A report shared by the Global Preparedness Monitoring Board (GPMB) in 2023 offers a “warning” that the “fragile progress to strengthen preparedness” made after the COVID-19 pandemic is “at risk”, leaving the world’s capacity to deal with a future threat “inadequate”. The report is called “A Fragile State of Preparedness” and identifies elements of weakness or decline in “critical areas of preparedness”. The Board offers four key recommendations to “urgently strengthen global preparedness”.  

Key messages 

The report begins with 7 key messages: 

  1. The world’s capacity to deal with a potential new pandemic threat remains inadequate. 
  2. The GPMB Monitoring Framework has revealed significant weaknesses or declining capacities in several critical areas of preparedness, including global coordination of R&D, efforts to address misinformation, community engagement, participation of low- and middle-income countries in decision-making, domestic and international financing of preparedness, independent monitoring, and meaningful involvement of relevant actors. Where there are signs of improvement, they are fragile, and in urgent need of reinforcement. 
  3. The trust deficit between countries and between communities is a significant impediment to progress in strengthening preparedness. Urgent steps are needed to build trust through operationalising principles of equity, leadership and accountability, and coherence within all measures to strengthen pandemic prevention, preparedness, and response (PPPR).  
  4. Evidence-based monitoring, including independent monitoring, is essential to increase effectiveness, ensure accountability, and build trust. 
  5. PPPR financing requires fundamental reform to free it from the limitations of development assistance and place it on a sustainable footing, based on burden-sharing. Strengthening PPPR requires ensuring sustainable financing for WHO and other international organisations working on PPPR.  
  6. Strengthening regional capacities for R&D, manufacturing, and supply will help to address the inequities in global access to medical countermeasures. 
  7. There is a need to strengthen mechanisms for coordination across the many sectors that play a key role in PPPR, nationally, regionally, and globally.  
A post-COVID-19 consensus  

The report acknowledges a “consensus” in the wake of the COVID-19 pandemic that the world needs “much stronger preparedness and response”.  

“That consensus has yet to result in action at the necessary scale, or with the unity of purpose and urgency it requires.” 

“Momentum and commitment” are decreasing at a time when they are “most needed”, leaving the world more vulnerable to future health threats. In February 2023 the GPMB issued a checklist for reform in the Manifesto for Preparedness, anticipating that the UN High-Level meeting would “elevate PPPR to the highest priority”. Although the political declaration adopted in October was a “welcome commitment”, the report suggests that it “fell short of the necessarily ambitious agenda”.  

After the “emergency footing” from the peak of the pandemic, countries have moved to routine approaches with COVID-19 no longer a PHEIC, the world has become “complacent”. Not only does COVID-19 continue to pose a risk, but other disease events are becoming more frequent. For example, since the outbreak of the pandemic there has been an mpox PHEIC, an Ebola outbreak in Uganda, “simmering” Nipah virus outbreaks and a surge in cholera due to a confluence of climate and human factors. At the same time, avian influenza “continues to expand”.  

“The risk of pandemics remains an ever-present threat. Myriad crises are competing for global political attention.”  

This competition results in a “relative lack of resources for PPPR”. Furthermore, there is a “shadow” over these efforts: an “ever-widening gulf in trust”.  

“Trust between countries is at a low ebb, not only due to geopolitical rivalries but also the profound disappointment by many countries that when the COVID-19 pandemic was raging, countries used their economic power to put self-interest ahead of global solidarity.”  

Looking back to the GPMB Annual Report of 2021, the current report states that concerns about a “fragmented and broken world” have “heightened”.  

The findings 
“Of the capacities assessed in this report, none are adequate, and many remain insufficient or absent.”  

The weakest areas of PPPR relate to: 

  • Financing  
  • Global R&D coordination 
  • Global management of misinformation and disinformation 
  • The participation of all low- and middle-income countries and all relevant actors in prevention, preparedness, and response 



What does the report conclude? 

Although “some aspects” of global preparedness show signs of improvement, the report emphasises that the world “lacks a commonly agreed framework” that is “comprehensive in scope, based on shared goals and targets, and able to facilitate planning, implementation, monitoring, and resource mobilisation”. The following conclusions are drawn in relation to the assessments GPMB received.  

