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EMERGENCIES … BUT CURRENT EFFORTS REMAIN GROSSLY INSUFFICIENT. In the next section, the Board lists examples of progress and persistent challenges in the following categories: 1. Leadership drives progress 2. Building effective systems 3. Preparing for the worst: a rapidly spreading lethal respiratory pathogen pandemic 4. Financing 5. International coordination mechanisms The Board proposes seven urgent actions that national and global leaders must take to prepare for health emergencies. Some aspects of these actions can be achieved in the next year, and the Board challenges political leaders to move forward on these rapidly. 6 What is preparedness? The United Nations and WHO define preparedness as the ability (knowledge, capacities, and organizational systems) of governments, professional response organizations, communities and individuals to anticipate, detect and respond effectively to, and recover from, the impact of likely, imminent or current health emergencies, hazards, events or conditions. It means putting in place mechanisms that will allow national authorities, multilateral organizations and relief organizations to be aware of risks and deploy staff and resources quickly once a crisis strikes (20,21). A WORLD AT RISK 7 Progress, challenges, actions National and local leaders are responsible for ensuring preparedness from the country to the community level. Action and investment prior to an emergency are essential to provide the best possible protection. Ensuring recurrent spending for preparedness is a key articulation of political will and leadership. Long-term, sustained community engagement is crucial for detecting outbreaks early, controlling amplification and spread, ensuring trust and social cohesion, and fostering effective responses. In addition to their domestic responsibilities, national leaders have preparedness obligations to the world at large.i All countries have adopted the binding International Health Regulations [(IHR (2005)),] an agreement requiring governments to develop national core capacities to detect, assess, report and respond to health threats, as well as to report any “public health emergency of international concern” to WHO and to take corresponding action (22). Regional and global leaders must support country actions and develop networks of partners to aid in preparedness and disease control. Although the contexts and drivers for increased frequency and severity of epidemics and pandemics are increasingly complex, leaders can plan and galvanize robust preparedness for their communities, countries, and for the world through determined measures. Leadership drives progress PROGRESS, CHALLENGES, ACTIONS: LEADERSHIP DRIVES PROGRESS 8 i. These obligations include maintaining effective disease surveillance and laboratory systems; reporting newly emerging diseases that could spread internationally; and maintaining the necessary infrastructure to respond to health emergencies. See https://www.who.int/ihr. 1 2 • Each country has identified an IHR focal point to manage IHR-related reporting requirements in keeping with their commitments under the IHR (2005). National assessments and planning have improved considerably: as of July 2019, 190 countries reported their progress in implementing IHR (2005) in 2018, using the State Party self-assessment annual reporting (SPAR) tool; 102 countries have conducted a voluntary Joint External Evaluation (JEE),ii 103 countries have conducted simulation exercises, 51 countries have completed after-action reviews, 59 countries developed a National Action Plan for Health Security (NAPHS) and 51 have costed them (23). • Recognizing the shared threat of a global health catastrophe, national leaders have undertaken political actions to advance preparedness. Political bodies, such as the G7, G20 (24), G77 and several regional intergovernmental organizations such as the African Union (25) have adopted political commitments for action on various aspects of health and health emergencies, including funding and linkages to health systems strengthening and universal health coverage. The G77 foreign ministers recognized that