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educational levels. Many financial, human, infrastructure, surveillance and laboratory health resources already exist in countries that can directly support preparedness efforts. However, resources for disease-specific programmes, such as those for HIV, tuberculosis, malaria and polio eradication, often do not include or sustainably support preparedness. For example, entities providing funding and programmatic support for countries, such as the Global Fund to Fight AIDS, TB and Malaria (Global Fund) and Gavi, do not explicitly include prevention and preparedness to achieve broader health security. The Global Polio Eradication Initiative has developed extensive laboratory and disease surveillance networks focused on poliovirus detection and identification, but this capacity is not leveraged sufficiently for broader health monitoring. Where polio assets have supported other outbreak preparedness efforts (as seen with the outbreak of Ebola in Nigeria in 2014-2016), capacities are threatened, as funding will predictably wane once polio eradication is achieved. Breakdown of trust and social cohesion Existing health system and disease control assets are not maximized to support preparedness: PROGRESS, CHALLENGES, ACTIONS: BUILDING EFFECTIVE SYSTEMS 15 16 Progress indicator(s) by September 2020 • At a minimum, the 59 countries that have completed an NAPHS identify a national high-level coordinator (board, commission or agency) to implement national preparedness measures across all sectors and to lead and direct actions in these sectors in the event of a public health emergency. • WHO, the World Bank and partners, working with countries, develop and cost packages of priority interventions to increase preparedness capacity that can be financed in current budget cycles and map these interventions to expected results in the near term. • There are fewer, but better harmonized coordination mechanisms, global, regional and country networks, institutions and initiatives for preparedness and readiness and for research and development (R&D). Required actions Ultimate objectives: All countries have identified a high-level coordinator to plan and implement preparedness and response across all sectors, including health, security, finance and other relevant ministries. The coordinator demonstrates through exercises or actual events that national preparedness and response systems are capable of mitigating all types of public health emergencies. Preparedness activities involve communities in all phases of planning and implementation. 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 human and animal health, security, and foreign affairs sectors; the private sector; local leaders; and women and youth). PROGRESS, CHALLENGES, ACTIONS: BUILDING EFFECTIVE SYSTEMS High-impact respiratory pathogens, such as an especially deadly strain of influenza, pose particular global risks in the modern age. The pathogens are spread via respiratory droplets; they can infect a large number of people very quickly and, with today’s transportation infrastructure, move rapidly across multiple geographies. In addition to a greater risk of pandemics from natural pathogens, scientific developments allow for disease-causing microorganisms to be engineered or recreated in laboratories. Should countries, terrorist groups, or scientifically advanced individuals create or obtain and then use biological weapons that have the characteristics of a novel, high-impact respiratory pathogen, the consequences could be as severe as, or even greater, than those of a natural epidemic, as could an accidental release of epidemic-prone microorganisms. Preparing for the worst: a rapidly spreading, lethal respiratory pathogen pandemic 17 4 PROGRESS, CHALLENGES, ACTIONS: PREPARING