Second reporton progress

Prepared by the Independent Panel for Pandemic Preparedness
and Response for the WHO Executive Board, January 2021

This is the second report on progress from the Independent Panel for Pandemic Preparedness
and Response. The report represents over three months of work by the full Panel since it held its
first meeting on 17 September 2020. This report has been informed by the review of hundreds of
documents, expert consultations across many sectors, case studies, submissions received by the
Panel from Member States, academia, civil society , and citizens, and almost 100 interviews withthose at the frontlines of pandemic preparedness and response.
The work of the Panel, however, is not yet complete and, as detailed in this report, there are anumber of critical questions which remain to be examined in depth before conclusions can be
drawn and recommendations made. The first progress report was presented to the resumed
session of the 73rd World Health Assembly on 5 November 2020. Following this report, thePanel will again report to the 74th World Health Assembly scheduled for May 2021.

Disclaimer:
The designations employed and the presentation of the material in this publication do not imply the expression of
any opinion whatsoever on the part of the Independent Panel for Pandemic Preparedness and Response concerning
the legal status of any country, territory, city of area or of its authorities, or concerning the delimitation of its frontiers
or boundaries.

Table ofContents

Preface4
Key messages

5

Progress, observations and next steps

9

1. Build on the past10

2. Review the present

15

3. Understand the impact

20

4. Change for the future

27

Conditions around the emergence of the pandemic
Preparedness assessment and previous panels

Early responses
International recommendations issued during 2020

National leadership and coordination
Impact on health services
Economic impactImpact on communities

10
12

15
18

20
20
24
24

Global and regional leadership
27
Essential supplies
28
Diagnostics, vaccines and therapeutics
29
Financing30

About the Independent Panel

32

Co-Chairs and members

33

Preface

The COVID-19 pandemic has been much more than an outbreak of a new
infectious disease. The direct health impact seen in the number of people
infected and deaths caused has been magnified by substantial indirect impacts
on essential health and other services and on people’s livelihoods and well-being.
Across the planet, people have died, families have been left bereft, and societies
and economies reshaped.
Stark inequalities have been laid bare within and between countries. Progress
towards the Sustainable Development Goals has been halted and even reversed.
The worst of the pandemic and its impact are yet to come as we write at the
beginning of January 2021.
As Co-Chairs, we are deeply mindful of the need to ensure that out of thetremendous suffering and loss caused by this pandemic comes a renewed resolve
to make the world more prepared, more secure, more just, more equitable, andmore resilient for the challenges of the future, which will surely include more
pandemic threats. The clarity with which the world realizes today that pandemics
pose a fundamental threat to humanity must translate into lasting, structuralchange for the better.
For all that our institutions and systems have sought to respond to the pandemic,
often with heroic and unprecedented measures, the sobering fact is they havebeen no match for the virus and the speed with which it has spread acrossthe globe. Despite the myriad shining examples on every continent of humaningenuity in response to the virus, we have failed in our collective capacity tocome together in solidarity to create a protective web of human security.
As 2020 came to an end, the world was gratified to see vaccines given approvaland begin to be used. But this blossoming of hope has been blighted by the
manifest inequity in plans for vaccine rollout. Whether you happen to be bornin Liberia, or New Zealand, or anywhere else, should not be the factor that
determines your place in the vaccine queue. Only the application of principles
of universality and equity will be sufficient to enable the world to come out of
this crisis together.
COVID-19 emerged at a high point of geopolitical tension, which has impacted on
the response to it. In early January 2020, the United Nations Secretary-Generalobserved that geopolitical tensions were at their highest level this century,
coincidentally just at the moment when first news of the outbreak was spreading.
Those tensions have detracted from decisive and internationally co-ordinatedresponses to the pandemic. The virus has thrived on division, and the resultant
pandemic has exacerbated tensions and undermined multilateral action justwhen it was most needed.
The Independent Panel for Pandemic Preparedness and Response is tasked withcharting what went wrong, what lessons can be learnt from that, and what could
be done better in future. This Report sets out the progress which the Panel has
made since it first met in September. While our inquiries are ongoing into where
the international system could have done better, we are conscious that the means
to curb the pandemic through non-pharmaceutical interventions are well known,
but still the pandemic rages on. For that reason, this report on progress includes
the views of the Panel on critical lessons which are already evident, and on ways
in which the response could be reshaped right now.

Her Excellency Ellen Johnson Sirleaf
Co-Chair

The Right Honourable Helen Clark
Co-Chairon behalf of the Independent Panel
Second report on progress by The Independent Panel for Pandemic Preparedness & Response4Key messages

The world was not prepared, and must do better
The Independent Panel for Pandemic Preparedness and Response
is painfully aware that the world was not prepared for the coronavirus
disease (COVID-19) pandemic.
When the scale of the pandemic and its impact became evident, as wellas the failures in the chain of preparedness and response, communities
and leaders around the world rallied in response, rethinking systems,
providing mutual support and solidarity, and sparing no effort in devising
the care, treatments, and prevention needed to confront severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2). Frontline workers
exposed themselves to risk and put their lives on the line for their fellow
human beings.
While the work of the Panel and our inquiries are ongoing, and we areconscious that the pandemic is continuing to evolve with many countries
facing their most challenging period yet in their response to COVID-19,
we are unanimous in our view that more decisive and effective action canbe taken immediately to save lives and reduce the overall damage fromthe pandemic. We are also convinced that the evidence of deficiencies inpandemic preparedness and response calls for far-reaching change forthe future.
• The public health measures which would curb the pandemic need to be
applied comprehensively. Non-pharmaceutical interventions, including
early case detection, contact tracing and isolation, physical distancing,
limits on travel and gathering, hand hygiene, and mask wearing are
effective. These measures must continue to be used at scale, even as
vaccination is rolled out. In too many countries, the failure to apply suchmeasures is continuing to result in an unacceptable toll of death, illness,and transmission. Social protection measures focussed on overcoming
vulnerability will both enhance the effectiveness of these public healthmeasures, and reduce the drivers of risk.

The full potential of vaccines cannot be realized if narrow
national interests and economic power determine who gets
access, instead of basic principles of fairness and ensuringthat allocation will optimize their public health impact.
• The pandemic response has deepened inequalities. Inequalities
both within and between nations have worsened as vulnerable andmarginalized people in a number of countries have been left without
access to health care, not only to treat COVID-19 infection, but also
because health systems have been overwhelmed, shutting many outof basic care and services. There is a gap between countries in the level

Second report on progress by The Independent Panel for Pandemic Preparedness & Response5Source: The Economist Intelligence Unit, January 2021.

