From preparedness to solidarity reimagining global health security post-COVID-19

Summary box.

• Global health security strategies have traditionally focused on national preparedness, border controls and resource stockpiling, but these measures have repeatedly proven insufficient in the face of pandemics like COVID-19.

• This commentary underscores the critical importance of trust, transparency and solidarity, often overlooked pillars in achieving effective and equitable pandemic responses. It calls for enforceable international commitments and a shift towards collective action.

• By advocating for a solidarity-based framework, this study can inform future policy reforms, guide research priorities and promote more inclusive, cooperative global health practices.

Introduction and the limits of the current preparedness paradigm

The COVID-19 pandemic was not merely a biological event; it was a global stress test that exposed the fault lines in our collective approach to health security. In Wuhan, the first clusters of severe pneumonia were met with confusion and fear, but few could have anticipated that these early cases would soon snowball into a crisis that would touch every nation, upend daily life and claim millions of lives worldwide. As the virus leapt from city to city, country to country, the world witnessed not only the devastation by a novel pathogen but also the unravelling of the systems and strategies we had painstakingly built to protect ourselves.

Despite decades of warnings about the inevitability of pandemics and the existence of global frameworks like the International Health Regulations (IHR), the response to COVID-19 was marked more by fragmentation than unity. The pandemic revealed the limits of a preparedness paradigm that has long prioritised national stockpiles, border controls and self-sufficiency. While these measures were not without merit, they proved woefully insufficient in the face of a threat that respected no borders and exploited every weakness in our interconnected world.

A closer examination of prevailing preparedness models reveals a troubling pattern of reactive, inward-looking policies. In the early months of 2020, countries rushed to close their borders, hoard personal protective equipment (PPE) and secure vaccine contracts for their own populations. National governments invoked emergency powers, sometimes at the expense of transparency and civil liberties, and the global health community watched as the principles of international cooperation frayed under the pressure of urgent self-preservation.

The shortcomings of this approach were clearly evident. Border closures, while politically popular, failed to halt the spread of the virus; SARS-CoV-2 had already seeded itself globally before most travel restrictions took effect. Studies have shown that travel bans, especially when implemented late, only modestly delayed but did not prevent the international dissemination of COVID-19.¹ Meanwhile, the scramble for PPE and ventilators led to fierce competition between countries, with wealthier nations often outbidding poorer ones and leaving frontline workers in low-resource settings dangerously exposed.²

Perhaps most tellingly, the focus on national preparedness did little to address the profound disparities in health outcomes both within and between countries. The USA and the UK, both ranked highly on the Global Health Security Index prior to the pandemic, suffered some of the highest per capita death rates in the world.³ This paradox underscores a critical flaw: preparedness on paper does not necessarily translate into effective, equitable action in practice.

The failures of the current paradigm are not merely technical; they are moral. By prioritising national interests over global solidarity, the world allowed preventable suffering to proliferate. The pandemic showed the limits of a system that values stockpiles over sharing and self-sufficiency over mutual aid. It is clear, in retrospect, that no country can truly be prepared in isolation. Health security, in an age of pandemics, is a collective endeavour.

As we reflect on these lessons, it becomes evident that the next pandemic demands more than a return to business as usual. The time has come to move beyond the narrow confines of preparedness and embrace a model of global health security rooted in trust, transparency and solidarity. Only by reimagining our approach by shifting from preparedness to partnership can we hope to build a safer, more equitable future for all.

The missing pillars: trust, transparency and solidarity; lessons learned

The failures of the COVID-19 response were not merely operational; they were rooted in the absence of trust, transparency and solidarity. These three pillars, often relegated to the periphery of technical preparedness discussions, proved to be the true pillars of effective global health security. While the importance of trust, transparency and solidarity is widely acknowledged, operationalising these principles requires concrete actions. Building trust involves consistent, culturally sensitive public health messaging and the establishment of feedback mechanisms that allow communities to voice concerns and shape responses. Transparency can be enhanced through standardised data sharing protocols, open-access scientific platforms and independent audits of resource allocation. Solidarity must be reflected not only in rhetoric but in binding commitments to share resources, technology and knowledge, particularly with low- and middle-income countries (LMICs). These actions, taken together, can help transform aspirational values into effective practice.

