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outbreaks of epidemics or other global health threats deserved to be given the same level of attention as other serious threats confronting countries (26). • The Global Health Security Agenda (GHSA), a multi-country coalition launched in early 2014, aims to increase country level capacities and coordination for disease detection, prevention and control, has grown to nearly 70 member countries and partner organizations (27). Its Private Sector Roundtable is working with industry to enhance the latter’s participation in global health security. • Multilateral institutions and donors have acted to prepare for the worst pandemic challenges. At the global level, in addition to the IHR (2005) and further recommendations for their improvement adopted in 2009 and 2016, (28) health leaders have developed the Pandemic Influenza Preparedness (PIP) Framework to address virus-sharing and benefit-sharing concerns arising from the 2006 H5N1 outbreak. • In 2017 Germany, India, Japan, Norway, the Bill & Melinda Gates Foundation, the Wellcome Trust and the World Economic Forum founded the Coalition for Epidemic Preparedness Innovations (CEPI) to facilitate focused support for vaccine development to combat major health epidemic/pandemic threats. Progress to date 9 ii. A WHO managed process where countries undertake a voluntary, multisectoral assessment of their core capacities under IHR (2005), with national self-assessment and an external evaluation team with experts, See https://www.who.int/ihr/procedures/joint-externalevaluations/en/. PROGRESS, CHALLENGES, ACTIONS: LEADERSHIP DRIVES PROGRESS Preparedness is hampered by the lack of continued political will at all levels. Although national leaders respond to health crises when fear and panic grow strong enough, most countries do not devote the consistent energy and resources needed to keep outbreaks from escalating into disasters. As of 2018, only one third of countries have the capacities required under the IHR (2005) (29). While progress has been achieved in many higher-income countries, low- and middle-income countries struggle with funding these functions. Not only does this impact their own ability to respond to outbreaks, it puts the whole world at risk. The great majority of national health systems would be unable to handle a large influx of patients infected with a respiratory pathogen capable of easy transmissibility and high mortality. Although G7, G20, G77 and regional intergovernmental organization leaders have made a number of commitments to health and preparedness in recent years, follow-through is lacking. Collective security and the performance of international health systems in an increasingly globalized world are only as “strong as their weakest link”. For example, although the G7 has committed to supporting 76 countries in building their IHR (2005) core capacities in four separate meetings (30), G7 Member States have not monitored the follow-up to these commitments. Persistent challenges and obstacles Insufficient national and local leadership Weak compliance with the IHR (2005) Inadequate international support for preparedness in the poorest countries PROGRESS, CHALLENGES, ACTIONS: LEADERSHIP DRIVES PROGRESS 10 Progress indicator(s) by September 2020 • All countries that have completed an assessment of their capacities by 1 July 2019 have developed a costed NAPHS, identified required resources and started to implement the plan. Progress indicator(s) by September 2020 • G7, G20, G77 and regional intergovernmental organizations monitor their commitments to preparedness for health emergencies. Ultimate objectives All countries have reached full compliance with IHR (2005), have completed voluntary external or other independent assessments, and are objectively monitored by WHO on a regular basis to ensure continued improvement in preparedness. Recurrent national spending for preparedness is secured. Follow-up of countries’ political and funding commitments made before G7, G20, G77 and regional organizations are monitored routinely. Countries and regional organizations must lead by example Required actions Heads of government must commit