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Since its establishment in 1997, the US Department of Defense (DoD) Global Emerging Infections Surveillance (GEIS) program has provided support for infectious disease pandemic preparedness and response. The GEIS program has shown the value of having a central hub responsible for coordinating a global network of DoD laboratories that conduct surveillance for militarily relevant infectious disease threats. The program has supported the establishment and maintenance of capabilities for collecting, characterizing, and reporting on major infectious disease events, including the COVID-19 pandemic and mpox outbreak. The GEIS program enables the US government to mitigate infectious disease threats to DoD mission readiness and to effectively respond to pathogens worldwide. Continued investment in maintaining the GEIS program and its network is critical for timely detection and response to future emerging infectious disease threats in various populations within locations where gaps in US government or host-nation surveillance might exist.

Project NextGen plans to support trials assessing the safety, efficacy, and immunogenicity of experimental Covid-19 vaccines. New platforms could also enable a rapid response to future health threats.

Preparing for the Next PandemicA few key measures could help the global health community support and expand regulatory capacity during public health emergencies, ensuring more equitable access to essential medicines.

Pandemic preparedness has gained increased significance in public health following the COVID-19 pandemic. Traditionally, it has been assessed from an internal organizational perspective, focusing on health sector readiness and addressing shortcomings. However, this perspective often overlooks the public’s perception of preparedness and its influence on behaviors within the healthcare sector. This study investigates how public views on pandemic preparedness shape attitudes, behaviors, and the image of the healthcare industry, which are critical in determining how individuals interact with health entities and respond to public health advice during a pandemic. To explore this, a set of hypotheses linking pandemic preparedness with health service quality, attitudes, and healthcare image was formulated. An online survey conducted in Türkiye gathered 322 responses. Hypothesis testing was performed using Structural Equation Modeling. The findings suggest that pandemic preparedness significantly impacts health service quality, public attitudes, and the image of the healthcare system during pandemic conditions. These results highlight the need to consider public perceptions of preparedness and their effects on behavior. Proactive communication strategies and public involvement in preparedness planning are essential for fostering a collective and informed response to the challenges posed by pandemics.

Public health measures were decisive in controlling the SARS epidemic in 2003. Isolation is the separation of ill persons from non-infected persons. Quarantine is movement restriction, often with fever surveillance, of contacts when it is not evident whether they have been infected but are not yet symptomatic or have not been infected. Community containment includes measures that range from increasing social distancing to community-wide quarantine. Whether these measures will be sufficient to control 2019-nCoV depends on addressing some unanswered questions.

Background WHO postulates the application of adaptive design features in the global clinical trial ecosystem. However, the adaptive platform trial (APT) methodology has not been widely adopted in clinical research on vaccines. Methods The VACCELERATE Consortium organized a two-day workshop to discuss the applicability of APT methodology in vaccine trials under non-pandemic as well as pandemic conditions. Core aspects of the discussions are summarized in this article. Results An “ever-warm” APT appears ideally suited to improve efficiency and speed of vaccine research. Continuous learning based on accumulating APT trial data allows for pre-planned adaptations during its course. Given the relative design complexity, alignment of all stakeholders at all stages of an APT is central. Vaccine trial modelling is crucial, both before and in a pandemic emergency. Various inferential paradigms are possible (frequentist, likelihood, or Bayesian). The focus in the interpandemic interval may be on research gaps left by industry trials. For activation in emergency, template Disease X protocols of syndromal design for pathogens yet unknown need to be stockpiled and updated regularly. Governance of a vaccine APT should be fully integrated into supranational pandemic response mechanisms. Discussion A broad range of adaptive features can be applied in platform trials on vaccines. Faster knowledge generation comes with increased complexity of trial design. Design complexity should not preclude simple execution at trial sites. Continuously generated evidence represents a return on investment that will garner societal support for sustainable funding. Adaptive design features will naturally find their way into platform trials on vaccines.

This is the first published study examining whether, and to what degree, innovative financing could effectively support the financing needs of the global pandemic prevention, preparedness and response (PPPR) agenda. Background: What is already known? In the context of global health, innovative financing encompasses a range of financial instruments that supplement international development assistance and other traditional sources of financing, with the intention of mobilising additional resources and channelling them more effectively. Examples including Advance Market Commitments (AMCs), Advance Purchase Commitments (APCs), vaccine bonds and pandemic bonds, have been used in the past to address major disease outbreaks, such as the Ebola and Covid-19 crises. Following the Covid-19 outbreak, innovative financing has been proposed as a major vehicle to fund PPPR. Results: What are the new findings? Despite recent pronouncements that innovative financing has ‘huge untapped potential’ for PPPR, there is little evidence within the literature to support such claims. This has been confirmed by our examination of four innovative financing mechanisms and their historical use in response to disease outbreaks. Our findings suggest that flaws and trade-offs in the design and application of these mechanisms have resulted in failure to deliver on their promise, raising concerns regarding their prospective use in financing PPPR. Although innovative financing could play a role, existing mechanisms in health have not generated the scale of funds proposed. In addition, the amounts generated have historically focused on specific interventions, which threaten to enhance fragmentation (disjointed financing of health) and alignment failures (not well integrated within overall national strategic plans) with and within PPPR. Conclusions: What do the new findings imply? Our findings reveal a set of innovative financing tools shrouded in unsubstantiated claims to success and effectiveness that look to have underwhelming promise of ‘value for money’ in global health. This stems from evidence suggesting design flaws, inadequate application, lack of transparency, private sector profiteering and associated opportunity costs. Thus, contrary to popular claims, they may not be the ‘silver bullet’ for bridging PPPR financing gaps and addressing costly, complex and multifaceted PPPR interventions.

