Introduction

‘Global health security (GHS) is undergoing major transformation today after COVID – 19 crisis. GHS has shifted from exclusively referring to revisions occurring to international public health norms to now marking a complex arena where multiple actors debate and reconsider what counts as both ‘preparedness’ and measurable health systems strengthening ‘action’. The shift has far-reaching effects on global health policy. GHS is nebulous, defying stable definition or singular meaning. Coordinates for GHS have changed, with new pieces fitting together in ways unexpected or unimagined. The history and origins of the idea of GHS have been explored by others (Weir, 2012; Weir, 2015; Kamradt-Scott, 2015; Davies, Kamradt-Scott & Rushton, 2015).

GHS as an idea today evokes a complex history of high-level political urgencies, international legal reforms and public health emergencies. The idea points to an imagined world resilient to resurgence and increased spread of infectious diseases, alongside a timeline that juxtaposes global health blunders of Ebola, the politicisation of influenza or Zika, neglect of public health systems and ongoing debates over vaccine research and development, COVID – 19 crises. The idea of GHS today includes much wider perspectives and issues than referring to major transformations happening in the world of global health governance. Making and remaking of GHS introduces new possibilities for designing and executing GHS projects and constitutes a new manner of thinking about today’s global health governance problems and their implications for all countries.

What is Global Health Security (GHS)

The concept of Global Health Security comprises three complex and fluid terms: global, health, and security. Security in its broadest form is an absence of threats and danger and a continuous state of readiness to detect and address threats. The definition of health is narrowly conceived as the absence of disease; however, the World Health Organization (WHO) definition from the Constitution of WHO, signed in 1946, describes health as a state of “complete physical, mental and social well-being” (WHO, 2002). WHO definition further states that the health of all people is “fundamental to their attainment of peace and security” (WHO, 2002). Global in context of health security recognises how health is shaped by constant flows and connections of people and goods, social and environmental consequences of global economic order and that infectious diseases do not stop at international borders.

World Health Organization’s annual World Health Report for 2007, A Safer Future: Global Public Health Security in the 21st Century, indicated that there had been an alarming shift in the “delicate balance between humans and microbes.” A confluence of factors—demographic changes, economic development, global travel and commerce, and conflict—had “heightened risk of disease outbreaks,” ranging from new infectious diseases such as HIV / AIDS and drug-resistant tuberculosis to food-borne pathogens and bioterrorist attacks (WHO 2007:1). WHO report proposed a framework, “Public Health Security,” for responding to this new landscape of threats. Some of the biological threats discussed in the report— use of bioweapons—have been taken up under the rubric of national security and approached by organisations concerned with national defence. Others, such as infectious disease, have generally been managed as problems of public health, whose history, has been institutionally distinct (King 2002). The report emphasised a space of “Global Health” distinct from both biodefense and public health. “In the globalized world of the 21st century,” it argued, simply stopping disease at national borders is not adequate. Nor is it sufficient to respond to diseases after they have become established in a population. It is necessary to prepare for unknown outbreaks in advance, something that can be achieved only “if there is immediate alert and response to disease outbreaks and other incidents that could spark epidemics or spread globally and if there are national systems in place for detection and response should such events occur across international borders” (WHO, 2007:11).

According to WHO, functioning GHS apparatus would have to focus on preparing for catastrophic disease outbreaks anywhere in the world. To adequately plan for the future, it is proposed to reimagine the concepts and practices of GHS. This would involve policymakers and decision-makers more explicitly recognising health security as a pillar of national security— protection of citizens and social, economic, food and health systems from manmade and natural threats. The momentum in this direction is growing with a widening of the Global Health Security Agenda (GHSA) 2024 Framework (GHSA, 2018a; GHSA, 2018b). A broader definition of GHS should be considered that would extend well beyond threats of pandemics and bioweapons. Following the Ebola outbreak in West Africa in 2014, the issue of GHS has fundamentally transformed and has taken on pressing imminence, importance and sense of novelty, gaining significant attention and investment by a broad collection of national and international actors. Stakes of GHS as a priority cannot be grasped without critical attunement to its recent history and development in the context of the COVID – 19 pandemics and taking a closer look at how the idea of GHS seen today produces a changing world.