Figure 1: Predicted widespread access to COVID-19 vaccinesof access to diagnostics, therapeutics, and essential supplies. The fullpotential of vaccines cannot be realized if narrow national interestsand economic power determine who gets access, instead of basic
principles of fairness and ensuring that allocation will optimize their
public health impact. We cannot allow a principle to be established that
it is acceptable for high-income countries to be able to vaccinate 100%of their populations while poorer countries must make do with only 20%
coverage. COVID-19 did not start in the poorest countries, but they are
suffering the greatest collateral damage, and they need enhanced
solidarity and support from the international community.
• The global pandemic alert system is not fit for purpose.
Critical elements of the system are slow, cumbersome and indecisive.
The Panel has been advised that an increasing majority of alerts
concerning outbreaks come to WHO via news or social media and isaware that platforms to collate epidemic intelligence from open andnon-traditional sources have been created. Overall, the proceduresand protocols attached to the operation of the International HealthRegulations (2005) (IHR), including those leading up to the declarationof a public health emergency of international concern, seem to comefrom an earlier analog era and need to be brought into the digitalage. A system of distributed information, fed by people in local clinics
and laboratories, and supported by real-time data gathering anddecision-making tools, is necessary to enable reaction at the speed
required — which is days, not weeks — to confront epidemic risk. This
technical updating must be accompanied by a political step-change inthe willingness of countries to hold themselves accountable for taking allnecessary actions as soon as an alert is issued.
Second report on progress by The Independent Panel for Pandemic Preparedness & Response6

A family prays at the gravesite of a relative who died of COVID-19. Lima, Peru. (Photo: Angela Ponce)• There has been a failure to take seriously the already known
existential risks posed by pandemic threat. Previous pandemic crises
have prompted numerous evaluations, panels and commissions whichhave issued many recommendations for strengthening preparedness
and response. Too many of those were not acted on. There has been
a wholesale failure to take seriously the existential risk posed bypandemic threat to humanity and its place in the future of the planet.
The collective reaction has amounted to wishful thinking instead of farsighted risk assessment and action. This crisis shows how quickly a newvirus can sweep away decades of hard-won progress and investmentin the future. The Panel believes that for the international community
to fail again to heed calls for preparedness against pandemic threat
would be unconscionable.
• The World Health Organization has been underpowered to do the job
expected of it. The Panel is struck that the power of WHO to validate
reports of disease outbreaks for their pandemic potential and to beable to deploy support and containment resources to local areas isgravely limited. The incentives for cooperation are too weak to ensure
the effective engagement of States with the international system in a
disciplined, transparent, accountable and timely manner. The impactof this pandemic ought to be to provide a once-in-a-generation

Second report on progress by The Independent Panel for Pandemic Preparedness & Response7

opportunity for Member States to recognize the common benefit ofa suitably reinforced suite of tools available to the international system
to enable robust pandemic alert and outbreak containment functions.
The Panel believes that the COVID-19 pandemic must be a catalyst
for fundamental and systemic change in preparedness for futuresuch events, from the local community right through to the highest
international levels. Institutions across the policy spectrum, not just in
health, must be part of effective pandemic preparedness and response.
A new global framework is needed to support prevention of and protection
from pandemics. Building the capacity to respond effectively to them must
be seen as a collective investment in mutual human security and wellbeing.
The Panel believes that such a global reset is achievable, and its report in
May will set out recommendations to that end. To be implemented, they
will need the global community to come together with a shared senseof purpose and to leave no actor outside the circle of commitment totransformative change.

Health workers around the world had to rapidly shift their priorities to treat patients with a disease of whichlittle was known, and against which they were often insufficiently protected. (Photo: Christine McNab)

Second report on progress by The Independent Panel for Pandemic Preparedness & Response8

Progress,
observations
and next steps

The Terms of Reference of the Independent Panel for Pandemic
Preparedness and Response are to review experience gained andlessons learnt from the international response to COVID-19, while
also analysing past and future challenges and the health, social andeconomic impacts of pandemics. The Panel has organized its Programof Work around four broad themes: building on past experiences ofpandemic response, reviewing what has taken place in the COVID-19
response to date, understanding the range of impacts of the pandemic,
and considering what a future international pandemic preparedness
and response system should look like, including the place of WHO in
this system.
This report on progress outlines the observations the Panel has madeon evidence put before the Panel and the analysis it has conducted.
The observations should be regarded as provisional, both because
the investigations of the Panel are not complete and because thepandemic is continuing to evolve, with many countries facing theirmost severe challenges yet in responding to COVID-19. The futurelines of investigation the Panel intends to undertake and criticalquestions it will seek to answer are detailed below.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response91. Build on
the past

In addressing the critical issue of whether the world could havebeen better prepared to avert the COVID-19 pandemic, the Panelis considering whether there are characteristics of the virus and theenvironment into which it emerged which have created particularly fertile
conditions for its spread. As well as the natural and social environment
in which the virus emerged, the preparedness policy ecosystem appears
to have lacked predictive metrics and follow-through on previous
recommendations to strengthen preparedness.

Observations
Conditions around the emergence of the pandemic

History tells us that zoonotic outbreaks will continue to occur, and they
seem to be appearing at a faster pace. From 2011 to 2018, WHO tracked
1483 epidemic events in 172 countries.1 Since coming into force in 2007,
the International Health Regulations (2005) have been used to declarea Public Health Emergency of International Concern six times, five of
which have occurred since 2014. Four of those five were due to virusesof zoonotic origin which have only emerged as human threats within
the past 50 years but have become increasingly common causes of
epidemics. Factors driving zoonotic outbreaks include the increasing
human population, urbanization, global commerce and travel, andhuman encroachment on natural habitats, leading to increased
volumes and types of contact between animals and humans.

The COVID-19 pandemic differs from disease outbreaks andpandemics of the recent and more distant past in the scale,speed, and breadth of its impact.
The United Nations Environment Programme and the International LivestockResearch Institute have identified2 seven human-mediated factors driving
the emergence of zoonotic diseases: increasing human demand for animal
protein; unsustainable agricultural intensification; increased use andexploitation of wildlife and its illegal trafficking; unsustainable utilizationof natural resources accelerated by urbanization, land use change andextractive industries; increased travel and transportation; changes in foodsupply; and climate change. For example, global travel has more thanquadrupled since 1990, from one billion people travelling by air then to 4.2
billion in 2018. Addressing these risk factors require ‘one health’ approaches
which combine human, animal and environmental health considerations.
The COVID-19 pandemic differs from disease outbreaks and pandemicsof the recent and more distant past in the scale, speed and breadth of its
impact. The facts that the virus is infectious before symptoms appear, andthat a high proportion of infections remain asymptomatic, have aided
its spread to nearly every country and territory on earth. The pandemic
has had an impact on nearly every aspect of social and economic life. It
Second report on progress by The Independent Panel for Pandemic Preparedness & Response10

