In a foreword for the Global Preparedness Monitoring Board's report "A World in Disorder", co-chairs Gro Harlem Brundtland and Elhadj As Sy lament the world's collective failure to take seriously pandemic prevention and call for urgent action to strengthen health systems and mitigate future risks.

Never before has the world been so clearly forewarned of the dangers of a devastating pandemic, nor previously had the knowledge, resources and technologies to deal with such a threat. Yet, never before has the world witnessed a pandemic of such widespread and destructive social and economic impact.

The COVID-19 pandemic has revealed a collective failure to take pandemic prevention, preparedness and response seriously and prioritize it accordingly. It has demonstrated the fragility of highly interconnected economies and social systems, and the fragility of trust. It has exploited and exacerbated the fissures within societies and among nations. It has exploited inequalities, reminding us in no uncertain terms that there is no health security without social security.

COVID-19 has taken advantage of a world in disorder. The last century has witnessed numerous developments and innovations that have improved and prolonged lives the world over. But the same advances have also created unprecedented vulnerability to fast moving infectious disease outbreaks by fueling population growth and mobility, disorienting the climate, boosting interdependence, and generating inequality. The destruction of tropical rain forests has increased the opportunities for transmission of viruses from wild animals to humans. We have created a world where a shock anywhere can become a catastrophe everywhere, while growing nationalism and populism undermine our shared peace, prosperity and security. Infectious diseases feed off divisiveness; societal divisions can be deadly.

As the Global Preparedness Monitoring Board (GPMB) noted last year, pathogens thrive in disruption and disorder.¹ COVID-19 has proven the point. Where sufficient resources, cooperation, and organization were applied, it was slowed. Where disarray, division and poverty reign, it has thrived.

In issuing its warning in last year’s inaugural report, the GPMB stressed the inadequacy of systems and financing required to detect and respond to health emergencies. As COVID-19 has proven, these systems remain dangerously deficient and under-resourced. This pandemic has also called out the human dimensions of health security, the actions of leaders and citizens that are so critical to vigorous preparedness and response.

Our report this year highlights responsible leadership and citizenship, as well as the adequacy of systems and resources, as key factors for success. It puts a special emphasis on the factor that binds these four elements together into an effective whole: the principles and values of governance that ensure the right choices, decisions and actions are taken at the right time. It points out that none are safe until all are safe and calls for a renewed commitment to multilateralism and to WHO and the multilateral system.

The pandemic is far from over. Some countries have been relatively successful in suppressing the virus, protecting their populations, saving millions of lives. Others have not. Close to a million lives have been lost to COVID-19. The devastating economic and societal impact of COVID-19 reminds us, yet again, of the centrality of investment in pandemic preparedness to human security, and the need to reconsider how national security budgets are spent.

We have already learned many crucial lessons that demand immediate action if we are to say with any confidence, “never again”. But learning without action is pointless, and unsustained commitment is futile. As we warned in our last report, “For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides.”

Again, we say: “It is well past time to act.” And we identify the commitments and actions leaders and citizens must take - boldly, decisively, immediately, and with new energy animated by the grim recognition that inaction kills.

1. Global Preparedness Monitoring Board. A World at Risk: Annual Report on Global Preparedness for Health Emergencies. World Health Organization, 2019, p. 6