The development of the global pandemic architecture

1. After the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS)/H1N1, significant progress was made towards strengthening pandemic preparedness. Most notably, the International Health Regulations (IHR) were agreed, providing an overarching legal framework to define the rights and obligations of countries in handling public health events and emergencies with the potential to cross borders. The Global Outbreak Alert and Response Network (GOARN) had already been established back in 2000, but its global toolkit was expanded with the concept of the Public Health Emergency Operations Centre Network, which became a reference for best practice. The SARS outbreak also resulted in the adoption of the concept of a ‘public health emergency of international concern (PHEIC)’ within the revised International Health Regulations, which was agreed to in 2005.

2. Despite these advances, the inadequacies of pandemic preparedness and response were laid bare during the Ebola outbreak in West Africa in 2014-16. The pandemic reached PHEIC status, overwhelmed national and regional capacities, and presented incontrovertible evidence of gaps in epidemic/pandemic preparedness and response, alongside the significant impact on affected communities. The performance of the formal system was largely deemed to be inadequate and there were urgent discussions about reform. Despite widespread concerns that the global health system was not fit-for-purpose and sustained advocacy on the importance of strengthening the global health system, that reform was never fully achieved. After the international threat had passed, there was a lack of sufficient support to develop a radically changed set of instruments.

3. That is not to say that progress in strengthening pandemic preparedness completely stalled. In 2016, the Joint External Evaluation (JEE) Process was developed as a voluntary, independent process to assess national public health preparedness capacities under the IHR. This mechanism for country-level assessment was intended to assist in developing national action plans and provided the baseline for global preparedness of states. Over 100 JEEs were conducted between 2016 and 2019, many by African states. Additionally, the Pandemic Influenza Preparedness (PIP) Framework contributed to this foundation of preparedness, as did the work of the Strategic and Technical Advisory Group on Infectious Hazards with Pandemic and Epidemic Potential (STAG-IH). Between 2016 and 2019, the World Health Organization (WHO) reported that 63 After Action Reviews and 117 Simulation Exercises had been conducted.

Emergence and impact of COVID-19

4. On 30 January 2020, WHO declared a PHEIC due to the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). However, most countries did not take action until WHO characterized COVID-19 as a global pandemic on 11 March 2020.

5. The scale and scope of the pandemic was extraordinary and the global nature of the response was of a magnitude and complexity that went far beyond any previous IAHE action. The dimensions of the crisis stretched the capacity of the collective humanitarian system for a number of reasons:

In 2020, the number of people assessed to be in need of humanitarian assistance was already at the highest level for decades and the pandemic occurred at a time when the system was already overstretched.

The increase in the scale and geographic spread of needs was significant. By December 2020, 243.8 million people across 75 countries required humanitarian assistance, an increase of 45% from pre-pandemic projections. The global nature of the pandemic had implications for funding as donors were responding to domestic needs in addition to funding the international response.

Movement restrictions and travel bans made it more difficult to access those in need and significantly disrupted humanitarian delivery systems.

The pandemic response was launched at a time when information about it was scarce; key gaps in knowledge included factors that were thought to exacerbate the spread of the virus, challenges in making sense of the caseload and mortality data, a lack of understanding and analysis of the secondary impacts of the crisis, and limited information about national response plans.

6. While almost all countries have reported cases of COVID-19, the timeline above (Figure 1 in the PDF) illustrates that countries and regions experienced waves of infection at different times for the period under review even taking into account relative testing and reporting capacities.

7. The COVID-19 pandemic was not only a health crisis, but also a disruption to long-term socio-economic development, impacting supply chains, unsettling financial markets, affecting education (particularly due to school closures), and livelihoods (particularly of low-wage workers and the informal sector). A combination of these factors and measures put in place to suppress the virus have led to higher levels of food insecurity as well. The pandemic highlighted global inequalities whereby lower-income countries or specific population groups are affected disproportionately in terms of access to food and basic services, causing existing vulnerabilities to be further exacerbated. Effects on vulnerable groups include domestic violence, early child marriage, and child protection (CP) risks. Border closures had a significant impact on refugee crises, as 160 countries fully or partially closed their borders, with over half of them making no exception for refugees or asylum seekers. This exacerbated the impact of a triple crisis (with health, socioeconomic and protection dimensions) that the pandemic created for refugees, Internally Displaced Persons (IDPs), migrants and stateless persons.

8. The pandemic has continued into 2022 as well with significant ongoing global effects. According to the 2022 Global Humanitarian Overview (GHO), COVID-19 infections show no sign yet of abating and have claimed at least 1.8 million lives across the GHO countries. Economic and livelihoods continue to be affected which have served to increase humanitarian needs with additional millions of persons estimated to have been pushed into extreme poverty.

9. COVID-19 has continued to also have indirect effects on health and education as school closures and strains on the health systems have limited children’s access to health and education. Globally 870 million students face disruptions to education and 23 million children missed basic childhood vaccines just in 2021. The pandemic has also contributed to ongoing food security challenges with the Food and Agriculture Organization (FAO) reporting that by the end of 2021, food prices had increased by more than 30 percent since the initial COVID-19 outbreak and have reached their highest levels since 2011.

Source: Inter-Agency Standing Committee