Now that some countries have successfully managed to bring the first wave of COVID-19 under control, it is time to take an early look back and consider what could have been done differently to improve outcomes in all countries. In advance of COVID-19, a series of infectious threats --SARS, highly pathogenic avian influenza virus infection, MERS, and the first pandemic of the century, 2009 H1N1 influenza – had already established a pattern of potential but imminent pandemic emergence, and adoption of IHR(2005) by all Member States should have pushed development of core capacities for detection, reporting, and mitigation to the top of the priority list for national and international leaders and their communities. However, countries have often failed to deliver on this mandate due to other pressing priorities and, notably, a lack of financial commitment: response overrides preparedness. How did these lapses affect countries’ readiness for and response to COVID-19? Sessions will address lessons learned so far -- and particularly what went well to improve preparedness for future events.

Since 2011 and the launch of the Pandemic Influenza Preparedness Framework, preparedness for the emergence of novel influenza viruses with pandemic potential has gained momentum. The PIPF approach was also considered generally adaptable to any other emerging respiratory viruses, including the hypothetical ‘Disease X.’ COVID-19 fits the Disease X paradigm perfectly, complemented as it is by the opportunities provided by the R&D Blueprint to add diagnostics, vaccines, and therapeutics. The core PIPF components have informed the COVID-19 response at national and global levels, including a whole-of-society approach, use of non-pharmaceutical public health interventions, the important role of communication, and the cross-sectoral partnerships among faith-based organizations, industries, labor/employers, and occupational and trade unions. The Global Influenza Surveillance and Response System (GISRS), covering 122 countries, has equipped countries with diagnostic capacity, along with the contributions of other major disease programs, e.g., HIV, TB, and malaria, that have enabled local laboratories to perform PCR tests for COVID-19 diagnosis.

In one of the first speeches after his appointment, Tedros Ghebreyesus, the WHO Director-General, noted that ‘in an interconnected world, we are only as strong as our weakest link.’ No country is safe if disease transmission is active in some parts of the world. COVID-19 hit the wealthiest countries hard, with effects far beyond health, while some middle- and lower middle-income countries managed to get their situations under control. In addition to the levels of pandemic preparedness, the disparities reflect the characteristics of the various health systems, such as emphasis on primary health care, extent of public funding for health care, public-private mix in healthcare delivery and adequacy of human resources in health. COVID-19 is confirming the importance of community engagement and ownership, and informed and community-supported self-directed health and hygiene behaviours of each individual in controlling the pandemic. ‘Solidarity’ has become a symbol of the COVID-19 response – from the global level and down to the grassroots. One remarkable achievement has been demonstrated in healthcare facilities. To save lives when the flood of patients was overwhelming hospitals and ICUs, national and international aid teams were sent – either voluntarily or through their organizations -- to create and maintain surge capacity.

Another issue to explore is the international connectivity among megacities and their roles as trade, traffic, and disease propagation hubs. As shown during SARS, the 2009 influenza pandemic, and this time again, when an emerging pathogen starts its global propagation, it hits the big cities first, then amplifies and spreads to other international hubs. These cities are often more connected to each other than to other places in the same country. Urbanization is another critical factor to explore if we want to prepare better for future epidemics and pandemics.

Finally, efforts are ongoing to identify the SARS-CoV-2 animal source, investigate the human-animal interface (HAI), and determine how this virus was introduced in humans. To manage and control the future risk of emergence of Disease X, the public health and human health security communities must further strengthen HAI work, including the environmental component (i.e., the ‘One Health’ approach)as well as the potential for deliberate or accidental release of engineered organisms (i.e., synthetic biology).

Thus, as we look to the near future, we will use this opportunity to identify the urgent problems yet to tackle and the ways in which we can and should augment readiness. Countries will be invited to relate their experiences with preparedness, containment, and mitigation during both the early phases of the pandemic and continuing as the situation evolves, as well as their assessment of the recovery measures implemented by governments. We will also examine the role and contributions of international organizations and communities in aiming to draw lessons for the world and lessons for countries.