Jan 30, 2021 — Trends.pdf/, accessed 6 January 2021. 4 Secretary-General’s statement to the press, 6 January 2020. Available at.
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This is the second report on progress from the Independent Panel for Pandemic Preparedness and Response. The report represents over three months of work by the full Panel since it held its ˜rst meeting on 17 September 2020. This report has been informed by the review of hundreds of documents, expert consultations across many sectors, case studies, submissions received by the Panel from Member States, academia, civil society , and citizens, and almost 100 interviews with those at the frontlines of pandemic preparedness and response. The work of the Panel, however, is not yet complete and, as detailed in this report, there are a number of critical questions which remain to be examined in depth before conclusions can be drawn and recommendations made. The ˜rst progress report was presented to the resumed session of the 73rd World Health Assembly on 5 November 2020. Following this report, the Panel will again report to the 74th World Health Assembly scheduled for May 2021. Disclaimer: The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Independent Panel for Pandemic Preparedness and Response concerning the legal status of any country, territory, city of area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

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Table of Contents Preface 4Key messages 5Progress, observations and next steps 91. Build on the past 10 Conditions around the emergence of the pandemic 10 Preparedness assessment and previous panels 12 2. Review the present 15 Early responses 15International recommendations issued during 2020 18 3. Understand the impact 20National leadership and coordination 20 Impact on health services 20 Economic impact 24 Impact on communities 24 4. Change for the future 27 Global and regional leadership 27 Essential supplies 28 Diagnostics, vaccines and therapeutics 29 Financing 30 About the Independent Panel 32 Co-Chairs and members 33

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 4Preface The COVID-19 pandemic has been much more than an outbreak of a new infectious disease. The direct health impact seen in the number of people infected and deaths caused has been magni˜ed by substantial indirect impacts on essential health and other services and on people™s livelihoods and well-being. Across the planet, people have died, families have been left bereft, and societies and economies reshaped. Stark inequalities have been laid bare within and between countries. Progress towards the Sustainable Development Goals has been halted and even reversed. The worst of the pandemic and its impact are yet to come as we write at the beginning of January 2021. As Co-Chairs, we are deeply mindful of the need to ensure that out of the tremendous su˚ering and loss caused by this pandemic comes a renewed resolve to make the world more prepared, more secure, more just, more equitable, and more resilient for the challenges of the future, which will surely include more pandemic threats. The clarity with which the world realizes today that pandemics pose a fundamental threat to humanity must translate into lasting, structural change for the better. For all that our institutions and systems have sought to respond to the pandemic, often with heroic and unprecedented measures, the sobering fact is they have been no match for the virus and the speed with which it has spread across the globe. Despite the myriad shining examples on every continent of human ingenuity in response to the virus, we have failed in our collective capacity to come together in solidarity to create a protective web of human security. As 2020 came to an end, the world was grati˜ed to see vaccines given approval and begin to be used. But this blossoming of hope has been blighted by the manifest inequity in plans for vaccine rollout. Whether you happen to be born in Liberia, or New Zealand, or anywhere else, should not be the factor that determines your place in the vaccine queue. Only the application of principles of universality and equity will be su˛cient to enable the world to come out of this crisis together. COVID-19 emerged at a high point of geopolitical tension, which has impacted on the response to it. In early January 2020, the United Nations Secretary-General observed that geopolitical tensions were at their highest level this century, coincidentally just at the moment when ˜rst news of the outbreak was spreading. Those tensions have detracted from decisive and internationally co-ordinated responses to the pandemic. The virus has thrived on division, and the resultant pandemic has exacerbated tensions and undermined multilateral action just when it was most needed. The Independent Panel for Pandemic Preparedness and Response is tasked with charting what went wrong, what lessons can be learnt from that, and what could be done better in future. This Report sets out the progress which the Panel has made since it ˜rst met in September. While our inquiries are ongoing into where the international system could have done better, we are conscious that the means to curb the pandemic through non-pharmaceutical interventions are well known, but still the pandemic rages on. For that reason, this report on progress includes the views of the Panel on critical lessons which are already evident, and on ways in which the response could be reshaped right now. on behalf of the Independent Panel Her Excellency Ellen Johnson Sirleaf Co-Chair The Right Honourable Helen Clark Co-Chair