People have had to balance the need to protect themselves with the realities of their lives. (Photo: Angela Ponce)has been notable for the large number of infections and deaths whichhave occurred in high-income countries, but the economic impact of thepandemic has also been harsh on low- and middle-income countries alongwith the impact on health outcomes beyond COVID-19.
COVID-19 has also emerged in a dynamic media and information
environment. When severe acute respiratory syndrome (SARS) spread in
2003, smartphones enabling data access were the preserve of the future,and under a billion people, some 15% of the global population, had any
internet access. By 2014, 2.4 billion people had mobile internet access, andthis rose to 3.8 billion by 2019, half the world’s population. 3 Social media andthe accelerated volume and distribution of both accurate and inaccurate
information, together with polarized political environments, have triggered
what has been dubbed an “infodemic”. This has not only influenced the
behavior of people but has also created anxiety, resulting in a mix ofpressures in policy decision-making which have proved hard to manage.
At the very beginning of 2020, the United Nations Secretary-Generalobserved that “geopolitical tensions are at their highest level thiscentury”. 4 This was the world into which COVID-19 emerged, and the
pandemic has been a vehicle for the expression of those tensions aswell as an exacerbating factor. This has been particularly manifested
in controversies around the work of WHO and expressions of a lackof confidence in WHO by some of its Member States. It has also been
Second report on progress by The Independent Panel for Pandemic Preparedness & Response11

reflected in the initial failure of the United Nations Security Council toachieve consensus around resolutions in response to the pandemic. This
impasse is remarkable in the face of a global crisis with the dimensionsof this pandemic.

Preparedness assessment and previous panels

As at the end of 2020, the confirmed count of cases in 218 countries andterritories stood at over 80 million with more than 1.7 million recorded
deaths. Actual numbers are almost certainly far higher than thoserecorded. The sheer toll of this epidemic is prima facie evidence thatthe world was not prepared for an infectious disease outbreak with
global pandemic potential, despite the numerous warnings issuedthat such an event was probable. Key issues for the Panel are whether
better assessment of preparedness and its gaps and more assiduous
implementation of previous recommendations to reinforce global healthsecurity would have enabled better defences to be put in place.
A number of efforts have been made to assess country capacities forpandemic preparedness, both under the monitoring and evaluation
framework of the International Health Regulations (2005) and by academic
institutions. These include results from the State Parties Self-Assessment
Annual Reporting Tool, scores assigned under joint external evaluations
as part of the International Health Regulations (2005), and the recent
Global Health Security Index. Scores achieved in these preparedness
assessments have failed to predict the relative success of countries incontaining the spread of COVID-19. They may not, for example, have had
sufficient regard for leadership and political factors which have a bearing
on how countries respond.
A series of review committees and panels in recent years have pointed
to the lack of country core capacities in pandemic preparedness,insufficient implementation of the International Health Regulations (2005)
requirements by national governments, weaknesses in WHO´s emergency
response systems and programmes, and other gaps and challenges
in pandemic preparedness and response at national and international
levels, including fundamental weaknesses in health systems.
The Independent Panel has reviewed the reports of 12 commissions
and panels assessing gaps in pandemic response. Their conclusions
have consistently pointed to a need for WHO to strengthen its role as theleading and coordinating organization in the field of health, focusing bothon its normative work, and on building up a unified, effective, operational
capacity for health emergencies with a capacity for rapid decision-making
and support for supply chains and surge capacities. Similarly, many
previous panels have proposed strengthening the functioning of theInternational Health Regulations (2005). Among the reform proposals
which have been suggested are changes to notification and alert
systems, such as the criteria for declaration of a public health emergency
of international concern, and the creation of a transparent, politicallyprotected Standing IHR Emergency Committee.
Second report on progress by The Independent Panel for Pandemic Preparedness & Response12

Figure 2: Twelve different commissions and panels have examined outbreaks, pandemics, and the International
Health Regulations (2005)
COVID-19
1
2020

Review Committee on the Functioning of the International HealthRegulations (2005) during the COVID-19 Response

2

2020

Independent Oversight Advisory Committee for the WHO Health
Emergencies Programme

3

2020

Global Preparedness Monitoring Board, Annual Report, A Worldin Disorder

4

2019

Global Preparedness Monitoring Board, Annual Report, A world at
risk

5

2019

Independent Oversight Advisory Committee for the WHO Health
Emergencies Programme

6

2017

UN Global Health Crises Task Force

7

2017

Independent Oversight Advisory Committee for the WHO Health
Emergencies Programme

82016 UN High-Level Panel on the Global Response to Health Crises
Ebola 201492016 Director General´s Advisory Group on Reform of WHO´s Work in
Outbreaks and Emergencies
10

2016

Commission on a GH Risk Framework for the Future: A Framework
to Counter Infectious Disease Crises

11

2016

Review Committee on the Role of the International HealthRegulations (2005) in the Ebola Outbreak and Response

12

2015

Ebola Interim Assessment Panel

13

2015

Review Committee on Second Extensions for Establishing National
Public Health Capacities and on IHR Implementation

H1N1 2009
14
2011

Review Committee on the Functioning of the International HealthRegulations (2005) in relation to Pandemic (H1N1) 2009

Figure 3: Summary of themes emerging from report recommendations

IHR

GH Security Framework

Joint External Evaluations

PHEIC System

Standing & Independent Emergency Committee
Periodic Reveiws

Sustainable Financing
Pandemic Product Development Committee

Emergency Programme

WHOCore capacities

Assessed contributions
National Focal Points

Contingency Fund

Global R&D fundR&D Coordination
Interagency collaboration

UNGA HL Council
Global Strategic PlanUNSC GH Committee

National Strategy Plans

Member States

GH Security

Community involvement

GH Governance

Second report on progress by The Independent Panel for Pandemic Preparedness & Response13

Many of the previous panels produced good ideas and some of themwere implemented, including the creation of a dedicated WHO Health
Emergencies Programme.
Yet, overall, there has been a failure to undertake comprehensive reforms
and to address leadership, funding, and governance issues at the highest
international level. For example, a number of the earlier review processes
made recommendations concerning the larger picture of global healthsecurity, calling for the development of a global strategic plan to improve
public health preparedness and response, together with sustainable anddedicated financing for this purpose.
The Panel notes with deep concern that the failure to enact fundamental
change despite the warnings issued has left the world dangerously
exposed, as the COVID-19 pandemic proves. The Independent Panel
does not want to present yet another report to sit on the shelves, leaving
historians to ask what if its recommendations had been heeded.

The Panel notes with deep concern that the failure toenact fundamental change despite the warnings issued
has left the world dangerously exposed, as the COVID-19
pandemic proves.
Priorities for the Independent Panel’s continued work
• The Panel will conduct additional reviews and analysis of the megatrends, societal changes, and systemic inequalities which havecontributed to making the impact of this pandemic so devastating.
• Further analysis will be undertaken to understand better why the present
system to assess national preparedness capacity failed to predict actual
performance, and how metrics could be improved.
• In an effort to avoid repeating the pattern of neglect, the Panel will work
to discern key factors explaining why previous recommendations havenot been implemented, including what is needed to generate a sufficientcoalition for change.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response14

2. Review
the present

The Panel is conscious that it is easy to identify shortcomings in theearly response to an outbreak with the benefit of hindsight, but far
more difficult to exercise good judgement in the context of emerging,scientifically-uncertain, and incomplete information. Nevertheless, thePanel believes there are important lessons to be drawn from what was
known about and acted on in response to the emergence of COVID-19
from its earliest stage. In understanding more clearly national responses
to the emerging outbreak, the Panel will pay particular attention to theadvice and recommendations which were issued to countries and to how
they responded to this advice.

