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and invest 11 Heads of government in every country must commit to preparedness by implementing their binding obligations under the IHR (2005). They must prioritize and dedicate domestic resources and recurrent spending for preparedness as an integral part of national and global security, universal health coverage and the Sustainable Development Goals (SDG). G7, G20 and G77 Member States and regional intergovernmental organizations must follow through on their political and funding commitments to preparedness and agree to routinely monitor progress at their annual meetings. PROGRESS, CHALLENGES, ACTIONS: LEADERSHIP DRIVES PROGRESS Building effective systems 12 Planning for emergencies creates a virtuous cycle, whereby preparedness enables a successful response and from which built capacities and knowledge gained during an outbreak become the foundation to prepare for the next threat. Setting up these arrangements will require prioritizing systems-building across the whole society, in a variety of contexts, testing different models, and creating environments and mechanisms for sharing best practices, among countries at all economic levels. Effective, accessible and efficient local health systems delivering primary health care, and mental health and psychosocial services essential for prevention will also yield multiple benefits beyond preparedness, including infectious disease prevention and control, better health outcomes and increased community trust, as well as surge response capacity. When a health emergency strikes, national and regional authorities need to be able to count on a global backup system that is well resourced, well coordinated and well practised. Every country and community must be prepared for the unexpected. 3 PROGRESS, CHALLENGES, ACTIONS: BUILDING EFFECTIVE SYSTEMS • Timeliness in detection of outbreaks has increased significantly, as shown by the swift declaration of the 2016 outbreak of Zika, the 2018 outbreak of Ebola in the Democratic Republic of the Congo (DRC), and the first Ebola cases in Uganda. Rapid detection, isolation and treatment of recent Ebola cases in Uganda reflect better preparedness planning and investments. In addition, nine countries neighbouring the eastern DRC have enhanced their preparedness efforts. • As part of IHR (2005) monitoring, 103 simulation exercises and 50 afteraction reviews have been conducted, and 26 countries have an IHR (2005)-Performance of Veterinary Services national bridging workshop (31,32). • China, Nigeria and the WHO African and Eastern Mediterranean regions, among others, have developed public health organizations/institutes and training programmes modelled on successful programmes and agencies. • A number of Member States of the Commonwealth of Independent States Countries and those active in the European Environment and Sustainable Development Advisory Councils have increased their surveillance and laboratory capacities, including rapid operational engagement of mobile medical teams. • At the global level, the new Health Emergencies Programme established at the World Health Organization (WHO) following the 2014-2016 Ebola crisis in west Africa enabled the Organization to take on a stronger, more effective operational role in outbreaks. The reforms have already made a significant difference in emergency response worldwide. • There is increased awareness of the need for community involvement in all aspects of preparedness. Recent outbreaks of Ebola and Zika, and other diseases saw calls for an increase in community engagement in view of its high effectiveness. WHO’s new IHR (2005) monitoring framework has expanded by including risk communication and community engagement assessments. • Political will, financial investment and health system improvements lead to results. For example, the Republic of Korea successfully contained a second potential MERS outbreak in 2018; before the 2014-2016 outbreak of Ebola virus disease in west Africa, Nigeria implemented an epidemic preparedness infrastructure that resulted in rapid control of Ebola cases and cost savings compared with experiences