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 5The world was not prepared, and must do better The Independent Panel for Pandemic Preparedness and Response is painfully aware that the world was not prepared for the coronavirus disease (COVID-19) pandemic. When the scale of the pandemic and its impact became evident, as well as the failures in the chain of preparedness and response, communities and leaders around the world rallied in response, rethinking systems, providing mutual support and solidarity, and sparing no e˚ort in devising the care, treatments, and prevention needed to confront severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Frontline workers exposed themselves to risk and put their lives on the line for their fellow human beings. While the work of the Panel and our inquiries are ongoing, and we are conscious that the pandemic is continuing to evolve with many countries facing their most challenging period yet in their response to COVID-19, we are unanimous in our view that more decisive and e˚ective action can be taken immediately to save lives and reduce the overall damage from the pandemic. We are also convinced that the evidence of de˜ciencies in pandemic preparedness and response calls for far-reaching change for the future. Ł The public health measures which would curb the pandemic need to be applied comprehensively. Non-pharmaceutical interventions, including early case detection, contact tracing and isolation, physical distancing, limits on travel and gathering, hand hygiene, and mask wearing are e˚ective. These measures must continue to be used at scale, even as vaccination is rolled out. In too many countries, the failure to apply such measures is continuing to result in an unacceptable toll of death, illness, and transmission. Social protection measures focussed on overcoming vulnerability will both enhance the e˚ectiveness of these public health measures, and reduce the drivers of risk. Ł The pandemic response has deepened inequalities. Inequalities both within and between nations have worsened as vulnerable and marginalized people in a number of countries have been left without access to health care, not only to treat COVID-19 infection, but also because health systems have been overwhelmed, shutting many out of basic care and services. There is a gap between countries in the level Key messages The full potential of vaccines cannot be realized if narrow national interests and economic power determine who gets access, instead of basic principles of fairness and ensuring that allocation will optimize their public health impact.

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 6of access to diagnostics, therapeutics, and essential supplies. The full potential of vaccines cannot be realized if narrow national interests and economic power determine who gets access, instead of basic principles of fairness and ensuring that allocation will optimize their public health impact. We cannot allow a principle to be established that it is acceptable for high-income countries to be able to vaccinate 100% of their populations while poorer countries must make do with only 20% coverage. COVID-19 did not start in the poorest countries, but they are su˚ering the greatest collateral damage, and they need enhanced solidarity and support from the international community. Ł The global pandemic alert system is not ˜t for purpose. Critical elements of the system are slow, cumbersome and indecisive. The Panel has been advised that an increasing majority of alerts concerning outbreaks come to WHO via news or social media and is aware that platforms to collate epidemic intelligence from open and non-traditional sources have been created. Overall, the procedures and protocols attached to the operation of the International Health Regulations (2005) (IHR), including those leading up to the declaration of a public health emergency of international concern, seem to come from an earlier analog era and need to be brought into the digital age. A system of distributed information, fed by people in local clinics and laboratories, and supported by real-time data gathering and decision-making tools, is necessary to enable reaction at the speed required Š which is days, not weeks Š to confront epidemic risk. This technical updating must be accompanied by a political step-change in the willingness of countries to hold themselves accountable for taking all necessary actions as soon as an alert is issued. Figure 1: Predicted widespread access to COVID-19 vaccines Source: The Economist Intelligence Unit, January 2021.

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 8opportunity for Member States to recognize the common bene˜t of a suitably reinforced suite of tools available to the international system to enable robust pandemic alert and outbreak containment functions. The Panel believes that the COVID-19 pandemic must be a catalyst for fundamental and systemic change in preparedness for future such events, from the local community right through to the highest international levels. Institutions across the policy spectrum, not just in health, must be part of e˚ective pandemic preparedness and response. A new global framework is needed to support prevention of and protection from pandemics. Building the capacity to respond e˚ectively to them must be seen as a collective investment in mutual human security and wellbeing. The Panel believes that such a global reset is achievable, and its report in May will set out recommendations to that end. To be implemented, they will need the global community to come together with a shared sense of purpose and to leave no actor outside the circle of commitment to transformative change. Health workers around the world had to rapidly shift their priorities to treat patients with a disease of which