Observations
Early responses

Evidence before the Independent Panel suggests that the emergenceof a new pathogen such as SARS-CoV-2 should trigger a complex early
response dynamic whose elements include the identification of caseclusters (in this instance manifesting as a pneumonia of unknown cause),establishing a likely new causal agent through laboratory and genetic
analyses, triggering of surveillance and alert systems, developing novel
diagnostics and therapeutics, issuing advice and recommendations foraction, interaction between national, regional and international systems,
and resultant willingness to take action based on national capacities.
The initial chronology 5 of the early phase of the outbreak suggests that
there was potential for early signs to have been acted on more rapidly,with an escalation of response tied more immediately to the emerging
information about the spread of the virus. If the precautionary principle had
been applied in relation to the earliest indicative but unconfirmed evidenceof human-to-human and asymptomatic transmission, more timely andstronger warnings of the potential for human-to-human transmission
could have been issued by both WHO and national and local authorities.
The Panel is not conducting a forensic inquiry into the origins of thevirus or seeking to pinpoint the spillover event when it moved from animal
to human hosts. We note that WHO has convened a global study ofthe origins of SARS-CoV-2, the first phase of which will explore how
the circulation of SARS-CoV-2 might have started and gather evidence
from the cluster of cases identified in December 2019 for potential
clues as to its origin. The Panel will seek to be informed by the ongoing

If the precautionary principle had been applied in relation to
the earliest indicative but unconfirmed evidence of humanto-human and asymptomatic transmission, more timely andstronger warnings of the potential for human-to-humantransmission could have been issued by both WHO andnational and local authorities.
Second report on progress by The Independent Panel for Pandemic Preparedness & Response15

Jimvelle Cac prepares for her night-shift as a nursing assistant at an emergency
department in Baltimore, Maryland, USA. (Photo: Rosem Morton)

work of this study. To date we have seen no new facts which contradict
the conventional wisdom concerning likely origins, but we regret thelack of a transparently-established, global consensus on the origins.
Notwithstanding the clarity such a consensus would have furnished,
the focus of the Panel is on the response actions which were taken,
or not taken, from the earliest moment at which information wasavailable about a new pneumonia of unknown etiology.
In retrospect, it is clear that the volume of infections in the early period of
the epidemic in all countries was higher than reported. A largely hidden
epidemic contributed to the global spread: simulations have shown thatmobility networks of air travel predicted the emerging global diffusionof the virus during the early phase of the epidemic.
There is evidence from Wuhan that locally available, commercial, nextgeneration-sequencing conducted in late-December 2019 provided thefirst suggestion that a novel virus may be responsible for the clinicallyobserved cases of pneumonia of unknown origin. This may indicate
the potential for a more significant role for these relatively inexpensive
techniques, which are able to use technical advances in parallel
sequencing to enable high-throughput and reliable results at a fractionof previous costs. They could be made widely available, and protocols
could be set in place so that the results they produce can be incorporated
into public health surveillance systems.
Second report on progress by The Independent Panel for Pandemic Preparedness & Response16

A close reading of the chronology of the earliest events in the emergenceof COVID-19 also suggests to the Panel that there were lost opportunities
to apply basic public health measures at the earliest opportunity. Whilestill collecting information, the Panel is becoming more confident in its
understanding of the early events in Wuhan, China, where the first presently
known cluster of cases was identified setting in train the identification of
SARS-CoV-2 as the cause. The Panel is aware of emerging reports of novel
coronaviruses possibly being evident in other countries as well, and thePanel will continue to monitor the scientific developments associated withthe ongoing investigations and sampling from this time.
What is clear to the Panel is that public health measures could have been
applied more forcefully by local and national health authorities in China in
January. It is also clear to the Panel that there was evidence of cases in a
number of countries by the end of January 2020. Public health containment
measures should have been implemented immediately in any country witha likely case. They were not. According to the information analysed by the
Panel, the reality is that only a minority of countries took full advantageof the information available to them to respond to the evidence of an
emerging epidemic.
Similarly, the earliest evidence of the success of measures taken against
SARS-CoV-2 could have been shared more widely and proactively, andaction should have been taken more rapidly to employ the most successful
containment measures in all places where cases appeared. The Panel
has noted that when WHO conducted a technical briefing at its Executive
Board session on 4 February 2020, it reported that there had been over
12 000 confirmed cases in China but only 176 cases in the rest of theworld — definitive evidence of human-to-human transmission, and also aclear signal to all countries with even a handful of cases that they neededto act quickly to contain the spread. In far too many countries, this signal
was ignored.
The Emergency Committee established under the International HealthRegulations (2005) was convened on 22 January 2020. It is not clear
why the committee did not meet until the third week of January, nor is
it clear why it was unable to agree on the declaration of a public healthemergency of international concern when it was first convened. A publichealth emergency of international concern was declared on 30 January,
but on the evidence considered thus far by the Panel, the extent ofresponse to that in countries around the world fell short of what shouldhave been expected. The Panel is continuing to consider what actions
could have been taken including by WHO and regional, national, and local
actors, that may have resulted in more forceful country action, in particularin the period from the beginning of February 2020 until early March.
One question is whether it would have helped if WHO had used the word
pandemic earlier than it did. Although the term pandemic is neither used
nor defined in the International Health Regulations (2005), its use does
serve to focus attention on the gravity of a health event. It was not until
11 March that WHO used the term.
Second report on progress by The Independent Panel for Pandemic Preparedness & Response17

International recommendations issued during 2020

The Independent Panel has documented in total almost 900
recommendations published by WHO, including its regional offices, andother international organizations from 1 January to 14 November 2020.
Those recommendations are mainly technical guidance documents, suchas technical, scientific, and policy briefs, considerations, interim and risk
assessment guidance documents, fact sheets, and protocols, checklists
and other tools prepared for governments, public health authorities andfrontline health workers. Advisory documents for the general public havenot been included in this inventory.
This inventory includes 330 technical guidance documents published by
WHO including its regional offices, and more than 570 technical guidance
documents produced by major international and national public healthorganizations. The Panel intends to conduct a detailed examination tounderstand when they were made and on what scientific evidencebase, and whether or not they had a significant impact in shaping the
response to COVID-19. The Panel also wants to understand more about
recommendations or non-recommendations on critical areas of the
response, including on the issues of travel restrictions, the nature oftransmission — including whether it was assumed to be by droplets oraerosolized, mask wearing, and other features of virus transmission
and effectiveness in containment.
Even before its detailed examination is conducted, however, the sheer
volume of recommendations issued suggests to the Panel the major riskof a lack of direction, clarity and consistency of the type which would haveassisted countries to set priorities in their responses. The coherence andprioritization of recommendations, and evidence concerning their actual
patterns of use as experienced in countries, will be an issue to which thePanel will pay particular attention.
Figure 4: COVID-19 related recommendations made by WHO and other International Organizations
COVID-19 related recommendations per month
180
160
140
120
100
80
60
40
20
0

ry

ua

Jan

ry

rua

b
Fe

h

rc
Ma

WHO-HQ

ril

Ap

y
Ma

WHO-ROs

e

Jun

y
Jul

UN organizations

st

gu

Au

r

be

tem
ep

S

CDCs

er

tob

Oc

r

be

m
ve
No

d

ate

d
Un

AU + EU

Source: Analysis by The Independent Panel.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response18