Securitising health

The notion of securitisation has been conceptualized by the Copenhagen School of Security Studies (Buzan, Wæver& De Wilde, 1998). Securitisation refers to the process by which an issue is socially constructed as a security threat through speech and representations of relevant political actors. The central issue for securitisation studies is not how much of a security threat a particular issue poses. It aims to understand who defines threat to security and whose interests are being served by securitisation. The end of the Cold War, the War on Terror and the increasing focus on domestic security has led to the broadening of perception of what constitutes a threat to security. The Copenhagen School argues that security is invoked in a variety of different arenas: it does not just refer to military threats to the state. It identifies four other sectors: political, societal, economic and environmental. The Copenhagen School argues that framing an issue in terms of security is the most effective strategy for bringing about a large-scale response (Buzan, Wæver& De Wilde, 1998). Since the 1990s, health issues have increasingly been framed as security threats and health has become one of the most important non-traditional security issues (Heymann et al., 2015). The securitisation of health has occurred in two distinct ways. First, referent object is individual human beings and health issue is presented as a threat to their well-being and lives. This is apparent in a report published by the United Nations Development Programme (UNDP) in 1994 entitled New Dimensions of Human Security, which identifies seven categories of threat to human security, including health. It distinguishes between the idea of human security, an individual, people-centred concept and a more traditional state-centred concept of security. The report argues that irrespective of the threat, people rather than borders, international relations or economics should be the primary concern of politicians and policymakers. The infield of health policy has been referred to as “individual health security”, which is defined as “security that comes from access to safe and effective health services, products, and technologies” (Heymann et al., 2015:1884). Second, the referent object is state and health issue is presented as a threat to international peace. Heymannet et al. (2015) refer to this as collective health security.

Why Securitisation of Health

Increased securitisation of health in the past couple of decades has been driven by concern that infectious diseases have the potential to cause problems far beyond public health. This has been resulting in fears about HIV/AIDS epidemic, SARS in 2003, fears about avian flu. In 2000, HIV/AIDS was the first health issue to be recognised by the UN Security Council as a threat to international security, when it passed Resolution 1308, regarding the impact of HIV / AIDS on peacekeeping operations in Africa. The securitisation of health was the result of a perceived threat of ‘bioterrorism’ in wake of the sarin gas attack in the Tokyo subway system in 1995 and the mailing of anthrax spores to US senators and media in 2001 (Calain&Sa’Da, 2015). Securitisation of infectious diseases reached its apogee in reaction to the 2014 Ebola outbreak in West Africa (Burci, 2014). Concern for the people of West Africa was not what motivated the international reaction to Ebola in West Africa. It was fear that the epidemic could spread out of Africa and cause harm to Western societies (Calain&Sa’Da, 2015). Three political decisions taken in September 2014 followed this reasoning. First, UN Security Council adopted Resolution 2177, which stated that the Ebola outbreak constituted a threat to international peace and security. Second, the USA deployed 3,000 military personnel to work on outbreak-control measures in Liberia. While this is generally seen to have had a positive effect on controlling outbreaks, it is also viewed as the militarization of humanitarian aid (De Waal, 2014). Third, United Nations created the first-ever emergency health mission, United Nations Mission for Ebola Emergency Response (UNMEER). Depicting Ebola as a threat to international security helped to increase the amount and speed of aid to affected countries. Rushton (2011:781) points out, “result has been the prioritization of measures designed to contain the disease within developing world rather than measures designed to address root causes of disease”. Ebola outbreak was a consequence of dysfunctional national health systems and delayed fragmented response from global health actors (Panel of Independent Experts, 2015).

