Mistrust curbs progress on pandemic preparedness, says monitoring body

Global pandemic preparedness is on “fragile” ground, according to the latest assessment by an independent body set up to monitor and report on the world’s preparedness for global health crises. While there are clear efforts being made globally, there’s a lack of coordination on initiatives such as research and development and deep mistrust between and within countries. Multiple crises are also taking place globally, providing a difficult backdrop for preparedness. “There are many reasons to divide or distract countries from finding effective multilateral solutions, including conflicts in Ukraine and the Middle East, and the growing impacts of climate change,” Kolinda Grabar-Kitarović, former president of Croatia and co-chair of the Global Preparedness Monitoring Board, said in a press briefing ahead of the launch of the body’s annual report on Monday. But the world, she said, needs to find ways to invest in health amid these difficult realities. “The world's ability to deal with a potential new pandemic threat remains inadequate, with many capacities insufficient to guarantee our collective safety,” she said. Much needs to be done The report finds there’s progress made on several pandemic preparedness fronts, such as on financing with the launch of the Pandemic Fund for pandemic preparedness initiatives, and improvements in building R&D capacity, including through the setting up of the mRNA technology transfer hub in South Africa. However, most areas for preparedness remain insufficient or incomplete. “Not one critical capacity for preparedness [that] was assessed is fully met in this report, which is deeply concerning and disappointing,” said Joy Phumaphi, former minister of health of Botswana and co-chair of the board. Most financing for global health emergency preparedness and response continues to rely on official development assistance and replenishment mechanisms that rely on charity from donors. The Pandemic Fund is still inadequately financed. Countries have also reduced their spending on pandemic prevention, preparedness and response. It’s also unclear whether calls for governments to include access conditions in their R&D funding to ensure the equitable distribution of medical products will make it to a pandemic agreement. Vaccine manufacturing also remains limited to a few, mostly high-income countries. There also remain gaps in independent monitoring for preparedness. In addition, while the concept of One Health — which recognizes that human health, animals and the environment are all interconnected — has received policy attention in recent years, it’s not fully integrated into national systems, and sectors still operate in silos. Civil society and the private sector are also not “meaningfully engaged” in formal state-based negotiations. Meanwhile, the report identified some areas as “poor.” The current draft text of the pandemic agreement does not encompass the social and economic dimensions of preparedness. Misinformation management also remains poor. Grabar-Kitarović said there is no global governance body or coordination mechanism that addresses misinformation, which is one of the key elements fueling mistrust. Building trust as a key solution The board makes several recommendations to improve global preparedness, including strengthening independent monitoring and accountability; reforming the global financing system for pandemic prevention, preparedness and response to make it more sustainable; strengthening regional capacities for R&D, manufacturing and supply of medical products to help address access inequities; and improving coordination across sectors. Specifically, they are calling for the completion of the negotiations on a pandemic agreement and its adoption by the 77th World Health Assembly in 2024. The agreement should include a mechanism to review state compliance to the agreement, and “strong measures” for R&D coordination and ensure equitable access to medical products. The agreement and the amendments to the International Health Regulations should also be tested for effectiveness and coherence before they are finalized, they said. Countries must commit to ensuring intellectual property rights do not impede access to lifesaving medical countermeasures, Grabar-Kitarović said. “One of the reasons for the erosion of trust is not just the geopolitical issues and tensions, but the fact that a number of countries perceived that nationalism or self-interest or economic interests dominated access to medical countermeasures in response to the pandemic, including access to vaccines or access to other therapeutic measures, and therefore the question of the [intellectual property] waivers has come up as one of the solutions,” she said. Meanwhile, they call on international financing institutions, intergovernmental bodies, and United Nations member states to consider how they can further improve financing for pandemic prevention, preparedness and response in 2024, including at the World Bank and the International Monetary Fund spring meetings, the U.N. Forum for Financing for Development, and the Group of 20 leading economies’ summit in Brazil. Many of these can help with rebuilding trust. “Trust is essential to preparedness and response. Because to defeat pandemics, people need to take collective action for the common good. They do so when they believe that leaders, systems and information are trustworthy and acting in their interests. Sadly, this belief has been eroded during COVID-19, often by the experience of inequity,” Grabar-Kitarović said.