Table 1. Key messages for always on approach.

• With a future characterised by increased pandemic threats, there is an unmet need for robust global pathogen surveillance systems. Simultaneously, there is a need for clinical diagnostics that can detect drug-resistant pathogens as part of routine care. • We propose the Always On approach, that looks for synergies between systems aimed at detecting and responding to health emergencies and the provision of routine clinical care and public health services, which could offer economic and system benefits. • While many countries are scaling back pathogen surveillance systems developed during the COVID-19 pandemic, there is an opportunity to sustain this as key health security infrastructure and build towards integrating this with tools that bring sequencing of pathogens closer to the point of patient care.