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Connecting these three sets of decisions is the fact that scientific knowledge about a disease changes and (ideally) increases as a new epidemic progresses. There is little guidance on how to craft policies and procedures while living through the uncertainty caused by a new virus. When this outbreak recedes, that guidance is where we must focus. This report examines the current state of preparedness for pandemics caused by “high-impact respiratory pathogens”—that is, pathogens with the potential for widespread transmission and high observed mortality. Were a high-impact respiratory pathogen to emerge, either naturally or as the result of accidental or deliberate release, it would likely have significant public health, economic, social, and political consequences. Novel high-impact respiratory pathogens have a combination of qualities that contribute to their potential to initiate a pandemic. The combined possibilities of short incubation periods and asymptomatic spread can result in very small windows for interrupting transmission, making such an outbreak difficult to contain. The potential for high-impact respiratory pathogens to affect many countries at once will likely require international approaches different from those that have typically occurred in geographically limited events, such as the ongoing Ebola crisis in Democratic Republic of the Congo (DRC). Numerous high-level reviews have been commissioned in recent years to take stock of global preparedness for infectious disease outbreaks, epidemics, and pandemics. These reviews have assessed current preparedness structures and capabilities, have identified existing gaps, and have proposed recommendations for strengthening outbreak prevention, detection, and response. But preparedness for a high-impact respiratory pathogen pandemic has received little specific focus in these high-level reviews. While there has been some focus on improving international and national capacities for pandemic influenza, specifically after the 2009 H1N1 pandemic, there have been few (if any) high-level reviews or recommendations focusing on the possibility of other high-impact respiratory pathogens with pandemic potential. The lack of global attention on and consideration of this threat speaks to the urgency of addressing preparedness for epidemics and pandemics that might be caused by high-impact respiratory pathogens. While there is overlap between the systems and capabilities required to respond to any disease outbreak, a high-impact respiratory pathogen poses serious additional challenges that deserve special consideration. In preparing this report, Preparedness for High-Impact Respiratory Pathogen Pandemics, we reviewed dozens of high-level reviews of global preparedness and conducted interviews with international experts in pandemic preparedness and response. The state of national and global readiness in 10 functional areas were examined: global preparedness mechanisms; multisectoral involvement and coordination; surveillance, monitoring, and assessment; health systems and clinical management; community engagement; risk communication; research and development for medical countermeasures; nonpharmaceutical interventions; accidental release and biosafety; and deliberate use and biosecurity. In our findings, we detail capabilities and gaps that would likely hamper efforts to 7 respond to a high-impact respiratory pathogen. The report identifies priority actions for countries, international organizations, and other stakeholders to pursue that would mitigate the public health, economic, social, and political consequences of the emergence of a high-impact respiratory pathogen. These conclusions are summarized below. SUMMARY OF CONCLUSIONS 1. Countries should build up their national core public health capacities. • Countries should continue to build and improve core public health capacities across the globe in accordance with International Health Regulations (IHR) core capacity obligations. • Member states should pursue Joint External Evaluation (JEE) assessments if they have not already completed one, and they should ensure that WHO has the resources it needs to continue to play a coordinating role. • Countries should develop, cost, finance, and implement sustainable national action plans to improve their core capacities and conduct exercises to test the extent to which capacities will function as planned during emergencies. • The IHR core capacities are unlikely in their current formulation to adequately prepare countries and the international community for high-impact respiratory events. Therefore, evaluations of risk-specific exercises (eg, pandemic influenza) and actual events should be compared to the capacities in JEEs and national action plans and should be used to update, modify, or enhance ongoing capacity development efforts. • Donors should work with countries to address remaining shortfalls and to incentivize additional national investments, including participation in initiatives such as the Global Health Security Agenda and the Alliance for Health Security. • Data will be essential to motivate political leaders and measure progress. Additional sources of data should be sought by World Health Organization (WHO) and the Global Preparedness Monitoring Board (GPMB) that could provide ongoing assessment of global progress toward IHR capacity development. 2. National and global surveillance capacities should be improved, with a focus on helping improve the management of epidemic response. • Donors should work with countries to strengthen global, regional, and national surveillance capacities, which will be essential for detecting a potentially high-impact respiratory pathogen before transmission becomes widespread. • Rapid systems of data exchange are needed to better understand and fully monitor the near-term impacts and severity of an event, such as the percentage of cases 8 developing severe illness. Data sharing from nontraditional sources, such as the private sector,