In the past 20 years, the time between deadly global disease outbreaks has decreased and the economic and human cost of these epidemics has increased. In 2002, severe acute respiratory syndrome (SARS) led to 800 deaths and US$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 worldwide, and is estimated to have contributed to more than 17 million deaths, with economic losses estimated to reach $12.5 trillion by 2024. These threats spread faster and resulted in more deaths.
The next epidemic-disease threat could prove to be even more dangerous and expensive. It is up to political leaders to stop it. In May 2021, we and our colleagues on the Independent Panel for Pandemic Preparedness and Response published an evidence-based package of actions for transformational change that could make COVID-19 the last pandemic of such devastation (see go.nature.com/3iqfqhm). We recommend a shift in mindset to enable faster detection and reporting of threats and outbreaks by an independent, well-funded World Health Organization (WHO). The council would be headed by the president and prime ministers. It would coordinate multisectoral actions and promote accountability. All areas would have access to medical countermeasures. The international fund that finances new health threats prevention and response would support this system.
To stop the next threat to health, leaders of state and government must act together, both nationally and in solidarity. With some exceptions, the COVID-19 pandemic has been characterized by too many words and not enough action, despite its clear threat to global health, economies and security. The global COVID-19 summits have brought welcome funding announcements and leaders have spoken at WHO gatherings, but action has not been sustained.
We believe that a global leader-level council is necessary to identify gaps in preparedness, mobilize funds, hold public and private stakeholders responsible, and provide leadership when there is a threat. This council should be established through a political declaration that is negotiated by United Nations General Assembly.
Global pandemic prevention is estimated to cost $10.5 billion each year–a sizeable sum, but a fraction of the cost of not being prepared. The board of the World Bank approved a new fund for pandemic preparedness, prevention and response in June. However, it is still too early to properly evaluate. Early signs suggest that the fund is based on an old ‘donor-beneficiary” model. This means that high-income countries have too much influence and not enough money being pledged. We recommend a global, inclusive public investment funding model that gives lower income countries a seat at a table and disburses funds according to a country’s financial needs.
The WHO’s role must also be considered. The WHO must be recognized as the coordinating authority for global healthcare. It must have the funding, independence, and authority to fulfill its role. When the SARS-CoV-2 virus was discovered, the WHO was too slow in declaring a public-health emergency international concern (PHEIC). Now, work is underway to amend the international regulations on international public-health threats (PHEIC), to give the WHO the authority to communicate freely about disease outbreaks, to declare a PHEIC based upon evidence, and to investigate without hindrance. However, these amendments are not scheduled to be accepted until May 2024, and changes won’t come into force until even later. This creates a dangerous interim time, during which the WHO must be bold in sounding the alarm if new threats emerge. Although it was encouraging to call a PHEIC for the current outbreak of monkeypox, some believe it should have been done sooner.
The area that is most resistant from industry and other countries is the guarantee that medical countermeasures are available where they are needed. Vaccines, therapeutics, and other vaccines are a global good. They are intended to prevent disease spread and protect people during an emergency. Countermeasures should be distributed fairly on the basis of public health need. Research and development must be tailored for the environment in which these products will be used. For example, ‘ultra-cold chains’ vaccines cannot be easily delivered to countries with lower incomes.
Evaluating the successes and failures of the Access to COVID-19 Tools (ACT) Accelerator, an initiative launched in April 2020, should reveal the practical next steps to achieve an equitable system. The WHO is currently negotiating a pandemic preparedness treaty that would ensure a comprehensive system for medical countermeasures. This includes research, development, and delivery. It will also consider the public-health needs in all countries. To prevent wealthy countries from prioritizing their own populations in a crisis of health, these considerations must also include support for manufacturing around the world.
These recommendations are not exhaustive. These recommendations are not exhaustive. The choice is now for political leaders: either to wait and see if a new pandemic-threatening disease emerges or to create the foundations to stop it. Given the damage done by COVID-19, it’s hard to fathom why this is a choice at all.