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improve global health security at the country, PREFACE xiii regional, and international levels by country governments, local and international institutions, civil society organizations, donor agencies, multilateral organizations and universities, and yet more needs to be done. The purpose of the proposed global monitoring arrangement is not to create entirely new bodies of research, but rather, wherever possible, to consolidate existing work into a comprehensive framework that can be shared widely and strategically to strengthen impact. By monitoring international-, regional-, and national-level actions to prevent, detect, and respond to infectious disease outbreaks, we can celebrate improvements, shine a light on outstanding gaps and weaknesses, and hold policymakers accountable. Routine, transparent, and objective monitoring will also help to ensure sustained financial support and effective prioritization from international organizations, donor agencies, national governments, and the private sector. This report is a step towards developing such a shared framework and monitoring mechanism. It reflects the outcome of discussions involving over 50 international experts in veterinary and human public health, public policy, finance, and economic development from a meeting co-hosted by the National Academy of Medicine and the Harvard Global Health Institute on April 18th, 2017. These discussions were structured around a draft monitoring framework developed by the research team1 and sought to build consensus around what should be monitored, and how an overall implementation approach could facilitate collaborative partnerships amongst a range of academic institutions, international organizations, think tanks, and public-health institutes in both developed and developing countries. This report is primarily intended for the community of policymakers and researchers concerned about the rising risks of domestic, regional, and global infectious disease epidemics, and the collective failure to take the coordinated actions required to reduce such risks. These risks include the expected health, economic, and societal costs that are borne by countries, regions, and even all nations in the case of pandemics (which are worldwide epidemics). These risks also include the consequences of increasing antimicrobial resistance (AMR) and its spread within regions and globally. A necessary first step is to monitor whether a broad range of stakeholders are acting to prevent outbreaks from becoming epidemics, whether their capacities to respond to epidemics are robust, and whether preparedness to respond to pandemics and limit the resulting economic and health damage is improving. Analyzing the adequacy of these efforts is vitally important for the decisions of policymakers to invest in the public health and disaster-risk management capacities. Early and effective control of disease outbreaks prevents substantial health and economic costs whether or not the disease can spread globally and become a pandemic. Disease spread within a region can also be deeply impoverishing and should be prevented. The capacities that reduce the risk of epidemics are an essential part of the arsenal required to mitigate pandemic risk. The investments made to mitigate these risks are also indispensable in reducing endemic disease burdens (such as malaria, tuberculosis, HIV and vector-borne diseases among others). A pandemic of influenza or similarly fast-growing contagion, as well as AMR, are natural hazards that pose a top global catastrophic risk to public health, economies, and societies — and they can even present an important existential risk to humanity. Public health capacities to detect and effectively control outbreaks and the prioritization of pandemic preparedness are necessary to reduce costly impacts on public health and economies, but they will not by themselves be sufficient for an adequate response, especially to a regional epidemic or a pandemic, which will require leadership, effective communications, and measures from sectors other than public health. This report is intended to serve as an explanatory reference or baseline for future refinements of the indicators and evolution of the