Trust emerged as both a fragile asset and a powerful determinant of pandemic outcomes. Across the globe, public trust in health authorities and government institutions shaped community compliance with public health measures. In countries where trust was high, such as New Zealand and South Korea, populations largely adhered to guidelines on masking, social distancing and vaccination, resulting in lower transmission rates and better health outcomes.^{4 5} Conversely, in settings where trust was undermined by inconsistent messaging, politicisation or historical grievances, misinformation flourished and compliance faltered. The USA, for example, saw notable resistance to mask mandates and vaccines, fuelled in part by polarised political discourse and a legacy of health inequities.⁶ The erosion of trust had tangible consequences: higher case numbers, avoidable deaths and prolonged societal disruption.

Transparency was another casualty of the pandemic, with grave implications for timely and effective response. Early in the outbreak, delays in reporting cases and sharing genetic sequences of the virus hampered the global community’s ability to mount a coordinated defence.⁷ Even as the pandemic progressed, some governments withheld or manipulated data for political reasons, obscuring the true scale of the crisis and undermining international efforts to allocate resources where they were needed most. Conversely, countries that embraced transparency, such as Iceland, which rapidly sequenced and published viral genomes, enabled scientists worldwide to track the evolution of the virus and adapt public health strategies accordingly.⁸ The lesson is clear: transparency is not a luxury but a necessity for global health security.

Solidarity, perhaps the most aspirational of the three pillars, was also the most elusive. The ideal of coordinated, collective action was quickly tested by the realities of vaccine nationalism and resource hoarding. The persistent failure to translate calls for solidarity into meaningful action is rooted in deep-seated structural barriers. Power asymmetries between high-income and low- and middle-income countries, the influence of pharmaceutical companies over intellectual property and distribution and the lack of enforceable international legal mechanisms all contribute to the perpetuation of inequity. Without addressing these systemic obstacles, efforts to achieve equitable resource allocation and global solidarity will continue to fall short. Despite early rhetoric about ‘leaving no one behind’, high-income countries secured the lion’s share of vaccine doses through advance purchase agreements, leaving LMICs to wait months, or even years, for access.⁹ For example, the COVAX initiative, while initially ambitious in its goal to ensure equitable vaccine distribution, was hampered by insufficient funding, supply shortages and lack of binding commitments from wealthier nations.¹⁰ In contrast, Africa Centres for Disease Control (CDC) pooled procurement mechanism enabled African nations to collectively negotiate for diagnostics and vaccines, improving access and bargaining power despite global shortages.

These failures were not limited to vaccines. Supply chain fragility became a defining feature of the pandemic, as global disruptions led to shortages of everything from swabs and test kits to oxygen and essential medicines. The just-in-time supply model, optimised for efficiency rather than resilience, crumbled under the weight of surging demand and export restrictions.¹¹ LMICs, often at the end of the supply chain, were hit hardest, with devastating consequences for both COVID-19 and non-COVID-19 care.

Data sharing was both a bright spot and a cautionary narrative. On one hand, the unprecedented speed of SARS-CoV-2 genome sequencing and the open sharing of data enabled rapid development of diagnostics, vaccines and therapeutics.¹² On the other hand, uneven reporting, lack of standardisation and geopolitical tensions hindered real-time surveillance and response, especially as new variants emerged. The Omicron variant, for example, was first reported by scientists in South Africa, who faced travel bans and stigmatisation rather than support and collaboration.¹³

The lessons are sobering but instructive. Health security cannot be achieved through technical preparedness alone; it requires a foundation of trust, a commitment to transparency and a spirit of solidarity that transcends borders and self-interest. The pandemic has shown us what happens when these pillars are weak or absent. The challenge now is to build them into the very fabric of our global health architecture.

