The world is not ready for the next pandemic – and it won’t be unless local capacity is strengthened, global health experts agreed at an event in Geneva on Tuesday.

Does anyone brief cruise ship captains, cruise operators and passengers from Argentina that hantavirus is an endemic virus? asked Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response.

“We can have perfect rules, but if we’re not risk-informed, if we’re not alert to the possibility of endemic viruses emerging, none of it’s going to count for much,” said Clark, at an event co-hosted by the Independent Panel and the Global Health Centre‘s International Geneva Global Health Platform on Tuesday alongside the World Health Assembly.

Clark stressed that pandemic preparedness involves countries and people knowing their risk: “What are you looking out for? What are you preparing for?”

But Dr Mariângela Simão, Brazil’s Secretary of Health and Environmental Surveillance, said that local health facilities “need to have access to diagnostics to help timely intervention”. She noted that hantavirus can be similar to dengue to start with, while dengue, chikungunya, and Zika all have similar characteristics in early infection.

The current Ebola outbreak in the Democratic Republic of Congo (DRC) took over a month to detect, with a long journey from “village communities to specialised labs”, said Dr Edem Adzogenu, Global Emissary for the Accra Reset, Africa’s plan to move from aid dependency to health sovereignty.

“The inability to detect was simply because of the unavailability of a broad-spectrum diagnostic,” he added. ”What that tells us is, no matter how much preparation you put in place, if it’s not comprehensive, you miss that process.

“We’re talking about a country that, since 1976, has had cyclical outbreaks of Ebola, and still does not have the diagnostics to deal with detection at source.”

Mpox response ‘failed miserably’

Els Torreele, an advisor to The Independent Panel, recently completed research into the mpox outbreak – and describes the mpox response as having “failed miserably”.

“We need to stop outbreaks when and where they occur, and this is the repeated lesson that we don’t seem to be able to learn,” said Torreele.

The world realised that the global stockpiles of smallpox vaccines are effective against mpox – but during the international mpox outbreak in 2022, these were “made available mostly in the Americas and in Europe”, she said.

“None of these vaccines actually arrived at the endemic area,” said Toreele.  

“When the second mpox public health emergency of international concern (PHEIC) was declared [in 2024], we knew there was an effective vaccine, and again it wasn’t made available [immediately],” she pointed out.

“WHO pre-qualification was requested, even though the vaccine was registered by the FDA, EMA, and had been shown in the global outbreak to be effective, so delay upon delay.”

When vaccines eventually arrived in the DRC and other hot spots, “it was too little, too late because, in an epidemic response, vaccinating the right people at the right moment is critical to curb the pandemic”.

Officials in one of the countries affected by the outbreak told Torreele that their vaccines arrived when we didn’t have cases anymore.

In addition, only around 23% of all cases were ultimately confirmed in the DRC because it took too long to get samples to Kinshasa and regional capitals for testing.

Maria Guevara, international medical secretary for Médecins Sans Frontières (MSF), described the DRC’s health system as “broken”.

“If you look at the 2024 national immunisation numbers data, their measles coverage is 55% Why? Because the vaccines aren’t coming there, even if there are existing supplies,” she said, adding that conflict made several areas “inaccessible”, and that there are also “administrative barriers” 

Two MSF Ebola treatment centres were burnt down in 2019 because community members didn’t trust them, Guevara pointed out.

No trust, no PABS agreement

Trust is a key ingredient in pandemic preparedness, said Hanan Al Kuwari, advisor to Qatar’s Prime Minister for Public Health Affairs. The lack of it is hampering agreement on the pathogen access and benefit-sharing (PABS) annex to the Pandemic Agreement.

“Trust was weakened and jeopardised by specific facts during COVID-19. When South Africa rapidly sequenced and shared the Omicron variant, exactly what the global health agreements asked countries to do, more than 50 countries responded with immediate travel bans,” said Al Kuwari.

“The TRIPS waiver, which could have enabled local vaccine production in the countries that needed it most [during COVID-19], did not receive the support required, reflecting the difficult tensions between global equity commitments and industrial needs.

“Vaccines were not distributed equally, and health workers in poor nations went unprotected for months. These are not system failures in the abstract sense. These were decisions whose history sits at the PABS negotiating table with every delegation. That is why regaining trust is not a diplomatic formality. It is the operational precondition for PABS to work.”

She described PABS as “the core equity commitment of the entire architecture, which determines whether the country that rapidly shares a pathogen sample will actually benefit from the vaccines and treatments that follow. 

“Until that is resolved, the agreement cannot be signed or ratified,” Al Kuwari stressed.

The hanavirus outbreak depended on “countries sharing data rapidly and openly, as well as on a WHO that is fully funded and retaining competent staff able to interpret the evidence and inform the decision makers and the public”, she added.

Olla Shideed, WHO’s unit head for health emergencies governance, said that 64 countries had spoken about the need for PABS during a WHA debate on Monday.

She, along with Clark, urged countries not to wait for agreement on PABS but to start implementing the Pandemic Agreement.

“Speed is of essence. Speed in detecting speed in surveillance, speed in reporting, and speed in coordinating the action at the national, regional level, and international levels is really what helps us to move forward.”

No finances

Adzogenu also pointed out that the countries worst affected by the current Ebola outbreak – the DRC and Uganda – have “really serious fiscal constraints” as they are servicing debt.

“There’s the manufacturing gap as well,” he said, adding that the Accra Reset aims to ensure that countries have what they need on the ground.

Clark said that the United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response (PPPR), scheduled for September, could push for PABS negotiations to conclude.

“But I think it needs to bang a drum on finance, because we’re talking global public goods here. If a disease gets away, it knows no sovereignty, gender, or whatever.

“We need new ways of funding global public goods like preparedness. Some of the bold ideas out there, like global public investment, need member state champions.

“The global public investment model talks about everybody putting into the fund with applications according to need. If everyone’s putting up the money, low-income countries will get more say [in governance].”

Image Credits: John Wessels/ MSF.