Madrid — New report led by Ellen Johnson Sirleaf and Helen Clark proposes actions that must be implemented to help make the world safer
As H5N1 avian influenza surges in mammal populations and causes new human infections, and mpox is leading to deaths of children, the former Co-Chairs of The Independent Panel for Pandemic Preparedness and Response warn that leaders have not done nearly enough to prepare for pandemic threats, leaving some eight billion people vulnerable.
"In 2024, for everyone who survived COVID-19, a pandemic is a lived experience and not a theoretical threat," said Her Excellency Ellen Johnson Sirleaf. "Instead of taking action to prepare for the next major outbreak, leaders have turned away from pandemic preparedness. This is a gamble with our futures."
President Sirleaf has noted with alarm the number of child deaths occurring as a result of a more dangerous strain of mpox, a dearth of diagnostic testing, and the fact that while vaccines exist, they are not yet available where children are dying.
In their new report, No Time to Gamble: Leaders Must Unite to Prevent Pandemics, the former Co-Chairs take stock of progress against the package of recommendations The Independent Panel made to the World Health Assembly in May 2021 following its eight-month review of the response to COVID-19.
"We were clear in 2021 at the height of COVID-19, that leaders needed to act urgently to make transformative change to the international system, so that there would be a new approach to funding, new ways of managing equitable access to products like vaccines and tests, and a new Framework Convention to complement the rules for outbreaks and pandemics," said the Right Honourable Helen Clark at an event to release the report hosted by Club de Madrid.
"Instead, the funds now available pale in comparison to the needs, and high-income countries are holding on too tightly to traditional charity-based approaches to equity. The pandemic agreement is vital and must succeed but has yet to be agreed. In short, if there were a pandemic threat today - such as if H5N1 began to spread from person to person - the world would likely again be overwhelmed."
Some cause for hope
The report also points to progress. The 77th World Health Assembly agreement to amend the International Health Regulations (IHR) can result in faster information-sharing from countries and from WHO, more transparent processes in deciding a public health emergency of international concern, and a definition of a pandemic emergency, which was not codified before.
Other progress includes WHO Member States' decision in 2023 to increase the proportion of unearmarked funding to WHO's base budget, giving the organization more independence in allocation of funds.
However, the Co-Chairs also warn that WHO may be spending too much on the operational side of health emergencies including on delivery of supplies, when it should focus attention on excellence in normative and technical support. Given the attention both emergencies and technical excellence require, the report suggests WHO Member States consider whether WHO should be split into two entities so that emergency operations do not overwhelm the normative work.
Are countries prepared?
The Co-Chairs also underscore that it's impossible to know if countries are prepared for a pandemic, based on the current assessment tools and metrics. The report shows that while voluntary self- assessments reached a record high in 2023, the infrequency of joint external evaluations, lack of visibility on national plans, and limitations on the types of information being collected provide only a patchwork picture of country preparedness.
Address these seven areas to help change the future, starting now
The report lays out several steps that must be taken to implement The Independent Panel's package of recommendations and make the world safer from pandemic threats. Governments, international financial institutions, international and regional organizations and WHO should consider the following as priorities:
Pandemic rules:
In July, WHO Member States must set new ways of working to make progress on the pandemic agreement. New modalities must include inclusion of independent experts and civil society. The pandemic agreement should be adopted by December 2024.
Member States and WHO should immediately abide by the amended International Health Regulations and prepare for their coming into force by June 2025.
Multisectoral Leadership: In September at the time of the UN General Assembly
A new Champions Group to Prevent Pandemics, comprised of former and current leaders, should be established.
At the Summit of the Future in September, the UNGA must adopt a new Emergency Platform for complex global shocks as part of the Pact for the Future. The platform should expand to include emergency preparedness.
Accountability: In October, the Global Preparedness Monitoring Board should be made fully independent and de-linked from WHO, or a new independent PPR monitoring board, similar to the IPCC, should be established. The pandemic agreement must include an implementation and compliance mechanism.
Finance: The Pandemic Fund should have a successful pledging round of non-ODA funds in advance of the November G20. The G20 should lay plans to convert The Pandemic Fund into a preparedness and surge mechanism based on a global public investment model.
Equitable Medical Countermeasures: At the G20 this year and next, Brazil, South Africa and other middle-income countries should indicate the need to move away from a charitable model for medical countermeasures access and towards one of regional resilience, knowledge generation, and technology sharing to stop outbreaks, managing countermeasures as part of the global commons.
An independent and more authoritative WHO:
At the November G20, Member States must meet milestones for WHO's investment round and repledge their commitment to unearmarked funding.
The January 2025 Executive Board should initiate a one-term approach for the Director-General and Regional Directors, and WHO must work to depoliticize senior appointments.
Country preparedness: Countries must ensure they have updated pandemic plans based on WHO benchmarks. WHO must update assessment tools in line with the amended IHR and wider whole-of-government and society approaches; and should begin to publish clear annual assessments of country preparedness.
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The report underscores that there is about a fifty per cent chance that the world could face another pandemic threat on the same scale as COVID-19 in the next 25 years, making it even more important to invest in preparedness now.
"There were lessons to be learned from Ebola in West Africa," said Ellen Johnson Sirleaf. "Just five years later, having not applied those lessons, there were lessons to be learned again from COVID-19. There is no need to keep learning. Instead of gambling, leaders can make practical decisions and apply those lessons. Why would they make any other choice?"
More about The Independent Panel: The Co-Chairs, the RH Helen Clark and HE Ellen Johnson Sirleaf, led The Independent Panel for Pandemic Preparedness and Response together with 11 distinguished panelists. They spent eight months rigorously reviewing various dimensions of the pandemic. In May 2021 the Co-Chairs submitted their evidence-based landmark report entitled COVID-19: Make it the Last Pandemic to the World Health Assembly. They made recommendations which, taken as a package, could transform the international system in a way that could make it the last pandemic of such devastation.
The Independent Panel Co-Chairs, several members and advisors continue to advocate for implementation of the full package of recommendations due to concerns about the failure to implement recommendations of past high-level reviews of major outbreaks. Their interest is to see a fit-for-purpose, transformed, and effective international system for pandemic preparedness and response. They continue to do this work because of the serious implications of lack of transformative change being made.
