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international financing institutions, global funds and philanthropy must increase funding for the poorest and most vulnerable countries, through development assistance for health and greater/earlier access to the United Nations Central Emergency Response Fund to close financing gaps for their national health security action plans as a joint responsibility and a global public good. Member States need to agree to an increase in WHO contributions for preparedness and response financing and must sustainably fund the WHO Contingency Fund for Emergencies, including the establishment of a replenishment scheme using funding from the revised World Bank Pandemic Emergency Financing Facility. PROGRESS, CHALLENGES, ACTIONS: FINANCING 25 Ultimate objectives: All countries have completed and fully funded their NAPHS with domestic resources, supplemented by international sources for the poorest countries. The overall level of funding for preparedness has increased. The IMF and World Bank have functioning systems for financially supporting country preparedness and for making funding rapidly available in emergencies. WHO is adequately funded and equipped to support countries’ preparedness and to lead a global response to a public health emergency on any scale; and the CFE is sustainably financed by many contributors, including from the World Bank PEF. Progress indicator(s) by September 2020 • WHO Member States agree to an increase in contributions for preparedness at the Seventy-third World Health Assembly in 2020; and Member States, the World Bank and donors provide sustainable financing for the CFE to a level of US$ 100 million annually. PROGRESS, CHALLENGES, ACTIONS: FINANCING While the responsibility for preparedness lies largely with local and national leaders, an effective international response system is an essential global safety net. As the accumulation of new global trends and challenges creates more complex health emergencies, the international community must be better prepared. Poverty, deprivation and weak health and government structures can amplify a disease outbreak into a wide-ranging humanitarian catastrophe that quickly grows beyond what national authorities can manage. While WHO leads the international response to any health emergency, it needs reliable, systematic backup from other United Nations agencies to address logistical and humanitarian developments that are beyond its scope to manage. International coordination mechanisms 26 7 PROGRESS, CHALLENGES, ACTIONS: INTERNATIONAL COORDINATION The ongoing tenth Ebola outbreak in the DRC reveals the complex challenges facing global and national preparedness despite increased attention and progress in this area. Among the signs of progress, an apparently successful vaccine has been administered to 170 000 people as of July 2019, and therapeutic approaches (some studied in an earlier outbreak and some newly discovered) are available; strong engagement of the DRC Ministry of Health at the highest levels; rapid WHO deployment of a multidisciplinary incident management team; heightened preparedness levels in neighbouring countries; and use of innovative technologies (58). The Inter-Agency Standing Committee (IASC) activated its revised (April 2019) systemwide “Humanitarian Systemwide Scale-up for Infectious Disease Events” protocol to adjust humanitarian response already underway (59,60). Progress to date 27 New approaches for international preparedness and, ultimately, response, are needed as insecure contexts, such as the eastern DRC and Yemen, have blurred the lines between health and humanitarian emergencies. New agile approaches would systematically coordinate key multisectoral international actors for different parts of a response, in order to plan for, monitor, assess, and adjust activities in real time. Further, attention must be given to transition planning from response to long-term development, stability and sustainable development once the outbreak ends. The Secretary General of the United Nations belatedly identified a lead for public health emergencies in the 2014-2016 West Africa Ebola crisis (the United Nations Mission for