Priorities for the Independent Panel’s continued work
• The Panel will address remaining questions in relation to establishing
the facts of what occurred, especially in the earliest phase of theemergence of the pandemic, including through continued interviews,
consultations and analysis. The timeliness and impact of information
and advice issued by WHO and other bodies will also be reviewed inrelation to the chronology of the emergence, spread of, and responses
to COVID-19 and will be part of the Panel’s next report.
• The Panel will review the methods and tools employed by surveillance
and alarm systems and consider the extent to which such tools andprocedures are adequate to meet the needs of alerting decisionmakers and populations to a fast-moving novel pathogen of the type
represented by SARS-CoV-2.
• The Panel will seek a more complete understanding of the strengths
and weaknesses of the International Health Regulations (2005) as aninternational framework of relevance to pandemic preparedness andresponse. To support this, it is liaising with the Review Committee on thefunctioning of the International Health Regulations (2005) during the
COVID-19 response.
• The Panel will continue to gather evidence and to analyse the mainfeatures of national and subnational responses, including therelationship between decision-makers and sources of scientific advice,
the timeliness of decisions taken, the coordination between subnationaland national government responses and the degree of decentralizationin national health systems, whether there were perceived trade-offs
between economic costs and public health responses, the role ofcommunities in shaping responses, and the extent to which theinternational system was able to respond to national needs,
including through the quality and consistency of its advice.
• The Panel will continue to explore the part played by regional structuresand institutions in the response and their potential role in the future in
relation to pandemic preparedness and response.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response19

3. Understandthe impact

The pandemic’s impact has spread widely, but not randomly. Decisions
taken at national and global levels have shaped its severity. The direct
impact of the pandemic on health services has been a key concern, but
so too have been the indirect impacts on other health conditions. A
disturbing general trend has emerged which has seen low- and middleincome countries disadvantaged in access to essential supplies andsuffering more gravely than high-income countries in reduced accessto other health services and increased economic impacts. In many
countries, a trust deficit has been a significant factor impeding
effective COVID-19 responses.

Observations
National leadership and coordination

It is overwhelmingly evident to the Panel that choices made at both nationaland subnational levels of what policies and measures to implement, bywhom, and when, have shaped the severity of the epidemic in each country.
Very different outcomes achieved by countries with similar preparedness
planning suggests that there is not some simple, one-size-fits-all formulawhich guarantees response success. Rather, there is a complex interaction
between technical and other capacities and political and decision-making
systems which determines the willingness to take action.
This pandemic has shown that safeguarding the health of people, societies,
and environments, and their ability to cope, is an agenda which transcends
the health sector and requires whole-of-government and whole-of-society
responses. Initial evidence suggests that high-level coordination has beena key determinant of response success. The importance of this and other
determinants of success will be systematically examined by the Panel.

Impact on health services

The Panel has seen evidence suggesting that international, regional andnational institutions have struggled to deliver the necessary responses,
including to activate pandemic alert measures, deploy essential supplies(personal protective equipment, oxygen, ventilators etc.), and build
surge capacities for testing, isolation, contact tracing, and care. Accessto response measures has been inequitably distributed. A survey 6 by

… choices made at both national and sub-national levelsof what policies and measures to implement, by whom,
and when, have shaped the severity of the epidemic
in each country.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response20

Nurses rise to the challenge, at a cost
Nurses entered 2020, “The Year of the Nurse and the Midwife”, with a six-million-person deficit in the global workforce. In a year meant to highlight their work, leadershipand the need for more investment, nurses instead had
to face the challenge of a new, rapidly spreading virus
against which they too often had too little protection.

called for standardized and systematic collection of numbers of health care worker infections and deaths — not
only to measure the health toll on workers, but also tounderstand the dynamics of disease transmission. The
ICN has also called for COVID-19 to be labelled an occupational disease.

During an Independent Panel “Exchange” town hall withnurses in December, the Panel heard about the ways inwhich nurses adapted quickly, despite working in systems
often ill-prepared and ill-equipped to support them or
the patients for whom they were caring. The Exchange
meeting, coordinated with the International Council of
Nurses (ICN) and Nursing Now, and attended by about
250 nurses from around the world, heard how nurses
stepped in to innovate to help reorganize hospital andhealth care services, manage COVID-19 patients, provide
health messaging and increasingly, establish and staff
vaccine delivery systems.

Mental health is also an issue. Seventy per cent of national
nursing associations are reporting high levels of mental
health distress amongst nurses, together with reports ofphysical exhaustion, verbal and physical attacks and discrimination. There is concern that the stress of COVID-19
will result in nurses close to retirement leaving the profession early.
The Panel heard that 2021 should be the year to ‘act andinvest’ in nurses, ensure they have a seat at decisionmaking tables, educate more nurses, and support andretain those already in the workforce.

The Panel also heard about the direct deadly toll COVID19 has taken on nurses, with 1500 nurse deaths as of
October 2020 (now thought to be over 2000). The ICN has

WHO found low-income countries rarely able to access enough personal
protective equipment and treatment (dexamethasone) in the first half of2020, and many low- and middle-income countries have faced persistentconstraints in accessing oxygen, treatments such as monoclonal antibodies,and diagnostic tests, including reagents.
The burden of COVID-19 cases has threatened to overwhelm clinicalservices, not only during the initial peaks of the epidemic but also as
subsequent waves have hit. These burdens have taken a toll on front line
workers in a range of settings, including community treatment centres,
primary health centres, and hospitals. The impact on all staff in thesesettings has been substantial — not only the direct toll of deaths and illness
among frontline staff, but also the psychological toll as a result of dealing
with the crisis over a prolonged period.
Community engagement has been a successful strategy to enhancenational responses. This has included the deployment of community
health workers; for example, the cohort of 50 000 community informants
established for polio detection in Nigeria was also engaged in the COVID-19
response, Thailand’s network of village health workers has been a key
support to the response there, and India has drawn on a cadre of a million
women social health activists. The importance of community engagement,
however, extends well beyond inputs to the traditional health system.

