As climate change drives disease outbreaks, the world remains ill-prepared for another pandemic – lacking in collaborative surveillance, diagnostic tools and finance, speakers told the Global Pandemic Preparedness Summit (GPPS) in Brazil.

The two-day summit, attended by a global who’s who of pandemic experts, aimed to “reinvigorate the momentum for pandemic preparedness and response” – but it also offered a sober assessment of global shortcomings.

“Over half of pathogens are being amplified by climate change. With the global circulation of pathogens, there is a larger risk for transmission across different continents,” warned Professor Tulio de Oliveira, the South Africa-based scientist who is a key driver of Africa’s pathogen genome surveillance.

Ethiopia is experiencing its biggest dengue outbreak, while Burkina Faso is also dealing with dengue after a four-year break. There’s a new strain of Chikungunya and a new lineage of cholera in Cameroon, he noted.

The increased interaction between animals, humans and the environment – in part caused by the destruction of environments and migration – has increased the mobility of pathogens, De Oliveira told the summit, hosted by Brazil’s Ministry of Health of Brazil, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Oswaldo Cruz Foundation (Fiocruz).

The WHO is responding to 42 graded emergencies, 15 of which are Grade Three emergencies requiring international assistance, said Dr Mike Ryan, the WHO’s Executive Director of Health Emergencies.

“We’re tracking today a further 168 ongoing health emergencies around the world being managed at a national level, and … responding to cholera in 30 countries, mpox, avian influenza, H5N1, dengue and yellow fever, as well as multiple health emergencies related to war and natural disasters.”

“It’s our very connectedness that exposes us. We are the most connected human population in history. We live in mainly densely populated urban areas where we work, move, gather and socialise intensely.”

Diagnostic gaps

According to the non-profit organisation FIND, of 21 pathogens with outbreak potential, SARS-CoV-2 is the only pathogen for which there is adequate diagnostic readiness.

FIND launched its Pathogen Diagnostic Readiness Index (PDxRI), a comprehensive tool for evaluating diagnostic preparedness at the summit. 

“Fast, equitably distributed diagnostics are essential to spot & stem an emerging pandemic. FIND have a partnership-driven, five-year roadmap for diagnostic readiness to achieve the 100 Days Mission. But this requires $100 million in seed funding,” said FIND’s Dr Marta Fernandez Suarez.

The 100 Days mission refers to the need to develop vaccines, tests and treatments within 100 days of an outbreak, and enable access to those who need them most to prevent pandemics.

“Infectious diseases can pop up quickly and we need to make sure we are ready to respond quickly and equitably,” said CEPI CEO Dr Richard Hatchett.

“If a new coronavirus were to emerge, there is the potential we could respond in 100 days. But if a new disease were from the Paramyxovirus or Orthopoxvirus family, we’d likely not be ready yet. Importantly, we are moving in the right direction – but to reach the 100 Days Mission we need to advance capabilities with medical countermeasures and globalise access to these technologies. ”

Access gaps

Anban Pillay, South Africa’s Deputy Director-General of Health, noted that his country had been charged a higher price for COVID-19 vaccines than Europe.

“There are huge problems with the conduct of the pharmaceutical industry when it came to access to vaccines,” said Pillay. “They didn’t provide access. They raised the prices. They decided not to give certain countries stock, even though we were paying higher prices than Europe.

“So we need a different global system about where we access vaccines and other countermeasures, a system that’s equitable, that is linked to need.”

“But access supposes that you have something to access,” noted Dr Mona Nemer, the Canadian government’s Chief Scientific Advisor and Chair of the 100 Days Mission Steering Group.

“And clearly, when it comes to diagnostics and therapeutics, and I dare say to vaccines, for the for the all the different viral families that we now have in front of us, we have a long way to go.”

Financial gaps

The Pandemic Fund’s Priya Basu said that the World Bank had been able to mobilize $2 billion in seed capital from 28 contributors to start the fund and seen “tremendous demand, and good quality projects”. 

During the first round of funding last year, projects “really focused on coordination and collaboration across different arms of government – health, finance, agriculture, animal husbandry, livestock, environment, all coming together”

But demand has far outstripped available finances, with the Fund having raised $850 million but received high quality proposals worth $7 billion.

“One of our biggest challenges is really to raise more money to maintain that momentum, because soon we’ll see a lot of disappointed countries if they don’t receive the money. And so that’s why we’ve just launched our investment case, our short term resource mobilization effort, last week,” said Basu.

Political progress at INB

Post-COVID, much of the world’s focus has been on politicians at the World Health Organization (WHO) negotiating a pandemic agreement. 

Brazil’s Ambassador Tovar da Silva Nunes, who is a vice-chairperson of the WHO’s International Negotiating Board (INB), told the summit he was confident that an agreement would be reached before the next World Health Assembly.

Da Silva Nunes and Ambassador Anne-Claire Amprou will be chairing a sub-committee on pathogen access and benefit sharing (PABS), the biggest sticking point in the talks.

“If we are able to solve what we call article 12, the doors are open for us to conclude the agreement in good time,” Nunes told delegates.

He added that there was no longer much disagreement on clauses relating to One Health.

“There was a perception that a One Health approach that is not a complete approach was wrong and it was not leading to equity,” he explained, adding that lack access to clean water, for example, was a factor in the spread of certain diseases.

“Vector-borne diseases are clearly related to [access to water]. So it has to be complete. This is overcome. We have decided to incorporate one health. It’s a major step for global community health, provided that it is done in a very balanced way.”

Ryan noted that the finer details of PABS might take time, but without a broad international “it will be very hard to achieve what this conference is setting out to achieve”.

Global South solidarity

“Global partnerships are key to the 100 Days Mission’s success,” said Brazil’s Minister of Health, Dr Nísia Trindade Lima. 

“Post-COVID, we’ve learned that equitable R&D, investment and access are crucial for public health. We cannot work only within our countries; we must think beyond borders. It’s time for science, technology, and innovation to unite for robust public health policies. We must work together in global health so that it becomes a reality.”

Summitt attendees from the Global South signed the Rio de Janeiro Declaration, which calls for greater collaboration between partners within the Global North and Global South to overcome disparities in access to health tools and countermeasures in low- and middle-income countries. 

The Declaration also urges global health partners to prioritise research and equitable access policies to focus on end-to-end R&D and support the establishment of the Alliance for Regional and Local Production, Innovation and Access, as discussed within Brazil’s G20 Presidency framework.

“It’s time to think and design a different world with a new mindset to build global health systems and strengthen global pandemic preparedness and response, with coordination between the Global South and North,” Professor Mario Moreira, President of Fiocruz, which initiated the declaration.