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influenza outbreaks include reviews of the PIP Framework and accompanying processes, such as the Global Action Plan for Influenza Vaccines, the WHO Global Influenza Surveillance and Response System (GISRS), and the WHO Pandemic Influenza Vaccine Deployment Initiative. Numerous recommendations have been made for improving both the PIP Framework and its implementation, including the possibility of adding other diseases (such as animal or seasonal influenza) into the framework; implementation of the Nagoya Protocol to the Convention on Biological Diversity, which could influence influenza virus sample sharing and the equitable distribution of and access to vaccines and other benefits; and ongoing participation of the pharmaceutical sector and other private sector manufacturers in the legal process. It is important to note, however, that the PIP Framework does not apply to respiratory pathogens other than pandemic influenza.45,53,55 It should be noted that the 2009 H1N1 pandemic was relatively mild by the standards of other strains of pandemic influenza, such as the 1918 H1N1 pandemic. Thus, its applicability may have limits in the context of a more virulent outbreak of a respiratory pathogen. The Fineberg Report paved the way for subsequent high-level reviews of the global health 25 architecture, especially following the 2014-2016 Ebola epidemic. Many of these high-level assessments have also emphasized the challenges of IHR core capacity implementation and WHO operational response capacity.18,19,44 The IHR is the legal framework governing global disease detection and response, including novel strains of pandemic influenza.56 A consistent strong theme among high-level assessments is the lack of compliance among countries in fulfilling the IHR core capacity requirements. Numerous reviews show that there is wide agreement that IHR implementation for national health systems should be strengthened, including a need for enhanced monitoring and evaluation of core capacity requirements, backed by appropriate financial and technical support and other incentives for country implementation.18,19,45 The leadership role and operational capabilities of WHO, which would be expected to lead in the event of a high-impact respiratory disease outbreak, have been widely examined and documented, specifically through the UN Panel on Protecting Humanity from Future Health Crises and the subsequent UN Global Health Crises Task Force.47,48 While most high-level reviews have reaffirmed the central role of WHO in outbreak response, they have also called for wide-ranging reforms, which culminated in the establishment of the WHO Health Emergencies Programme. Monitoring of WHO’s new Health Emergencies Programme and its operational, leadership, and management processes is done through reports of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme. Recurring recommendations for WHO from these reports include strengthening emergency response leadership and operations; clarifying public health emergency procedures and accountability; increasing mobilization of financial support for health systems programming; increasing support for country research, development, and manufacturing capacities for medical countermeasures; and enhancing coordination with national governments, the United Nations system, and development and humanitarian actors.49 The importance of community engagement and social mobilization has emerged as a key theme among recent assessments. A 2019 report commissioned by the Wellcome Trust and UK Department for International Development (DFID) advocate for “people-centered” approaches to epidemic preparedness and response. The report recommended “making social science a permanent core part of the preparedness and response architecture,” including developing social science capacity in organizations such as WHO and the UN, as well as integrating social science with the Joint External Evaluation (JEE).57 A 2019 Center for Global Development after-action review of the 2014 Ebola epidemic observed the central role of behavior and community-driven methods in scaling up the response. Especially during a global event with millions of cases, during which traditional control strategies may be infeasible or unavailable, the report called for limiting transmission via 26 “a strategic shift toward behavioral interventions,” including equipping communities with the basic knowledge and tools needed to protect themselves.58 Some of the high-level analyses have argued that community engagement is highly relevant when considering public reactions (positive and negative) to outbreak responses, linking strong equitable health systems to preexisting constructive relationships with communities, and framing risk communication as a means to apply nonpharmaceutical interventions broadly and successfully. Reviews examining pandemic influenza vaccine focus principally on technical or operational challenges for research, development, production, and administration, rather than ultimate population uptake—a social challenge. Still other disease outbreak and health security frameworks and analyses do not address community engagement at all, or they treat it as an unelaborated aspect of risk communication.19,49,55 In addition, multiple reports* have recognized that a response to a severe outbreak will increasingly need to incorporate actors from all sectors, including the private and business sectors. Recommendations on this issue consist of engaging with private stakeholders, incorporating private-sector actors into national strategies and preparedness planning, strengthening public-private collaboration for research and development, and using the private sector and businesses for financial and technical support.7,50-52,59 A review by the National Academy of Sciences specifically references the expertise the private and business sectors contain that can be utilized in response mechanisms, including operations, logistics, and supply chains.52 Reports have noted that the support the private sector could provide would aid national