Path forward: a new framework for global health security

If the COVID-19 pandemic has taught us anything, it is that our current approach to global health security is not only inadequate but fundamentally misaligned with the realities of an interconnected world. The next pandemic, inevitable though it may be, demands a complete reimagining of our collective response, one that moves beyond the rhetoric of preparedness and embraces the practicalities of solidarity and mutual aid.

A new framework for global health security must begin by institutionalising solidarity as a core operational principle, not merely an aspirational value. This means embedding equity and shared responsibility into the very mechanisms that govern pandemic preparedness and response. International agreements must go beyond non-binding declarations and become enforceable commitments, ensuring that resources, whether vaccines, diagnostics or therapeutics, are allocated based on need rather than purchasing power. The concept of ‘pandemic commons’ should be explored, where critical medical technologies and knowledge are treated as global public goods, accessible to all, regardless of geography or income.¹⁴ Recent policy developments, such as the ongoing negotiations for a WHO Pandemic Accord and the strengthening of regional organisations like the Africa CDC and prevention underscore a growing recognition of the need for collective action. As of June 2024, negotiations on the WHO Pandemic Accord have advanced notably, with member states reaching consensus on several key provisions, including commitments to equitable resource sharing, transparent data reporting and the establishment of a global pandemic response fund. However, some contentious issues remain, such as intellectual property rights and the scope of WHO’s enforcement authority. The Accord is expected to be finalised at the next World Health Assembly, signalling a major step forward in institutionalising solidarity and accountability in global health governance. Similarly, Africa CDC’s leadership in pooled procurement and regional manufacturing during COVID-19 demonstrates the potential of regional bodies to complement and reinforce global frameworks.

Central to this vision is the strengthening of global governance. The WHO, despite its pivotal role, was hamstrung by limited authority and resources during COVID-19. Future frameworks must empower WHO or a reimagined global health body with the mandate and capacity to coordinate and enforce pandemic response measures. This could include the authority to trigger automatic resource mobilisation, oversee equitable distribution and monitor compliance with IHR. Such a body must be shielded from political interference and supported by sustainable, predictable funding from member states.¹⁵ Implementing this new framework will require resilience in the face of shifting political landscapes and funding uncertainties. For example, the impact of the US administration’s withdrawal of funding from WHO during the Trump era underscored the vulnerability of global health institutions to political decisions by major donors. To safeguard against such disruptions, the framework should prioritise diversified and sustainable financing mechanisms, such as multidonor trust funds, assessed contributions from all member states and innovative financing tools (eg, pandemic bonds). This approach would reduce reliance on any single country and help ensure the continuity and independence of global health operations, even during periods of geopolitical tension.

Integrated surveillance systems are another non-negotiable element of a resilient global health security architecture. The pandemic highlighted the necessity of real-time, transparent data sharing not just of case numbers but also of genomic, epidemiological and supply chain data. A new framework should mandate the creation of interoperable surveillance networks, governed by clear standards for data privacy and sovereignty, but with mechanisms to ensure timely sharing in the interest of global health. Investment in regional surveillance hubs and capacity building, particularly in LMICs, would not only improve early warning systems but also foster trust and reciprocity among nations.¹¹

Equally crucial is the development of resilient, cooperative supply chains. The just-in-time model must be replaced by a just-in-case approach, emphasising redundancy, regional manufacturing and pooled procurement. This means incentivising the establishment of regional production hubs for vaccines, diagnostics and essential medicines, as well as creating global stockpiles managed by international bodies rather than individual countries. Such measures would help buffer vulnerable populations from the shocks of export bans and market competition, ensuring that lifesaving resources reach those in need when they are needed most.¹¹

Finally, equity must be at the heart of all preparedness and response plans. This requires not only fair allocation of resources but also the inclusion of marginalised and vulnerable populations in decision-making processes. Community engagement, participatory governance and the dismantling of structural barriers to care are essential to ensuring that no one is left behind. The pandemic has shown that health security is indivisible; as long as one population remains at risk, all are vulnerable. A critical element of this framework is the meaningful inclusion of civil society organisations (CSOs) in decision-making processes. This can be achieved by establishing formal mechanisms for CSO representation within international pandemic governance bodies, such as dedicated seats on advisory panels, transparent public consultations and participatory policy-making forums. Furthermore, CSOs should be empowered to hold governments and international agencies accountable through independent monitoring and reporting functions. By embedding CSO participation into the governance structure, the framework can better reflect the needs and perspectives of marginalised populations and strengthen accountability at all levels.

