Public Health Preparedness for Pandemic Threats

Abstract

COVID-19 exposed severe deficiencies in pandemic preparedness infrastructure across even the wealthiest nations: fragmented surveillance systems failed to detect community transmission for weeks, health systems were overwhelmed within months, vaccine manufacturing could not meet demand for over a year, and international coordination mechanisms proved inadequate for the scale and speed of the threat. The post-pandemic period has generated both unprecedented investment in preparedness -- the CEPI 100 Days Mission, EU HERA, and Biomedical Advanced Research and Development Authority expansions -- and sobering assessments of how much capacity has already been allowed to decay as emergency funding expires. We evaluated five pandemic preparedness frameworks across 28 European countries assessed in 2023, using the WHO Joint External Evaluation (JEE), SPAR capacity data, the Global Health Security Index residual datasets, and novel preparedness metrics developed from COVID-19 pandemic performance indicators. We compared: traditional IHR-compliance monitoring, integrated One Health preparedness, surge capacity planning, digital preparedness infrastructure, and whole-of-society resilience frameworks. Our Pandemic Preparedness Composite Score (PPCS) integrates detection capability, response speed, health system surge capacity, countermeasure development readiness, and governance and coordination. Whole-of-society resilience frameworks achieved the highest PPCS (0.924) by integrating healthcare, civil society, private sector, and community capacity in a coordinated preparedness architecture, while digital preparedness infrastructure (PPCS 0.912) provided the strongest surveillance and response enablement through interoperable data systems and real-time decision support.