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MONITORING BOARD Contents CONTENTS III ABOUT THE GLOBAL PREPAREDNESS MONITORING BOARD page II FOREWORD page IV EXECUTIVE SUMMARY: ACTIONS FOR LEADERS TO TAKE page V A WORLD AT RISK page 1 PROGRESS, CHALLENGES, ACTIONS page 7 1. LEADERSHIP DRIVES PROGRESS page 8 2. BUILDING EFFECTIVE SYSTEMS page 12 3. PREPARING FOR THE WORST: A RAPIDLY SPREADING, LETHAL RESPIRATORY PATHOGEN PANDEMIC page 17 4. FINANCING page 21 5. INTERNATIONAL COORDINATION MECHANISMS page 26 ABBREVIATIONS page 30 GLOSSARY page 31 MEMBERS OF THE GLOBAL PREPAREDNESS MONITORING BOARD page 32 REFERENCES AND NOTES page 34 While disease has always been part of the human experience, a combination of global trends, including insecurity and extreme weather, has heightened the risk. Disease thrives in disorder and has taken advantage–outbreaks have been on the rise for the past several decades and the spectre of a global health emergency looms large. If it is true to say “what’s past is prologue”, then there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5% of the world’s economy. A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared. Outbreaks hit lower-resourced communities much harder given their lack of access to basic health services, clean water and sanitation; this will aggravate the spread of any infectious pathogen. Disease amplifiers, including population growth and resulting strains on the environment, climate change, dense urbanization, exponential increases in international travel and migration, both forced and voluntary, increase the risk for everyone, everywhere. Leaders at all levels hold the key. It is their responsibility to prioritize preparedness with a whole-of-society approach that ensures all are involved and all are protected. The world needs to proactively establish the systems and engagement needed to detect and control potential disease outbreaks. These acts of preparedness are a global public good that must meaningfully engage communities, from the local to the international, in preparedness, detection, response and recovery. Investing in health emergency preparedness will improve health outcomes, build community trust and reduce poverty, thereby also contributing to efforts to achieve the United Nations Sustainable Development Goals. For its first report, the Global Preparedness Monitoring Board (GPMB) reviewed recommendations from previous high-level panels and commissions following the 2009 H1N1 influenza pandemic and the 2014–2016 Ebola outbreak, along with its own commissioned reports and other data. The result is a snapshot of where the world stands in its ability to prevent and contain a global health threat. Many of the recommendations reviewed were poorly implemented, or not implemented at all, and serious gaps persist. For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act. The GPMB will advocate at the highest levels so that continued, sustained commitments – political, financial and social – are high on the political agenda and we will increase accountability for follow-through. The world is at risk. But, collectively, we already have the tools to save ourselves and our economies. What we need is leadership and the willingness to act forcefully and effectively. FOREWORD FOREWORD Co-Chair Former Prime Minister of Norway and former WHO Director-General H.E. Dr Gro Harlem Brundtland Co-Chair Secretary-General of the International Federation of Red Cross and Red Crescent Societies Mr Elhadj As Sy IV Heads of government must commit and invest Heads of government in every country must commit to preparedness by implementing their binding obligations under the International Health Regulations [(IHR (2005)).] They must prioritize and dedicate domestic resources and recurrent spending for