International Health Regulations (IHR)

The aftermath of Ebola and Zika epidemics and the inclusion of specific targets (3D) to implement International Health Regulations (IHR) in Sustainable Development Goals (SDGs) affirms that controlling infectious diseases and pandemic preparedness are global priorities. There are several challenges to achieving minimum core capacities for IHR that are embedded in countries’ health systems. IHR is not solely about disease surveillance and reporting but also about strengthening health systems. The rationale for strengthening state’s core capacities for surveillance, reporting, notification, verification, response and collaboration is hinged on assumptions that health system matures from being reactive to proactive and that inputs to health system’s components: institutional capacity, stewardship, leadership, appropriate structures and facilities, resources, effective systems and functional processes, would play role in the development of state’s IHR core capacities (WHO, 2013). The development of IHR to its current form can be considered one of the milestones of global health security, health diplomacy and global health governance.

Major approaches to health security: State-centric and Globalist

United Nation’s original conception of health security as a vital core of human security is based on principles of universality, interdependence, prevention and people-centred approach (Commission on Human Security, 2003; United Nations Development Programme, 1994) There are two major frameworks to health security: state-centric or statist and globalist approaches. The state-centric approach is focused on the threat of emerging infectious diseases to states, oriented towards preparedness, surveillance and early warning (Lakoff, 2010). The fundamental tenet of the globalist approach to health security is a reference to the threat of increasing vulnerabilities to individuals and communities, not states (Davies, 2010). An individual’s health security is threatened not only by communicable and non-communicable diseases but also health issues induced by poverty, violence and crises that threaten survival, dignity and livelihoods (Commission on Human Security, 2003). The globalist approach to health security also resonates in ‘humanitarian biomedicine,’ which is focused on alleviating the suffering of individuals from diseases by providing access to health care regardless of national boundaries or social groupings in poorer countries that lack or have weak public health infrastructure (Lakoff, 2010). Lakoff (2010) suggests ‘humanitarian biomedicine’ as an alternative to the security vision of global health. The former is motivated by concern for the suffering of others, whereas the latter is implicitly motivated by fear and selfishness (Hofman& Au, 2017).

Infectious diseases, pandemics and global epidemiology

Infectious diseases have produced a significant impact on global epidemiology. The Russian Flu (1889–1890), Spanish Flu (1918–1919), Asian Flu (1957–1958), Hong Kong Flu (1968–1970), and Swine Flu (2009–2010) together killed almost 60 million people. The Spanish Flu alone claimed 50 million lives. Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) which began in 1981 has killed over 25 million people worldwide (LePan, 2015). The spread of infectious diseases can be deadlier than world wars. Compare World War I with 20 million military and civilian deaths combined with 1918 Spanish flu, which killed as many as 50 million people (Johnson & Mueller, 2002). The staggering death toll was trailed by economic, political and social consequences that continue to be felt 100 years later. Today, rapid urbanisation and greater connectivity make us more vulnerable to infectious disease threats that transcend national borders (CSIS and CBACI, 2000). Pandemics have emerged as direct threats to national security and would produce a more telling impact in the next decade (Gagnon &Labonte, 2013). The outbreak of infectious diseases has long posed threat to domestic and international trade and commerce. Cholera epidemics that ravaged Europe in 1830 and 1947 made a strong case for mobilising international public health response, primarily with the intent of safeguarding economic interests. International Sanitary Regulations laid down measures for quarantine and eventually led to the creation of International Health Regulations (IHR) to ensure GHS. Having failed to contain SARS in 2003, the scope of IHR was enhanced in 2005. This has not prevented pandemics like H1N1 influenza, Ebola in West Africa or Covid-19, highlighting the vulnerability of our health systems with an international regulatory framework in place (Sharma, 2020). The fast-moving SARS epidemic had shaken the world in 2003. While the epidemic only lasted some six months and was responsible for 8096 cases and 774 deaths (WHO, 2015), it was judged by the WHO Regional Director for Western Pacific to have “caused more fear and social disruption than any other outbreak of our time” (WHO, 2006). SARS was a novel coronavirus causing respiratory disease. It travelled rapidly to 29 countries and debilitated health systems. SARS epidemic was followed by the 2009 H1N1 influenza pandemic, 2014–2016 Ebola outbreak in West Africa, Zika and other disease outbreaks, including another new coronavirus, Middle East respiratory syndrome (MERS). These outbreaks were the impetus for series of initiatives to strengthen health security, animated by the conviction that disease outbreaks and other health threats constituted major global risk and required a web of actions across all countries. SARS propelled decade-long negotiations to revise and broaden International Health Regulations (IHR) to the rapid conclusion (The Independent Panel for Assessing Pandemic Preparedness and Response, 2021). Groups of States also took initiatives to boost health security. Global Health Security Initiative was established in 2001 by eight States and the European Commission, with WHO as an observer. Global Health Security Action Group was its implementation and information-sharing body. Global Health Security Agenda was launched by the United States in partnership with two dozen other countries in 2014 and has now grown to include seventy countries and several international organisations. Since the 2009 H1N1 influenza pandemic, at least 11 high-level panels and commissions have made specific recommendations to improve global pandemic preparedness. Many concluded that WHO needed to strengthen its role as a leading and coordinating organisation in the field of health, focus on its normative work and receive more funding. Reviews also suggested improvements in the implementation of IHR (2005). Some of the reviews resulted in a specific action, including the establishment of the new WHO Health Emergencies Programme in 2016. Despite consistent messages that significant change was needed to ensure global protection against pandemic threats, the majority of recommendations were never implemented. National pandemic preparedness has been vastly underfunded, despite clear evidence that its cost is a fraction of the cost of responses and losses incurred when an epidemic occurs (The Independent Panel for Assessing Pandemic Preparedness and Response, 2021).

