that even though many pathogens have pandemic potential, the fast-moving nature of respiratory pathogens presents unique challenges that we are wholly unprepared to face. Over recent years, governments and the international community have taken various measures  to strengthen country capacity and improve preparedness for epidemics and pandemics; however, this report states that our current efforts are insufficient.

The GPMB identifies several priority actions to improve our state of readiness. To begin with, heads of government and leaders must prioritize preparedness through fully implementing the International Health Regulations (IHRs) and ensuring adequate resources are available for health security. Countries, regional bodies, and intergovernmental organizations must also fulfill their commitments, both political and financial, for health preparedness. In addition, countries must develop strong preparedness systems, focusing on whole-of-government and whole-of-society approaches which engage multiple stakeholders. Also, as a respiratory pathogen pandemic with high lethality should be considered a worst-case scenario, preparations specific to respiratory pathogens must be addressed. For example, countries must be prepared to share genomic sequences and medical countermeasures. Further, donors and multilateral institutions must ensure adequate funding and research in science and technology such as vaccine and therapeutic development, surge manufacturing and evidence-based non-pharmaceutical interventions. The International Monetary Fund, the World Bank, and other financial institutions should also incorporate financing with economic risk planning and ensure funding commitments include preparedness. Furthermore, the poorest, and therefore most vulnerable, countries must be prioritized for development aide and Member States must increase their contributions to WHO to finance preparedness and sustain the Contingency Funds for Emergencies. And finally, the UN must strengthen their coordination mechanisms for health and humanitarian emergencies.

‘Preparedness for a High-Impact Respiratory Pathogen Pandemic’

The GPMB commissioned the Johns Hopkins Center for Health Security to provide an assessment on the state of readiness for a high-impact respiratory pathogen pandemic, recognizing that respiratory pathogens, specifically those with the potential for wide-spread transmission and high observed mortality, are considered a major threat to global health security. Analysis from numerous high-level reviews of global preparedness and interviews with international experts involved in pandemic preparedness and response contributed to the development of the report. Ultimately the report, titled ‘Preparedness for a High-Impact Respiratory Pathogen Pandemic’, provides findings on the state of national and international preparedness for identified functional 10 areas:

  • Global preparedness mechanisms

  • Multisectoral involvement and coordination

  • Surveillance, monitoring, and assessment

  • Health systems and clinical management

  • Community engagement

  • Risk communication

  • Research and development for medical countermeasures

  • Nonpharmaceutical interventions

  • Accidental release and biosafety

  • Deliberate use and biosecurity

The report also provides a series of suggested priority actions for international organizations, countries, and NGOs. We call for countries to strengthen their national core public health capacities, specifically by implementing the IHR and pursuing Joint External Evaluations assessments. Surveillance capacities should also be improved at the national and international levels, with a specific focus on enabling these surveillance systems to help improve management of the outbreak response efforts. In addition, frameworks that focus on sample and benefit sharing for other respiratory pathogens beyond influenza should be developed. Countries must also assess the readiness of their health systems’ and work with WHO to improve their health infrastructure. Community engagement and social sciences should be better incorporated in preparedness efforts at both national and international levels. Furthermore, WHO and countries should continue to develop and exercise risk communication strategies that address high-impact respiratory events. Research and development on medical countermeasures including vaccine development, distribution planning, and surge manufacturing must become a top priority. Public health authorities should also develop plans for the use of evidenced-based non-pharmaceutical interventions. In addition, governments should prioritize the strengthening of their biosafety for respiratory pathogens. And finally, as a high-impact respiratory pathogen pandemic may originate from a deliberate event, national governments and international organizations must prioritize their preparation for the deliberate use of pathogens including early recognition of such an event and the development of coordinated response plans.

Conclusion

While the GPMB found the international state of preparedness for health emergencies to be inadequate, they provided concrete recommendations and priority actions that aim to greatly improve the current state of readiness. Part of the GPMB’s role is to promote the need for increasing national and international preparedness in order to strengthen global health security. Over the coming year, the GPMB will monitor global efforts to address their recommendations against pre-identified indicators outlined in their report. By September 2020, we hope the world’s state of preparedness for health threats will be stronger than it is today.

Photo courtesy of Pixabay.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.