High-Level Action Missing on Pandemic Preparedness

The September 20 UN High-level Meeting on Pandemic Prevention, Preparedness and Response (PPR) offered an opportunity to galvanize high level statesmanship in response to what was “one of the greatest global challenges in the history of the United Nations.” Despite the glaring and widespread repercussions presented by Covid-19—job losses, poverty, educational deficits, increased polarization—preparedness remains a low priority and firmly confined to the health sector. While highlighting the key issues associated with pandemic PPR and reiterating Covid-19’s range of immediate and long-term repercussions, the political declaration declined to advocate that the UN General Assembly endorse a high-level political council. Instead, it urged the secretary-general to advise on implementing the document’s call to action and organizing an associated review meeting in 2026.

The lack of concrete UN-level action puts additional pressure on ongoing negotiations in Geneva around a pandemic accord and amendments to the International Health Regulations as they currently serve as the only global avenue to deal with not only the fraught issues of vaccine equity and international accountability but the broader range of pandemic-related challenges. It also puts the World Health Organization squarely at the helm of global pandemic PPR, a position it has pushed for, although some question whether it has the scope to ensure high-level multisectoral action and the authority to hold countries accountable for international compliance. 

Attended by a dozen heads of state and government, including those from low- and middle- income countries and the European Union, the high-level meeting brought much-needed attention to an issue that, despite its global effects and repercussions, is fast fading from the policy realm. The declaration highlights key issues associated with pandemic PPR, including global access to countermeasures, strengthening local and national medical commodity production capacities, and increased support for the health workforce. It also aims to “further enhance political momentum and commitment” toward the Geneva negotiations and calls for additional funding for the World Health Organization, its Contingency Fund for Emergencies, and the World Bank’s Pandemic Fund, aimed at supporting country health system capacity building.

The declaration urges support for a multisectoral approach toward pandemic PPR “given the multifaceted causes and consequences of pandemics including their potential impact on social protection, education, agriculture, the environment, trade, travel, tourism, development and other sectors and at all levels.” But experts and advocates argue that only sustained high level leadership will muster the full resources and attention needed to prevent and mitigate the effects of future health emergencies. “Health threats should have the same level of attention that we give to threats of war, terrorism, nuclear disaster and global economic instability,” former members of the Independent Panel for Pandemic Preparedness and Response wrote in advocating for a UN-level Global Health Threats Council, a position that has been supported by the Biden administration.

The administration made concerted efforts during the height of the pandemic to galvanize global leadership and commitment to ending the pandemic and strengthening global health security. These included organizing two White House summits focused on the issue, one in September 2021 and another in May 2022. The summits drew participation from heads of state, leaders of international organizations, the private sector, philanthropies, nongovernment organizations and others. Commitments ranged from increased government donations to domestic and global vaccination efforts to supporting children orphaned by the disease. The United States pushed for increases to the Pandemic Fund, enhancing availability of vaccines globally, and supporting test-and-treat strategies for low- and middle-income countries to increase availability of antiviral medications.

As Covid-19 case numbers dwindle, leaders’ attention has turned to other pressing concerns, leaving little enthusiasm and resources for pandemic preparedness. For example, while the Pandemic Fund has made $338 million in awards to 37 countries for projects focused on surveillance, laboratory improvements, work force development, and community engagement, contributions remain well below preparedness needs. The fund has raised $1.6 billion, far short of the estimated $10 billion a year needed to establish global health emergency protections.

The Biden administration put a focus on multisectoral action through the new White House Office of Pandemic Preparedness and Response Policy, charged with overseeing a coordinated government response both to Covid-19 and the health threats of the future. After struggling to find a suitable candidate, Biden appointed Major General (retired) Paul Friedrichs, who had been serving as special assistant to the president and senior director for global health security and biodefense at the National Security Council.

Covid-19 reminded the world that pandemics are catastrophic, society-changing events. Along with millions of deaths, many lower-income countries, especially in Sub-Saharan Africa, are suffering long-term increases in poverty. Learning deficits, affecting not only education but social skills, with implications for “growth, prosperity, and social cohesion,” are substantial. Women’s health and wellbeing suffered in a variety of ways as they served as frontline care givers and experienced greater job losses.

While efforts are being made to improve health capacities for emergency response based on Covid-19’s lessons, more is needed and attention to the broader issues is gaining even less traction. More engaged leadership could ensure political and financial commitment not only to critical response capacities but push for policy changes and economic protections to mitigate damage from the next health emergency. These include research on effective protection measures beyond medical countermeasures, maintaining safety in high-risk spaces and housing situations—factories, prisons, and nursing homes—and social protections that allow sick leave, combating misinformation and disinformation, and building necessary trust in public health institutions.

Only high-level multisectoral leadership can galvanize the coordination and protections needed. While the high-level meeting missed the mark in that regard, other avenues are available, including the 2024 Summit of the Future where pandemic PPR could be considered along with protocols for other “complex global shocks” such as climate change. Even as “pandemic amnesia” settles in the United States, the White House Office of Pandemic Preparedness and Response Policy offers a model for establishing a whole-of-government coordination mechanism and should be given the support it needs. Continued bold leadership is essential both here and at the UN level to oversee preparedness efforts and to ensure a rapid, effective response when the next crisis hits.

Nellie Bristol is a senior associate with the Global Health Policy Center at the Center for Strategic and International Studies in Washington, D.C.

Nellie Bristol
Senior Associate (Non-resident), Global Health Policy Center