COVID-19

The novel coronavirus (now known as COVID-19) erupted in the capital of China’s Hubei province—Wuhan—in November 2019 (Campbell &Doshi, 2020). On 11th March 2020, World Health Organisation (WHO) declared COVID-19 a pandemic after the virus affected more than 118,000 people in 114 countries and taking the lives of 4291 in the epidemic. Only a few weeks earlier on 30th January 2020, WHO had declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC) (WHO, 2020a). As of 15th April 2020, the WHO situation analysis of COVID-19 reported 1,914,916 confirmed cases from 210 countries and territories with 56,985 deaths (WHO, 2020b). The emergence of COVID-19 poses a serious threat to human health and is causing significant social and economic disruption. Worldwide mass containment measures notwithstanding, figures have continued to rise. The daily rise in the number of fatalities reminds us that infectious diseases remain a major killer and can easily kill more people than war (Koblentz&Hunzeker, 2020; Murphy, 2020). It has been widely noted that in a globalised world, pathogens spread further and faster than ever before and that no state can isolate itself from the global circulation of viruses and other disease-causing microbes (Osterholm&Olshaker, 2017). An infectious disease that can cross the shores of a country, infect citizens and leave in its wake considerable morbidity and mortality surely constitutes a major threat to national security.

Global impact of COVID – 19

The worldwide spread of the virus has disrupted major globalising processes, it has plummeted 21st-century civilization and has also left citizens wounded (Donfried, 2020). Since December 2019, more than 182 million people have been infected by the Coronavirus worldwide, and close to four million people have lost their lives (as of 1st July 2021) (WHO, 2021). International travel and migration have receded as major terminals in the world remain deserted. International sporting events have been cancelled. The global economy could be heading towards a great recession. There are job losses in all economies and citizens of poor countries are enduring hunger and starvation (Oshewolo, Nwozor&Fayomi, 2020). According to OECD (2020) widespread travel restrictions, financial market turmoil, and heightened uncertainty could cost major economies up to 2 percentage points in annual GDP growth per month. This scale of economic disruption could jeopardise the stability of countries, triggering economic fallout. While harping on security implications of coronavirus, United Nations’ Secretary-General, Antonio Guterres observes that disease could lead to social/political unrest and violence and erosion of trust in public institutions (Davidson, 2020). COVID-19 emergencies/consequences confirm the viewpoint by Katz and Singer (2007) that as far as pandemics could lead to destabilisation or disruption of social order, political agitation and impairment of economy, they qualify as security concerns. COVID-19 pandemic is a sign of how vulnerable and fragile our world is. The virus has upended societies, placed the world’s population in grave danger and exposed deep inequalities. It has taken less than a few weeks for COVID-19 to erode the social fabric of our societies and dismantle their orderly structure, causing more than 1.3 million infections and over 73,000 deaths, at the time of writing (Daoudi, 2021). This virus has posed a serious security challenge at all levels, namely global, national and human. It is the worst combined health and socioeconomic crisis in living memory and catastrophe at every level. COVID-19 has shown how an infectious disease can sweep the globe in weeks and space of few months, set back sustainable development by years (The Independent Panel for Assessing Pandemic Preparedness and Response. 2021):