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Systems for health require substantive community engagement at every
step of pandemic preparedness and response, from early detection andalarm to the dissemination of reliable information throughout a community,
including effective ways to prevent, care for and treat infection. We cannot
overcome resistance to masks and vaccines or the misuse of therapies
through traditional health care systems alone. The Panel will continue toinvestigate the best models of community engagement, and whether there
has been a failure to use community responses as effectively as possible in
the COVID-19 response.

Systems for health require substantive community
engagement at every step of pandemic preparedness
and response, from early detection and alarm, to thedissemination of reliable information throughout
a community
Alongside the direct impacts of COVID-19 on health, 90% of 105 countries
surveyed by WHO have reported experiencing non-COVID-19 healthservice disruptions .7 Findings from that survey show these disruptions
have been substantial in low- and middle-income countries with thegreatest impacts on outpatient services, prevention/screening
and community-based services. The initial evidence suggests thatrecovery following initial disruptions has been stronger for campaignbased services such as immunization and anti-malaria programmes,
suggesting lessons that can be applied to accelerate service recovery
and building back better.

Apollo Mangula, a community health worker in Uganda, has shifted his work
to educate his community about COVID-19. (Photo: Miriam Watsemba)

Second report on progress by The Independent Panel for Pandemic Preparedness & Response22

There have also been service disruptions in high-income countries acrossa range of both communicable and noncommunicable diseases, although
only 4% of high-income countries reported disruptions to at least threequarters of their services, compared to 45% of lower income countries
which did so.

Figure 5: Percentage of countries reporting at least partial disruption in at least 75% of services (n=105 countries)
Income group23%

Global (n = 105)45%

Low income (n = 22)30%

Lower-middle income (n = 33)

13%Upper-middle income (n = 23)

4%

High income (n = 23)
0%

10%

20%

30%

40%

50%

60%

70%

Percentage of countries
Source: World Health Organization, Pulse survey on continuity of essential health services during the COVID-19
pandemic: interim report, 27 August 2020.

Figure 6: Percentage of countries reporting disruptions across entire service groups (n=105 countries)
Service group

18%

Communicable diseases

31%

48%

Noncommunicable diseases
and mental health

24%

Reproductive, maternal,
newborn, child and adolescenthealth, and nutrition

30%
19%
15%

Emergency and critical care

62%
0%

10%

20%

30%

40%

50%

60%

70%

Percentage of countries

All services at least partially disrupted (%);
No services disrupted (%)
Source: World Health Organization, Pulse survey on continuity of essential health services during the COVID-19
pandemic: interim report, 27 August 2020.

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Economic impact

Prioritizing health or prioritizing the economy has proved to be a false
dichotomy. A preliminary observation by the Panel is that economic
outcomes have been better in economies where strict public health control
measures have been implemented effectively, and in those countries
health outcomes measured by the numbers of cases and deaths havebeen substantially better. The same pattern appears to apply to thepace of recovery, with more strict public health measures being followed
by stronger economic recoveries. While the Panel is cognizant that the
pandemic is ongoing, and so the long-term trends in relation to economic
impact are yet to be definitively established, we nevertheless believe thatsufficient evidence exists to be confident that decisions to implement strict
public health control measures will leave economies at least no worse
off than those that do not implement these measures, while averting
significantly more death and illness.
There are critical feedback loops between epidemic control and economic
activity. For example, there is evidence that unless people feel safe, they
will be reluctant to re-engage in key economic and social activities, such as
schooling or commerce. Similarly, social protection and labour regulation
measures are key levers to reduce transmission risk.

… sufficient evidence exists to be confident that decisions
to implement strict public health control measures will
leave economies at least no worse off than those that
do not implement these measures, while averting
significantly more death and illness.
The world’s total GDP was US$ 87.8 trillion in 2019 (World Bank). At theend of 2019 the world economy was expected to grow 3% in 2020. Instead,as a result of the pandemic and other factors indirectly related to it, a 4%
contraction is expected. This means a loss of 7% in global GDP amounting
to some US$ 6 trillion. This is clearly a case where billions can save trillions,
implying rates of return that are not in the tens or hundreds, but inthe thousands.

Impact on communities

The COVID-19 crisis has revealed a trust deficit between people,
institutions and leadership in some countries. The trust deficit has also
fuelled the infodemic and set up a vicious cycle of disinformation andinadequate response. The profound gap in trust combined with the use
and impact of social media disconnected from other methods of managing
public health information is another illustration of the failure of analog
responses in a digital age.

The trust deficit has also fuelled the infodemic and set up
a vicious cycle of disinformation and inadequate response.
Second report on progress by The Independent Panel for Pandemic Preparedness & Response24

In most societies, disadvantage has been exacerbated by the
pandemic, with deepening inequalities in health access and infections
disproportionately affecting those in more precarious or informal
employment. Migration brings particular vulnerabilities in access to both
health services and social protection. As has been documented by theInternational Organization for Migration, migrants and forcibly displaced
persons, including those affected by conflict, often contend with poor
living and working conditions, face discrimination or exploitation, or do
not benefit from social protections. Only 43% of countries provide accessto health services to all migrants regardless of their legal status. 8
The United Nations High Commissioner for Human Rights has drawn
attention not only to the neglect of rights to health and protection in the
pandemic, but also to rights abuses as some governments have restricted
rights to free expression, to assemble, and to participate in public life, notto reduce the spread of the virus but rather in order to shut down politicaldissent and criticism under the cover of the COVID-19 response.9… disadvantage has been exacerbated by the pandemic,
with deepening inequalities in health access and infections
disproportionately affecting those in more precarious orinformal employment.
Priorities for the Independent Panel’s continued work
• The Panel will document the magnitude of the continued disruption ofother essential health services, such as routine vaccinations, maternaland child health services, cancer diagnostics and treatments, and sexualand reproductive health services. It will study what mitigation measures
have been put in place, and, where evidence exists, it will report on theimpact of these measures.
• The Panel will examine measures taken to address human resource
deficits, including best practice in expanding the pool of trained healthworkers, addressing the movement of health workers between countries,and service models which extend health service delivery modalities toovercome limitations in supply.
• The Panel will take stock of and analyse the climate that has led to
the COVID-19 infodemic. The Panel will consider the adequacy of themeasures taken by international and national systems to shape thecommunication environment and propose ways in which it could
be strengthened.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response25

Social protection measures, including ensuring food security, are a factor in
mitigating the wider impacts of the pandemic. (Photo: Katumba Badru Sultan)• Evidence considered by the Panel suggests that community engagementin the response has not to date been as widespread or effective as it
could have been, and this will be a key avenue for more detailed inquiry.
Civil society actors have proven innovative and resilient in pandemic
response; yet it appears that this resource has been neglected by manydecision-makers and response institutions.
• Both the economic impact and the social impact of the pandemic willbe the subjects of further analyses by the Panel, including the specificimpact on women and young people. The Panel will document thedevasting financial and social costs to humanity and societies, andwill also endeavour to shed light on the underlying structural factors
and pre-conditions that impacted outcomes.

