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FOR THE WORST • WHO established the Research and Development (R&D) Blueprint to help organizations identify research needs and work with country partners to plan for and implement studies during epidemics (34). • WHO Member States adopted the PIP Framework to improve pandemic influenza preparedness globally and support a more equitable response. Through the PIP Framework, WHO has supported countries financially and technically to improve certain essential public health capacities and established a virtual stockpile of pandemic influenza vaccines (currently estimated at more than 400 million doses). Global production capacity for influenza vaccines has increased to an estimated 6.4 billion doses (35). • Bolstering pandemic influenza preparedness, the Global Influenza Surveillance and Response System has grown to 151 laboratories in 115 countries and has been commended repeatedly for timely identification, assessment and monitoring of influenza and other respiratory pathogens, including MERS and SARS. • Funding for research has increased. While figures on R&D funding for epidemics are difficult to come by, studies show investment in research on neglected diseases rose by 7% between 2016 and 2017, representing a 10-year high. Over the last decade, national public-sector funding from low- and middle-income countries grew 17% (36). As of June 2019, CEPI has raised US$ 750 million to develop vaccines to stop future epidemics (37). Progress to date Preparedness and response systems and capabilities for disease outbreaks are not sufficient to deal with the enormous impact, rapid spread and shock to health, social and economic systems of a highly lethal pandemic, whether natural, accidental or deliberately released. There is insufficient R&D investment and planning for innovative vaccine development and manufacture, broad-spectrum antivirals, appropriate nonpharmaceutical interventionsiii (38), targeted therapeutics (including monoclonal antibodies), systems for sharing sequences of any new pathogen, and means for equitably sharing limited medical countermeasures across countries. In addition, such a pandemic requires advance planning across multiple sectors (financial, security, transportation, logistics, global communications and industry), for reinforcing social cohesion and for risk communication. Epidemic control costs would completely overwhelm the current financing arrangements for emergency response. Persistent challenges and obstacles Lack of planning and readiness for a rapidly moving, lethal pandemic caused by a respiratory pathogen 18 iii. Non-pharmaceutical interventions include public safety protocols, school and business closures, airline and transportation protocols, communications protocols, supply chain readiness etc., as well as coordination between the public and private sectors, national and local authorities. PROGRESS, CHALLENGES, ACTIONS: PREPARING FOR THE WORST Lack of data sharing and medical countermeasures in the context of a Public Health Emergency of International Concern is unacceptable The lack of optimized sample-sharing and information-sharing slows down the public health response and R&D. The PIP framework is limited to pandemic influenza, and there are no frameworks for other infectious diseases with pandemic potential. Concerns exist regarding the impact of the Nagoya Protocol (39) on timely sharing of pathogen samples (40). Limited medical countermeasures are shared inequitably at times and are likely to be prioritized for domestic use during a pandemic. Countries need to trust that, if they share samples and data, they will have access to any advances that result from them. These problems include (41): • National capacities are not well developed for research and development, including during outbreaks, as well as for deployment of vaccines, therapeutics, diagnostics, and other medical countermeasures, and creating new vaccine manufacturing methods. Country research approaches, regulatory, ethics and operational capacities require strengthening. Despite some promising developments, the technologies used for influenza