Implementing such a framework will not be easy. It will require difficult conversations about sovereignty, resource sharing and the balance between national interests and global good. But the alternative, a return to the fractured, self-interested approach of the past, is simply untenable. The world cannot afford to repeat the mistakes of COVID-19. The next pandemic will test not only our scientific and logistical capabilities but also our willingness to act as a global community. In this moment, we are presented with a rare opportunity: to turn the hard-won lessons of COVID-19 into lasting change. By reimagining global health security as a project of solidarity, transparency and trust, we can build a future in which preparedness is not the privilege of the few but the shared responsibility of all.

Achieving a solidarity-based global health security framework will require not only political will but also robust institutional reforms. By ensuring sustainable financing, empowering CSOs and operationalising the core principles of trust, transparency and solidarity, the global community can build a more resilient and equitable system for future pandemics.

To operationalise this new framework, policymakers should prioritise negotiating binding international agreements with clear enforcement mechanisms. Investing in regional manufacturing and surveillance hubs, particularly in LMICs. Engaging civil society organisations to ensure accountability and inclusion. Supporting open-access platforms for data and knowledge sharing. Establishing global financing mechanisms to guarantee equitable access to countermeasures during future pandemics.

Conclusion

The COVID-19 pandemic has left an indelible mark on the global psyche, serving as both a tragedy and a clarion call for change. As the world slowly recovers, the temptation to return to old habits, national stockpiling, border closures and inward-looking preparedness is strong. Yet, if we yield to this impulse, we risk not only repeating past mistakes but also deepening the inequities and vulnerabilities that the pandemic so brutally exposed.

The path forward demands courage and imagination. It requires us to recognise that pandemics are not isolated events but the inevitable consequence of our interconnectedness socially, economically and ecologically. In this context, health security cannot be achieved in silos. The safety of one nation is inextricably linked to the safety of all. The virus does not distinguish between rich and poor, north and south or east and west; our response must be equally blind to these divisions.

Crucially, the next generation of pandemic preparedness must be built on the pillars of trust, transparency and solidarity. Trust must be nurtured not only between governments and citizens but also among nations. This means honest communication, consistent public health messaging and a willingness to admit and learn from mistakes. Transparency must become the norm, with open sharing of data, resources and scientific knowledge. And solidarity must move from rhetoric to reality, underpinned by enforceable agreements, equitable resource allocation and a shared commitment to leaving no one behind.

This vision is ambitious, but it is not utopian. The collective scientific achievements of the COVID-19 era, rapid vaccine development, unprecedented data sharing and global collaboration demonstrate what is possible when humanity acts together. The challenge now is to harness this spirit of cooperation and embed it in the structures and norms that will shape our response to future threats.

Reimagining global health security will not be easy. It will require confronting uncomfortable truths about power, privilege and responsibility. It will demand investment, innovation and above all, political will. But the cost of inaction is far greater: more lives lost, more livelihoods destroyed and more opportunities squandered.

The world stands at a crossroads. We can choose to retreat into the false comfort of self-sufficiency or we can embrace the hard work of building a truly global system of health security, one that is resilient, equitable and just. The lessons of COVID-19 are clear. Let us heed them, not with words, but with action.

The global health community must seize this moment to move from aspirational rhetoric to concrete, enforceable commitments. By embedding solidarity, transparency and trust into the foundations of global health governance, we can transform the lessons of COVID-19 into lasting, systemic change that benefits all.

Data availability statement

Not applicable.