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must link preparedness with financial risk planning To mitigate the severe economic impacts of a national or regional epidemic and/or a global pandemic, the International Monetary Fund (IMF) and the World Bank must urgently renew their efforts to integrate preparedness into economic risk and institutional assessments, including the IMF’s next cycle of Article IV consultations with countries and the World Bank’s next Systematic Country Diagnostics for International Development Association (IDA) credits and grants. Funding replenishments of the IDA, Global Fund to Fight AIDS, TB and Malaria (Global Fund), and Gavi should include explicit commitments regarding preparedness. Progress indicator(s) by September 2020 • The IMF and the World Bank integrate preparedness in their systematic country risk, policy and institutional assessments, including in Article IV staff reports and for IDA credits/grants, respectively. • International funding mechanisms expand their scope and envelopes to include health emergency preparedness, including the IDA19 replenishment, the Central Emergency Response Fund, Gavi, the Global Fund and others. 5 Development assistance funders must create incentives and increase funding for preparedness Donors, 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 action plans for health security as a joint responsibility and a global public good. Member States need to agree to an increase in WHO contributions for the financing of preparedness and response activities 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 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 Contingency Fund for Emergencies to a level of US$ 100 million annually. EXECUTIVE SUMMARY 6 VII The United Nations must strengthen coordination mechanisms The Secretary-General of the United Nations, with WHO and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), must strengthen coordination in different country, health and humanitarian emergency contexts, by ensuring clear United Nations systemwide roles and responsibilities; rapidly resetting preparedness and response strategies during health emergencies; and enhancing United Nations system leadership for preparedness, including through routine simulation exercises. WHO should introduce an approach to mobilize the wider national, regional and international community at earlier stages of an outbreak, prior to a declaration of an IHR (2005) Public Health Emergency of International Concern. Progress indicator(s) by September 2020 • The Secretary-General of the United Nations, with the Director-General of WHO and Under-Secretary-General for Humanitarian Affairs, strengthens coordination and identifies clear roles and responsibilities and timely triggers for a coordinated United Nations systemwide response for health emergencies in different countries and different health and humanitarian emergency contexts. • The United Nations (including WHO) conducts at least two systemwide training and simulation exercises, including one for covering the deliberate release of a lethal respiratory pathogen. • WHO develops intermediate triggers to mobilize national, international and multilateral action early in outbreaks, to complement existing mechanisms for later and more advanced stages of an outbreak under the IHR (2005). • The Secretary-General of the United Nations convenes a high-level dialogue with health, security and foreign affairs officials to determine how the world can address the threat of a lethal respiratory pathogen pandemic, as well as for managing preparedness for disease outbreaks in complex,