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4. Change forthe future

The COVID-19 pandemic constitutes the most acute crisis across healthand economic dimensions faced by the global architecture since it wasestablished following the Second World War. The system has struggled
to meet the challenge of the pandemic. Global leadership has been
exercised weakly. There has been greater reliance than ever before on
WHO, and there have been major new needs in relation to coordinatedsupply, accelerated development of vaccines and other counter measures,and rapidly deployable financing. The Panel will consider the mostcritical steps that can be taken to address the deficiencies revealedby the pandemic.

Observations
Global and regional leadership

Never before in modern times has the international community beencalled on to respond to a global health crisis of this magnitude and withsuch widespread consequences. The international system’s response has
been found wanting in many respects. It took the members of the United
Nations Security Council until July 2020 before they could agree on any
response resolution, and even then it was limited in scope and ambition.
It was not until almost one year into the crisis that the United Nations
General Assembly convened a Special Session on the pandemic; it too
was limited in its tangible outcomes.
WHO has been providing global leadership for the international healthresponse. The existence of the WHO Health Emergencies Programme
has enabled much more rapid and stronger support from WHO incomparison to its response during the 2014–2016 Ebola outbreak. The
newly established Science Division has brought more rigour to the workof the Organization and has enabled a wider range of scientific advice tobe collated systematically and made available at a more rapid pace thanever before. At the same time, the pandemic has tested WHO’s capacities
to broker globally effective solutions to new problems, such as the global
race for personal protective equipment. It is too early in the course of the
Panel’s work to come to a definitive judgement concerning the exercise by
WHO of its various functions in pandemic preparedness and response. It
is however abundantly clear that the world is more reliant on an effective
WHO than ever before in the Organization’s history.
The Panel has also been struck by the limited effectiveness of significant
international groupings in having an impact on the course of thispandemic. For example, both the G7/8 and the G20 have given priority inpast meetings to health security and pandemic preparedness, including
by running simulation exercises, but their action in the COVID-19 pandemic
has been largely reactive, as has that of the G77.
Regional responses have varied. While there have been differences ofemphasis, countries in the Asia-Pacific regions have applied broadly
similar and rigorous public health measures, supported relatively
Second report on progress by The Independent Panel for Pandemic Preparedness & Response27

consistent messaging, and implemented border closures. Exemplary
leadership has been provided by the Africa Centres for Disease Control
and Prevention, supported by rapidly convened and sustained high-level
political leadership across the continent, with concerted attention to gaps
in response supplies and capacities. The Panel will continue to investigate
how regional responses have had an impact on country outcomes infacing COVID-19.

Major weaknesses in the global supply chain have been
revealed, including the absence of effective frameworks
to ensure equitable access, poor stockpiling, over-relianceon single sources, hoarding, and logistics limitations.
Essential supplies

Major weaknesses in the global supply chain have been revealed,
including the absence of effective frameworks to ensure equitable
access, poor stockpiling, over-reliance on single sources, hoarding andlogistics limitations (it is estimated that by June 2020, only around one
fifth of global demand for personal protective equipment and tests kits
had been met). The United Nations COVID-19 Supply Chain System was awelcome addition to supply modalities for lower-middle-income countries,
accounting for around half of supplies obtained, but it took three months
to become fully operational and roles should have been more clearly
defined and better fitted to the capabilities of the various organizations
responsible for governance and implementation.

Essential supplies, including oxygen, were insufficient in many countries. (Photo: Angela Ponce)

Second report on progress by The Independent Panel for Pandemic Preparedness & Response28

Figure 7: COVID-19 vaccine rollout projections

Source: The Economist Intelligence Unit, January 2021.

Trade and travel restrictions have had a negative impact on the flowof essential commodities but have most likely been helpful in curbing
transmission. The perceived need to balance disease containment against
the counter-veiling desire not to constrain trade and travel is as old as
the history of quarantine itself. A core element of the International HealthRegulations (2005) is to require health events where there is a significant
risk of international travel or trade restrictions to be notified to WHO.
In its wider investigation of the impact of advice issued to countries,
the Panel will pay particular attention to recommendations concerning
travel, alongside its continuing liaison with the Review Committee on thefunctioning of the International Health Regulations (2005) during the
COVID-19 response.

Diagnostics, vaccines and therapeutics

Global institutions, with the support of States and non-State actors, have
rapidly developed platforms for coordinated innovation in the developmentof new tools, particularly diagnostics, vaccines and therapeutics. The
Access to COVID-19 Tools Accelerator (ACT-A) platform has been deployed
rapidly and in largely collaborative fashion among institutions across its
research and development (R&D) acceleration, procurement and market
shaping efforts. Major implementation challenges remain, however,including ensuring equity and the reflection of country and civil society
voices, and operating within weaker institutional arrangements in the
non-vaccine pillars. In addition, the critical funding gap faced by ACT-A
threatens to jeopardize its success and requires urgent resolution.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response29

There are major risks that countries with less capacity and ability to selffinance vaccines and therapeutic advances will be left out. If that transpires,the consequence will be a two-tier world, divided between countries where
COVID-19 is relatively controlled, and those where COVID-19 adds to theoverall burden of disease as yet another ongoing, endemic disease. The
effective flow and access of new diagnostics, therapeutics, and vaccines
to the populations most in need, based on equitable public health criteria,must be the central plank of international co-operative efforts. Equitable
access to and participation in the knowledge economies driving innovation
will be a critical lever of change.

Financing

Pandemic preparedness financing has been treated as a cost rather thanan investment, and as a result has been neither secure nor sustainable.
In relation to response, it appears on preliminary evidence consideredby the Panel that financial mechanisms at the global level were too slow
and uncoordinated to provide the necessary financial support to enoughcountries in a timely fashion to enable them to escalate their responses
and to mitigate pandemic impacts sufficiently.

WHO finds itself required to engage in perpetual
fundraising efforts, to the detriment of its ability
to concentrate on the delivery of its core priorities,
including in pandemic preparedness and response.
There has been a lack of ignition funding and risk capital to accelerate R&D
and manufacturing. Weaknesses in the financing infrastructure also extend
to WHO, which finds itself required to engage in perpetual fundraisingefforts, to the detriment of its ability to concentrate on the delivery of
its core priorities, including in pandemic preparedness and response.

