Innovation alone can’t prevent another pandemic---political and economic alt causes

In the Independent Panel for Pandemic Preparedness and Response's 1-year progress report, Transforming or Tinkering?: Inaction Lays the Groundwork for Another Pandemic,7 published on May 18, 2022, we set out these grim tolls as reasons to make concerted efforts to end the harms of COVID-19 and transform systems through actions that are well within the collective capacity of governments and global agencies. Containing pandemic threats is a choice. Through fragmented and slow processes, the world is choosing to risk a repeat of the events that resulted in the current situation. To produce key evidence for the 1-year progress report,7 we consulted with civil society, received 50 responses to a survey from 24 countries, held two academic round tables, and did a systematic review of the literature. There was broad support for the recommendations of the Independent Panel for Pandemic Preparedness and Response, and after more than 2 years of learning, broader themes were also emphasised: the case for preventing pandemic threats upstream; the centrality of human rights, investing in communities, and maintaining trust; the need for regional self-sufficiency; the need to address inequalities and the social determinants of health; and the results of neglecting to invest in promoting healthy populations. Declining COVID-19 mortality globally,2 insufficient political focus, and relaxing of public health measures is leading to a premature perception in many countries that the pandemic is over, even as the number of COVID-19 cases remains high globally.2 Ongoing transmission of SARS-CoV-2 could lead to new, more virulent, or more transmissible variants.8 Although the omicron (B.1.1.529) variant may be less virulent than previous SARS-CoV-2 variants,9 its increased transmissibility combined with inadequately protected, vulnerable populations could lead to an additional 400 000 deaths between April and August, 2022.4 The prevalence and burden of long COVID is increasingly better understood in high-income countries, together with its social and economic costs.10 There are not enough data to understand the burden of long COVID in lower-income countries. Vaccination is essential to reduce severe disease and death. Yet the available COVID-19 vaccines seem to have limited effect on transmission, and boosters are required to continue to protect vulnerable populations. We need better, more accessible diagnostic tools, vaccines, and treatments and responsive public health strategies.11 Test and treat programmes must be implemented and accessible to prevent COVID-19 deaths. There are reasons for optimism, but the world remains dangerously unprepared for the next pandemic threat. This is despite the evidence-based roadmap provided by the Independent Panel for Pandemic Preparedness and Response,1 and overall convergence on these solutions by other review panels, including that of the G20 High Level Independent Panel and the Global Preparedness Monitoring Board.12, 13 Examples of the leadership required for pandemic preparedness and response include initiatives such as the US-initiated Global COVID Summit14 on May 12, 2022, co-sponsored with the chairs of the African Union, the Caribbean Community (CARICOM), the G7, and the G20, among others and efforts by the African Centres for Disease Control and Prevention (Africa CDC), the G7 100 days initiative,15 and the UN General Assembly High-Level Dialogue on Vaccine Access.16 The decision by the 74th World Health Assembly to establish an Intergovernmental Negotiation Body (INB) to agree a new legal instrument on pandemic prevention, preparedness, and response,17 together with current proposed amendments to the International Health Regulations (IHR) aimed at faster alert and response,18 are meaningful steps towards fixing the international legal framework. The announcement by the Government of Indonesia of G20 consensus to establish a financial intermediary fund is a step towards closing the US$10–15 billion annual funding gap that the report of the Independent Panel for Pandemic Preparedness and Response1 and the G20 High Level Independent Panel identified.12, 19 At WHO, the member state Working Group on Sustainable Financing also made progress towards improving WHO's fiscal autonomy by recommending non-earmarked funding, and an increase in assessed contributions to cover 50% of the WHO base budget, by contrast to the 16% in the previous programme budget.20 Work is also underway to develop improved tools for assessing preparedness, with more dynamic metrics being developed and piloted in a new universal periodic health review.21 The major issue remains a lack of sustained high-level political leadership that will bring the coherence and urgency required to fragmented reform processes. Much energy will be spent on developing a new pandemic instrument, a new financial intermediary fund, and reforms at WHO, but how will this all be linked together? WHO's health emergency preparedness, response, and resilience white paper22 suggests a framework anchored to the organisation, but effective pandemic preparedness and response extends well beyond WHO, and so should high-level monitoring and oversight. The issue of equitable access to COVID-19 vaccines, diagnostics, and treatments requires considerable work. By May 15, 2022, less than 15% of the population in low-income countries had received their primary COVID-19 vaccination series.23 Access to diagnostic tests in low-income countries is woefully inadequate, and COVID-19 therapies are hardly available. This failure has been catastrophic. It exposes the inability of a donor-driven charity model to deliver market-driven products, which should instead be inclusively and equitably produced and shared as global public goods. The failure to make vaccines available to vulnerable populations including health workers in low-income countries in 2021, when demand was high, is contributing to a closing window of demand this year. Poor surveillance and low testing capacity in low-income countries risks failure to detect the emergence of dangerous new SARS-CoV-2 variants. Steps to support vaccine manufacturing capacity in low-income and middle-income countries are also running into challenges—eg, one manufacturer had to stop production of COVID-19 vaccine due to insufficient orders.24 With no appreciable progress to create a platform that can equitably deliver global public goods, and the current sclerotic and insufficient progress to agree a Trade-Related Aspects of Intellectual Property (TRIPS) waiver, newer and more effective vaccines, diagnostics, and treatments will not be distributed equitably during this and future pandemic threats. Poorer countries will probably be expected to take excess doses of older and less effective vaccines, while wealthier countries will have preferential access to the most effective tools as they come on the market.