• About 17000 health workers died from COVID-19 in pandemic’s first year (Amnesty International, 2021).

• US$ 10 trillion of output is expected to be lost by end of 2021 and US$ 22 trillion in period 2020–2025, deepest shock to global economy since Second World War and largest simultaneous contraction of national economies since Great Depression of 1930–32(Gopinath, 2020).

• 15–125 million people have been pushed into extreme poverty (United Nations, 2021).

COVID-19 exposed gap between limited, disjointed efforts at pandemic preparedness and needs and performance of system when actually confronted by fast-moving and exponentially growing pandemic and revealed failures and gaps in international and national responses that must be corrected. Current institutions, public and private, failed to protect people from a devastating pandemic. Closing preparedness gap not only requires sustained investment, but also requires new approach to measuring and testing preparedness.

Health Security as key constituent of National Security

If the connection between pandemics and national security is beyond conjecture, national leaders must treat the threat of infectious diseases with seriousness and urgency. There is a need for greater investment in disease prevention and control. It does not make any security sense for a nation to invest heavily in building its military capabilities but succumb easily to the devastating pandemic. Disease prevention and control programme that is not well funded will slow down scientific efforts aimed at developing vaccines and hamper the ability to predict future scenarios of pandemics for adequate preparation. Within the framework of global health diplomacy, critical stakeholders — nations, individuals and corporations must together strengthen the efforts of WHO at delivering on its mandate. As infectious diseases continue to define global epidemiology and affect national security, national priorities must be broadened to include global health concerns. Members must be willing to share timely and honest information on health risks with WHO. Only comprehensive and transparent data can help health authorities understand infectious diseases sooner and allow them to develop result-oriented containment measures (Murphy, 2020). The current crisis owes much to China’s failure to divulge important information about novel coronavirus early. From realities on the ground, within a short period of time, the infectious disease could disorient the most carefully formulated national security plan. It is imperative to make the pandemic response a national security priority (Monaco, 2020). Post-Covid – 19 when normalcy sets in, health security will become a key constituent of national security. There is a strong need for collective action by all key stakeholders through a multi-pronged approach to mitigate, prevent and fight against health security threats through global health diplomacy.

Vaccine access and distribution

Vaccine access and distribution is a highly charged political issue and choice. The uneven access to vaccination is one of today’s pre-eminent global challenges. High-income countries have over 200% population coverage of vaccine doses, obtained mainly through bilateral deals with manufacturers to secure existing and future stocks. In many cases, low and middle-income countries have been shut out of these arrangements. In the poorest countries, fewer than 1% of people have had a single dose of vaccine. A core mechanism to address global vaccine availability is the COVID-19 Vaccines Global Access Facility (COVAX Facility). COVAX, launched by WHO and partners in April 2020 as the vaccines pillar of its Access to COVID-19 Tools Accelerator (ACT-A). Its initial aim expressed in September 2020 was to purchase 2 billion COVID-19 vaccine doses by the end of 2021 and deliver them to people in 190 countries (The Independent Panel for Assessing Pandemic Preparedness and Response. 2021). By mid-March 2021, COVAX had shipped 30 million doses to at least 54 countries (WHO, 2021; Gavi, 2021). At that time COVAX expected approximately 1.8 billion doses to be available to 92 low- and middle-income countries before the end of 2021, covering 27% of their populations. But these expectations must contend with uncertainties of manufacturing capacity, regulation, funding availability, final contract terms and readiness of countries to deliver their national COVID-19 vaccination programmes. If COVAX had sufficient and readily available early funding it would have been better able to secure enough immediate supply to meet its aims (BBC News, 2021). COVAX rapidly established with intention of ensuring global, equitable access, is making good progress but has been hampered in that goal by lack of sufficient funds and by vaccine nationalism and vaccine diplomacy. There are 5.7 billion people in the world aged 16 and over. All need access to safe and effective COVID-19 vaccines urgently, now.