Priorities for the Independent Panel’s continued work
• The Panel will further its understanding of the institutional arrangements
under which the international system exercises its mandates, including
the governance of pandemic preparedness and response, in order
to identify weaknesses and consider ways in which the global healtharchitecture can be optimized.
• The Panel will develop a definition of the functions of the international
system in pandemic preparedness and response, together with anassessment of which actors and mechanisms are needed for the
performance of these functions.
• The Panel will examine models of effective solutions to complex
collective action problems which exist elsewhere in the international
sphere, including in climate change adaptation, environmental
protection and security, and weapons control. Potential avenues toreinforce transparency and compliance with international agreements
Second report on progress by The Independent Panel for Pandemic Preparedness & Response30

will be analysed, including in relation to the International HealthRegulations (2005). The contribution and combination of both Statedriven and grassroots, community-led interventions will be assessed.
• Critical issues still to be examined include the roles and mandatesof the World Health Organization, and the ways in which leadershipand governance functions are exercised to achieve timely and robust
accountability internationally and from Member States. The Panel
will also consider whether clear authority and decision-making canbe exercised by WHO with the necessary speed in the context ofoutbreaks with pandemic potential, and the apparent disconnect
between expectations of the Organization and the manner andquantum of its funding.
• The Panel is reviewing the ecosystems that have evolved to respond to
the needs for essential supplies, as well as for the development of novel
diagnostics, treatments and vaccines. Critical issues to be examined
include whether there is a need for a predefined way of working,including clear roles and responsibilities, to be kept in readiness for the
future. The Panel will analyse carefully the gap between commitments
to equitable distribution and the realities as they have been experienced
in the COVID-19 response.
• The Panel will further review needs for international funding — for what
and by whom, as well as the source of funding, recognizing the need tothink beyond official development assistance when addressing financial
needs for global common goods.

At the height of nationwide and local lockdowns, nearly 1.5 billion schoolchildren were affected by school closures.
(Photo: Rosem Morton)

Second report on progress by The Independent Panel for Pandemic Preparedness & Response31

About the
Independent
Panel

The Independent Panel for Pandemic Preparedness and Response wasestablished by the WHO Director-General in response to World Health Assembly
resolution WHA/73.1 of 19 May 2020 requesting him inter alia to “initiate an
independent, impartial and comprehensive evaluation of the international healthresponse” to COVID-19. In July 2020, the Director-General requested former
Prime Minister of New Zealand, the Right Honourable Helen Clark, and theformer President of Liberia, Her Excellency Ellen Johnson Sirleaf, to be Co-Chairsof the Panel. The Co-Chairs selected 11 distinguished individuals with diverse
backgrounds and experience to comprise the Panel. All are participating in theirpersonal capacities and are not representing any governments or organizations.
The mission of The Independent Panel is to provide an evidence-based path forthe future, grounded in lessons of the present and the past, to ensure countries
and global institutions, including specifically WHO, effectively address healththreats. The Panel has to date held three full meetings, on 17 September 2020,
20–21 October 2020 and 16–17 December 2020. Reports of the Panel’s meetingsand other relevant documents have been published on the Panel’s website(www.TheIndependentPanel.org). Due to the exigencies of the pandemic, and incommon with enterprises and groups across the world, the Panel has conducted
its meetings and consultations virtually.
The areas of concern and key questions specified in World Health Assembly
resolution WHA73.1 provide the basis for the Terms of Reference adopted by
the Panel. The Panel’s Program of Work builds on the Terms of Reference andis organized around four main interconnected themes of enquiry:i. Build on the past: Learn from previous epidemics and pandemics and thestatus of the system and actors pre-COVID-19.
ii. Review the present: Determine an accurate and verified chronology of eventsand activities in relation to the COVID-19 pandemic; analyze recommendations
made by the WHO and responses by national governments.
iii. Understand the impact: Review how health systems and communities
responded, and assess the direct and indirect impacts of both the pandemic
and response measures.
iv. Change for the future: Develop a vision for a strengthened international
system ideally equipped for pandemic preparedness and response including
both the World Health Organization and the international system at large.
In applying the highest standards of quality and rigour in its analysis, the Panelis using a variety of methods to conduct its work including systematic reviewsof published data, mapping and analysis of both academic and policy literature,
in-depth interviews, symposia and expert consultations, commissioned analysis
and selected case studies.
The Panel has established a programme of stakeholder engagement which
includes open information exchanges, interactive discussions, brief opinion
surveys and open invitations for submissions through its website. The Panel isseeking engagement and perspectives from as many stakeholders as possible
in order to share knowledge and draw lessons from around the world. Regularbriefings of Member States are conducted through regional groupings. While theopportunity has been created for submissions and other input to the Panel to bemade confidentially, the Panel continues to be committed to working in a mannerthat is as open and transparent as possible, including by publishing on its website
reports of the Panel meetings and other key progress documents.

Second report on progress by The Independent Panel for Pandemic Preparedness & Response32

Co-Chairs
and members

Co-Chairs
Her Excellency Ellen Johnson Sirleaf
The Right Honorable Helen Clark

Panel Members
Dr Mauricio Cárdenas
Ms Aya Chebbi
The Honorable Mark Dybul, MD
Professor Michel Kazatchkine
Dr Joanne Liu
Ms Precious Matsoso
The Rt Hon David Miliband
Ms Thoraya Obaid
Ms Preeti Sudan
Professor Ernesto Zedillo
Professor Zhong Nanshan

Second report on progress by The Independent Panel for Pandemic Preparedness & Response33

Endnotes

1

Global Preparedness Monitoring Board (2019). A world at risk: annual
report on global preparedness for health emergencies. Geneva: World
Health Organization.

2

United Nations Environment Programme and International Livestock ResearchInstitute (2020). Preventing the Next Pandemic: Zoonotic diseases and how tobreak the chain of transmission. Nairobi, Kenya.

3

GSMA Intelligence. Global mobile trends 2021: navigating Covid-19 andbeyond, December 2020. Available at https://data.gsmaintelligence.com/apiweb/v2/research-file-download?id=58621970&file=141220-Global-MobileTrends.pdf/, accessed 6 January 2021.

4

Secretary-General’s statement to the press, 6 January 2020. Available athttps://www.un.org/sg/en/content/sg/statement/2020-01-06/secretarygenerals-statement-the-press, accessed 6 January 2021.

5

The Panel’s program of work includes determining an accurate
and verified chronology of events and activities in relation to the
COVID-19 pandemic.

6

World Health Organization (2020) ACT-Accelerator Urgent Priorities &Financing Requirements at 10 November 2020. Available at: https://www.who.
int/publications/m/item/urgent-priorities-financing-requirements-at-10november-2020

7

World Health Organization (2020) Pulse survey on continuity of essential
health services during the COVID-19 pandemic. Interim report 27 August 2020.

8

International Organization for Migration. IOM and UNHCR chiefs stressthat COVID-19 underlines the urgent need for universal health coverage, 12
November 2020. Available at https://www.iom.int/news/iom-and-unhcrchiefs-stress-covid-19-underlines-urgent-need-universal-health-coverage,
accessed 6 January 2021.

9

Office of the United Nations High Commissioner for Human Rights. Press
Conference opening statement, 9 December 2020. Available at https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26580,
accessed 6 January 2021.

Design: Michelle Hopgood (hopgoodcreative.com)

Second report on progress by The Independent Panel for Pandemic Preparedness & Response34