Leadership and accountability 
  • Monitoring and accountability have been insufficiently resourced and institutionalised. 
  • Systemic deficiencies in the global financing of PPPR were revealed in the past three years and available funding is not close to meeting identified needs. 
  • Negotiations on a WHO Pandemic Agreement are underway, but progress is limited due to differences between interest groups and a geopolitical context, as well as opposition from the pharmaceutical industry.  
  • Gross inequalities in access to COVID-19 interventions demonstrate a need for sustained and distributed R&D innovation that can deliver benefits fairly, based on need.  
  • Many of the positive COVID-19 community engagement efforts are in danger of falling into disuse as the emergency subsides. The pandemic affected communities differently, but there is no consistent effort to tackle these inequities. An increasingly fragment information environment meets mis- and disinformation to undermine trust, yet efforts to tackle this are not structured and lack reach and scale.  
  • A One Health approach has not been integrated effectively into preparedness. However, the WHO Pandemic Agreement has potential to address this. 
  • The failure of coordination that characterised the pandemic response remains a critical gap. 
What can be done? 

The report offers four recommendations:

Strengthen monitoring and accountability at all levels by improving national monitoring of pandemic prevention, preparedness and response, investing in better data and evidence collection, and strengthening global multisectoral independent monitoring. 

Actions for this recommendation: 

  • Member States to ensure the WHO Pandemic Agreement includes both a universal periodic peer review mechanism for PPPR and a Conference of Parties with the mandate of reviewing compliance with its measures.  
  • All countries to invest in building their national capacity for data collection and analysis on PPPR in collaboration with regional bodies. 
  • International organisations and other actors to invest in building data collection and analyses to support a better understanding of PPPR capacities globally.  
  • WHO and the World Bank Group to carry out an independent review of GPMB’s work and consider expanding co-conveners to include other relevant international organisations.  
Reform the global financing system for PPPR by fully financing the Pandemic Fund and reviewing its funding model, and finding new ways of financing pandemic prevention, preparedness and response. 

Actions for this recommendation: 

  • The World Bank Group, WHO, and the G20 to assess PPPR financing needs and flows. 
  • Donors to sustainably and adequately fund the Pandemic Fund to meet the $10 billion/year gap. 
  • The Pandemic Fund to assess potential new financial resources outside ODA and develop a more bottom-up approach to setting financial priorities.  
  • The Pandemic Fund, the Global Fund, Gavi, and other financing institutions to ensure that resources are coordinated and aligned with countries’ priorities and needs. 
  • The IMF, the World Bank Group, the G20, and public and private creditors, to support debt restructuring to improve debt sustainability.  
  • The IMF, the World Bank Group, and other banks to increase investment in PPPR and provide additional concessional financing for national investments in PPPR.  
  • All countries to develop domestic contingency funds to respond to health emergencies, integrated into broader emergency financing. 
  • WHO Member States to increase funding for the WHO Contingency Fund to meet the $500 million day-zero needs and ensure it is sustainably funded.  
  • Multilateral development banks globally and regionally, alongside G7, G20, and others, to implement strategies to boost international surge financing.  
Establish baseline regional capabilities to drive more equitable and robust R&D and supply chains. 

Actions for this recommendation: 

  • Countries and regional institutions to build sustainable regional capacity for R&D, manufacturing, regulatory processes, and deployment of medical countermeasures by creating strong regional ecosystems for R&D. 
  • Member States to adopt strong rules to address global R&D in the WHO Pandemic Agreement and to implement these rules through a global R&D roadmap with a focus on strengthening regional ecosystems. Countries should also ensure that intellectual property rights do not impede access to life-saving medical countermeasures and technologies for PPPR.  
  • WHO to support R&D coordination by publishing the updated list of R&D Blueprint priority pathogens. 
  • Funders to ensure terms for equitable access to technologies, countermeasures, and data and information are included in funding agreements. 
  • The private sector to support greater equitable access to medical countermeasures.  
Develop a new approach to multisectoral, multistakeholder engagement for pandemic prevention, preparedness and response. 

Actions for this recommendation: 

  • WHO, in collaboration with the Quadripartite for One Health and other key partners to develop a structured approach to improving multisectoral, multistakeholder PPPR at all levels.  
Forging a new path 

Co-Chair and former President of Croatia, Kolinda Grabar-Kitarović commented that a “lack of trust at every level” is a “significant obstacle to preparedness”. 

“We call on leaders to move past these divisions and forge a new path based on a shared recognition that our future safety depends on meaningful reform and the highest level of political commitment to health emergency preparedness.” 

Joy Phumaphi, co-Chair and former Health Minister for Botswana suggested that the report demonstrates that “although the state of the world’s preparedness is fragile, it is not without hope”. 

“There are many efforts underway to strengthen preparedness – but they will fail without the right resources and support. Leaders must double down on their commitment to learning from the lessons of the past and creating a world where we are all safe from pandemics.”  

The World Vaccine Congress West Coast next month will invite several experts to explore the future of preparedness and countermeasures in detail. To join us, get your tickets here. Don’t forget to subscribe for more insights.