Opinion: The case for democratizing global pandemic preparedness

As Harvard University professors warn, another pandemic is inevitable: “It’s just a matter of time.” Yet, international pandemic preparedness talks have stalled and major donor governments are less willing to commit funding — this waning enthusiasm is evident in lackluster fundraising for the Pandemic Fund. Added to this, the U.S. started a withdrawal from the World Health Organization on Donald Trump’s first day back in the presidential office. WHO has been negotiating a global pandemic accord for three years and concluded its 12th round of unsuccessful talks last month. The Pandemic Fund, housed at the World Bank since mid-2022, garnered less than half of its fundraising goal in the pledging at the G20 Joint Finance and Health Ministers meeting in Rio last fall. Pandemic preparedness is large-scale and complex work, so government buy-in has been a necessary condition. The United States and other donor governments have been integral to advancing pandemic preparedness in recent history, but facilitators are struggling to generate consensus, and it can be difficult for communities and minority groups to fully take part in top-down approaches to preparedness. Given this, the global health community must engage and invest in nongovernmental stakeholders. By democratizing pandemic preparedness, we can make systems more effective and inclusive. Democratizing pandemic preparedness Nongovernment entities such as international organizations and researchers have demonstrated the strategic value of addressing elements beyond purely government channels for disease prevention. Multistakeholder organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria are well-suited to address this challenge. As the world's top multilateral provider of grants for health systems strengthening, the Global Fund invests in disease surveillance, data management, and community health workforce. It requires participation from nongovernmental entities such as academia, the private sector, and civil society organizations, demonstrating a proven track record in democratizing disease prevention tools. Alongside other impactful multistakeholder organizations such as Gavi, the Vaccine Alliance, the Global Fund has a proven track record in strengthening health systems to meet their core missions. High-performing health systems can help care providers, supply chains, and communities adapt to evolving threats like COVID-19 and antimicrobial resistance and can be decisive in responding to them. Global health researchers also play a crucial role. It takes an estimated 17 years for health research findings to be translated into domestic medical practice — and international delays are probably even greater. WHO vetting of medical commodities is important, but far too slow. Research and practice can be simultaneous, with effective monitoring and evaluation systems generating data that guide future health programs and build local capacity. Zero TB in Kids at Johns Hopkins University, for example, has screened tens of thousands of Tibetan and Himalayan people for TB and provided treatment to everyone who tested positive. In the process, they have published multiple manuscripts about TB’s prevalence, treatment outcomes, and strategies to end TB in children, while simultaneously developing local expertise and infrastructure critical for disease prevention, screening, and surveillance. There is much to be done before the world is sufficiently prepared for future pandemics and some surmise that the world is no more ready for respiratory pandemics than before COVID-19. While governments have enabled coordination on a global scale, they may struggle to meet diverse needs, especially during crises. Other groups such as universities, civil society organizations, and regional health authorities are vital for sustainable and evidence-based power-sharing solutions.