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 9Progress, observations and next steps The Terms of Reference of the Independent Panel for Pandemic Preparedness and Response are to review experience gained and lessons learnt from the international response to COVID-19, while also analysing past and future challenges and the health, social and economic impacts of pandemics. The Panel has organized its Program of Work around four broad themes: building on past experiences of pandemic response, reviewing what has taken place in the COVID-19 response to date, understanding the range of impacts of the pandemic, and considering what a future international pandemic preparedness and response system should look like, including the place of WHO in this system. This report on progress outlines the observations the Panel has made on evidence put before the Panel and the analysis it has conducted. The observations should be regarded as provisional, both because the investigations of the Panel are not complete and because the pandemic is continuing to evolve, with many countries facing their most severe challenges yet in responding to COVID-19. The future lines of investigation the Panel intends to undertake and critical questions it will seek to answer are detailed below.

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 10 1. Build on the past In addressing the critical issue of whether the world could have been better prepared to avert the COVID-19 pandemic, the Panel is considering whether there are characteristics of the virus and the environment into which it emerged which have created particularly fertile conditions for its spread. As well as the natural and social environment in which the virus emerged, the preparedness policy ecosystem appears to have lacked predictive metrics and follow-through on previous recommendations to strengthen preparedness. Observations Conditions around the emergence of the pandemic History tells us that zoonotic outbreaks will continue to occur, and they seem to be appearing at a faster pace. From 2011 to 2018, WHO tracked 1483 epidemic events in 172 countries. 1 Since coming into force in 2007, the International Health Regulations (2005) have been used to declare a Public Health Emergency of International Concern six times, ˜ve of which have occurred since 2014. Four of those ˜ve were due to viruses of zoonotic origin which have only emerged as human threats within ˝he past 50 years but have become increasingly common causes of epidemics. Factors driving zoonotic outbreaks include the increasing human population, urbanization, global commerce and travel, and human encroachment on natural habitats, leading to increased volumes and types of contact between animals and humans. The United Nations Environment Programme and the International Livestock Research Institute have identi˜ed 2 seven human-mediated factors driving the emergence of zoonotic diseases: increasing human demand for animal protein; unsustainable agricultural intensi˜cation; increased use and exploitation of wildlife and its illegal tra˛cking; unsustainable utilization of natural resources accelerated by urbanization, land use change and extractive industries; increased travel and transportation; changes in food supply; and climate change. For example, global travel has more than quadrupled since 1990, from one billion people travelling by air then to 4.2 billion in 2018. Addressing these risk factors require ‚one health™ approaches which combine human, animal and environmental health considerations. The COVID-19 pandemic di˜ers from disease outbreaks and pandemics of the recent and more distant past in the scale, speed and breadth of its impact. The facts that the virus is infectious before symptoms appear, and that a high proportion of infections remain asymptomatic, have aided its spread to nearly every country and territory on earth. The pandemic has had an impact on nearly every aspect of social and economic life. It The COVID-19 pandemic di˚ers from disease outbreaks and pandemics of the recent and more distant past in the scale, speed, and breadth of its impact.

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Second report on progress by The Independent Panel for Pandemic Preparedness & Response 11has been notable for the large number of infections and deaths which have occurred in high-income countries, but the economic impact of the pandemic has also been harsh on low- and middle-income countries along with the impact on health outcomes beyond COVID-19. COVID-19 has also emerged in a dynamic media and information environment. When severe acute respiratory syndrome (SARS) spread in 2003, smartphones enabling data access were the preserve of the future, and under a billion people, some 15% of the global population, had any internet access. By 2014, 2.4 billion people had mobile internet access, and this rose to 3.8 billion by 2019, half the world™s population. 3 Social media and the accelerated volume and distribution of both accurate and inaccurate information, together with polarized political environments, have triggered what has been dubbed an fiinfodemicfl. This has not only in˙uenced the behavior of people but has also created anxiety, resulting in a mix of pressures in policy decision-making which have proved hard to manage. At the very beginning of 2020, the United Nations Secretary-General observed that fi geopolitical tensions are at their highest level this centuryfl. 4 This was the world into which COVID-19 emerged, and the pandemic has been a vehicle for the expression of those tensions as well as an exacerbating factor. This has been particularly manifested in controversies around the work of WHO and expressions of a lack of con˜dence in WHO by some of its Member States. It has also been People have had to balance the need to protect themselves with the realities of their lives. (Photo: Angela Ponce)

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