Writing in The Lancet in March 2023, public health experts called for “ambitious, transformational change” to the “epidemic countermeasures ecosystem”. The authors, including past interviewee Dr Jerome Kim of IVI, draw on years of collective experience to recommend “appropriate health countermeasures” to “rapidly” contain health threats.  

“We are living in an era of unrivalled convergence of epidemic and other health threats, exacerbated by the climate and biodiversity crises.” 

The paper acknowledges a contemporary “grave warning” from cases of avian influenza (H5N1) in mammals as an example of the hazards that we face. The authors call for a “fundamental change” in the deployment of health technologies, particularly relating to access to “knowledge and know-how”.  

Current limitations and failures 

As we witnessed during the COVID-19 pandemic, our current approach to R&D, manufacturing, and delivery of countermeasures is “deeply inequitable”. Disproportionately affecting people in LMICs and “vulnerable populations”, this approach needs transformation. Reference to the Access to COVID-19 Tools Accelerator (ACT-A) platform, describing a failure to provide “timely or equitable access”.  

“A transformed epidemic countermeasures ecosystem is urgently needed that is rooted in equity at every step, regional resilience, and knowledge and technology sharing.”  

As we heard in our interview with Dr Ike James recently, sharing technology and knowledge will be key to establishing more effective epidemic and pandemic preparation as well as responses. This new ecosystem must be based on a “common goods approach”, say the authors.  

Moving forward from COVID-19 they are calling for a redefinition of collaboration in order to achieve the “collective goal of epidemic control”. They identify specific meetings and occasions during which key stakeholders should be included. 

“We believe that LMIC representatives, civil society and community organisations, the scientific research and public health communities, and humanitarian groups must be meaningfully involved in all these discussions and processes.”  

Core principles 

The authors promote “core principles” for this transformed ecosystem. These will promote “equitable, effective, and sustainable” practises.  

  • Human rights 
  • Guaranteed equitable protection 
  • National and regional resilience 
  • A common goods approach 
  • Inclusive governance and decision making 
  • Equity 
  • Access and freedom to operate 
  • Sustainable financing designed for health impact 
  • Accountability for investment and impact 

Are there any principles that you would like to see added to this list? Which might be the most significant or challenging? 

Urgent priorities 

As well as the core principles mentioned above, the authors identify three priorities for change in the process of developing an equitable pandemic countermeasure ecosystem. 

  1. An end-to-end ecosystem that delivers equitable research, development, manufacturing, and access to epidemic countermeasures, grounded in a common goods approach that responds to local needs, with equity built in from research to access.  
  2. Inclusive and networked governance with decentralised decision making to address health needs optimally when and where they occur, shifting the centre of gravity to regions and countries. 
  3. A globally and regionally pre-negotiated financing system.  

Can you identify further priorities, or specific methods of addressing them effectively?  

“Now is the time for ambition and transformative change to protect people everywhere. If not now, when?” 

The report continues with examples of some attempts to achieve a more equitable and sustainable ecosystem, and you can read it in full here. For more on preparedness and equitable access at the World Vaccine Congress in Washington next month, get your tickets here.