Immediate actions to end COVID – 19 and long term to transform pandemic preparedness

There are immediate recommendations that are aimed at curbing COVID – 19 transmission and there are recommendations that will transform the international system for pandemic preparedness and response and enable it to prevent future infectious disease outbreaks from becoming a pandemic. Following recommendations are made in two sets are made by The Independent Panel for Assessing Pandemic Preparedness and Response (2021).

Fig. 1: Model for Ending the COVID – 19 Pandemic and enabling prevent future infectious disease outbreaks from becoming Pandemics (The Independent Panel for Assessing Pandemic Preparedness and Response. 2021)

Immediate recommendations for ending the COVID -19 pandemic:

• Every country should apply non-pharmaceutical public health measures systematically and rigorously at scale epidemiological situation requires, with evidence-based strategy agreed at highest level of government to curb COVID-19 transmission.
• High income countries with vaccine pipeline for adequate coverage should, alongside their scale up, commit to provide to 92 low and middle income countries of Gavi COVAX Advance Market Commitment, at least one billion vaccine doses no later than 1st September 2021 and more than two billion doses by mid-2022.
• G7 countries should commit to provide 60% of US$ 19 billion required for ACT-A in 2021 for vaccines, diagnostics, therapeutics and strengthening health systems with remainder being mobilised from others in G20 and other higher income countries.
• World Trade Organisation and WHO should convene major vaccine-producing countries and manufacturers to get agreement on voluntary licensing and technology transfer arrangements for COVID-19 vaccines.
• Production of and access to COVID-19 tests and therapeutics, including oxygen, should be scaled up urgently in low- and middle income countries with full funding in 2021 and full utilization of US$ 3.7 billion in Global Fund’s COVID-19 Response Mechanism Phase 2 for procuring tests, strengthening laboratories and running surveillance and tests.
• WHO should develop immediately roadmap for short-term and within three months scenarios for medium- and long-term response to COVID-19, with clear goals, targets and milestones to guide and monitor implementation of country and global efforts towards ending COVID-19 pandemic.

Long Term Recommendations to transform pandemic preparedness and response: Elevate Pandemic preparedness and response to highest level of political leadership

• Establish Global Health Threats Council led at Head of State level.
• Adopt Pandemic Framework Convention as per WHO Constitution within next six months.
• Adopt political declaration by Heads of State at global summit under auspices of United Nations General Assembly through Special Session convened for purpose of transforming pandemic preparedness and response.

Strengthen the independence, authority and financing of WHO

• Establish WHO´s financial independence.
• Strengthen authority and independence of WHO Director-General.
• Strengthen governance capacity of Executive Board of WHO.
• Focus WHO’s mandate on policy and technical guidance, including supporting countries and regions to build capacity for pandemic preparedness and response and resilient health systems.
• Empower WHO to take leading and coordinating role in operational aspects of emergency response to pandemics.
• Resource and equip WHO Country Offices sufficiently to respond to technical requests from national governments to support pandemic preparedness and response.

Invest in preparedness now to prevent the next crisis

• WHO to set new and measurable targets and benchmarks for pandemic preparedness and response capacities.
• All national governments to update their national preparedness plans against targets and benchmarks set by WHO within six months, ensuring that whole-of-government and whole-of-society coordination is in place and that there are appropriate and relevant skills, logistics and funding available to cope with future health crises.
• WHO to formalise universal periodic peer reviews of national pandemic preparedness and response capacities against targets of WHO.
• As part of Article IV consultation with member countries, IMF should include pandemic preparedness assessment, including evaluation of economic policy response plans.

A new agile and rapid surveillance information and alert system

• WHO to establish new global system for surveillance, based on transparency by all parties, using digital tools to connect information centres around the world.
• WHO to be given authority by World Health Assembly to publish information about outbreaks with pandemic potential on immediate basis, without prior approval of national governments.
• WHO to be empowered by World Health Assembly to investigate pathogens with pandemic potential in all countries with short-notice access to relevant sites, provision of samples and multientry visas for international epidemic experts to outbreak locations.
• Future declarations of PHEIC by WHO Director-General should be based on precautionary principle where warranted. PHEIC declarations should be based on clear, objective, and published criteria. On same day that PHEIC is declared, WHO must provide countries with clear guidance on what action should to be taken to contain health threat.

Establish a pre-negotiated platform for tools and supplies

• Transform current ACT-A into truly global end-to-end platform for vaccines, diagnostics, therapeutics, and essential supplies, shifting from model where innovation is left to market to model aimed at delivering global public goods.
• Ensure technology transfer and commitment to voluntary licensing are included in all agreements where public funding is invested in research and development.
• Establish strong financing and regional capacities for manufacturing, regulation and procurement of tools for equitable and effective access to vaccines, therapeutics, diagnostics and essential supplies and for clinical trials based on plans jointly developed by WHO, regional institutions and private sector, with commitments and processes for technology transfer and supported financially by International Financial Institutions and Regional Development Banks.

Raise new international financing for pandemic preparedness and response

• Create International Pandemic Financing Facility to raise additional reliable funding for pandemic preparedness and for rapid surge financing for response in event of pandemic.
• The facility should have capacity to mobilise long-term contributions to finance ongoing preparedness functions and have ability to disburse at short notice in event of declaration of pandemic. The resources should fill gaps in funding for global public goods at national, regional and global level to ensure comprehensive pandemic preparedness and response.
• There should be ability-to-pay formula where larger / wealthier economies will pay most.
• Global Health Threats Council will allocate and monitor funding to regional and global institutions to support development of pandemic preparedness and response capacities.
• Funding for preparedness needs to be pre-allocated according to function and institution.

Good Governance systems for Health security

• Ensure that national and subnational public health institutions have multidisciplinary capacities and multisectoral reach and engagement of private sector and civil society.
• Heads of State to appoint national pandemic coordinators accountable to highest levels of government, with mandate to drive coordination for both preparedness and response.
• Conduct multisectoral active simulation exercises yearly as means of ensuring continuous risk assessment and follow-up action to mitigate risks, cross-country learning and accountability and establish independent, impartial and regular evaluation mechanisms.
• Strengthen engagement of local communities as key actors in pandemic preparedness and response and as active promoters of pandemic literacy.
• Increase threshold of national health investments to build resilient health and social protection systems, grounded in high-quality primary and community health services, universal health coverage, strong and well-supported health workforce.
• Invest in risk communication strategies that ensure timeliness, transparency, accountability.
• Work with communities in co-creation of plans to promote at health all times.

Conclusion

COVID-19 can be characterised as a global health crisis leaving multidimensional implications on all facets of life like health, economy, education etc. for the entire globe. The world was caught unprepared by the COVID-19 pandemic despite decades of warnings of the threat of global pandemics and years of international planning. The failure to adequately fund and execute these plans has exacted a heavy human and economic price. Hundreds of thousands of lives have already been lost, and the global economy is in midst of painful contraction. The crisis—the greatest international public health emergency in more than a century—is not over. It is not too early, however, to begin distilling lessons from this painful experience so that the world is better positioned to cope with potential future waves of the current pandemic and to avoid disaster when the next one strikes. Health security will be one of the central themes in the creation of a national security framework in many countries going forward. The world needs a new international system for pandemic preparedness and response and it needs one fast to stop future infectious disease outbreaks from becoming catastrophic pandemics. Priority is to end illness and deaths from COVID – 19. The world must learn from this crisis and plan for the next one without losing precious time and momentum. The world needs to commit to clear targets, additional resources, new measures to prepare for the future. Examining major challenges involved in securing populations from health prism and exploring how governments need to urgently design extensive new medical countermeasure regimes to overcome those challenges.

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