Open spaces on campus offer various opportunities for students. However, the coronavirus disease (COVID-19) pandemic has affected students’ comfort when occupying open spaces on campus. The purpose of this study is to investigate possible spatial adaptation strategies for safe campus open spaces during the COVID-19 pandemic. For this research, a case study was conducted using a mixed methodology with behavioral mapping that investigated students’ perceptions at Korea University, Seoul, Korea. A qualitative approach was first conducted with behavioral mapping; the results show that despite some behavioral and spatial changes, people still occupy open spaces on campus for various meaningful activities. A quantitative approach with structural equation modeling (SEM) was also conducted to understand the required spatial modifications to improve the safety of open spaces on campus. The positive correlation between (i) social distancing measures, (ii) health protocols, and (iii) accessibility and occupational comfort with (iv) individuals’ fear of COVID-19 as a positive moderation are the four hypotheses proposed in this study. The results suggest that social distancing measures have no correlation with occupational comfort, while accessibility has the largest positive correlation. Suggestions are presented for providing accessible and equally distributed open spaces on campus to avoid overcrowding. Spatial health protocols are also found to positively correlate with occupational comfort, and the perception of the severity of COVID-19 strengthens this correlation. Tangible physical measures to prevent the spread of the virus are necessary to improve students’ sense of comfort and safety in open spaces on campus.

Introduction Emerging and re-emerging infectious diseases continue to pose a severe threat to public health in Sub-Saharan Africa (SSA) and globally. Community-related interventions, such as community e-Health literacy, can contribute to the preparedness to respond effectively to emerging and re-emerging infectious diseases. This study investigated the relationship between e-Health literacy and SSA countries’ perceptions of the importance of readiness for potential pandemics. Method This cross-sectional study was conducted in sub-Saharan African countries (Nigeria, Rwanda, Burundi, and South Africa) among adults aged 18 years and above between July 2020 and August 2021, respondents were recruited through a non-probability sampling technique. Participants were asked to self-report the perceived importance of 13 items on future pandemic preparedness scored on a 5 Likert-point scale. The four key dimensions of pandemic preparedness were online medical consultation, online courses, messaging for healthcare, and shopping. E-Health literacy was the key exposure. The questionnaire was adapted from a previously validated e-Health literacy scale. Data was collected through a self-administered questionnaire online. Data analysis was done using Stata and descriptive statistics including frequency, proportions, means, and standard deviation were used to summarize variables. Inferential statistics including chi-square and logistic regressions were used to test the significance of association between e-health literacy and pandemic preparedness setting the level of significance at 5%. Results A total of 1295 people participated in this study. Roughly half of all participants, 685 (52.90%), were aged between 18 and 29 and 685 (52.90%) were females. The standardised average (SE) e-Health literacy score was 29.55 (0.19). Shopping was perceived as the most important dimension of pandemic preparedness across participating countries (mean (SE) of 3.32 (0.06) and above across all countries for online shopping), while online medical consultation was the least perceived as important (mean (SE) of 2.88 (0.08) or less in two countries for instant health advice from chatbot). In the fully adjusted model, e-Health literacy was associated with 8 out of 13 items of the perceived importance of the pandemic preparedness questionnaire. Those include online consultation with doctors (OR = 1.11, 95% CI 1.02–1.21), telephone health advice (OR = 1.07, 95%CI 1.00–1.15), medicine delivery (OR = 1.04, 95% CI 1.03–1.06), getting medicine prescribed in a hospital visit/follow-up in a community pharmacy (OR = 1.07, 95% CI 1.05–1.10), receiving health information via email (OR = 1.08, 95% CI 1.01–1.17) and via social media (OR = 1.08, 95% CI 1.03–1.14), online shopping (OR = 1.07, 95% CI 1.03–1.11) and instant streaming courses (OR = 1.09, 95% CI 1.02–1.16). Conclusions The higher e-Health literacy scores were associated with a higher perception of most elements as important in future pandemic readiness. Strengthening e-Health literacy can be a key element of the preparation for pandemics in SSA countries.

Background Covid-19 has reinforced health and economic cases for investing in pandemic preparedness and response (PPR). The World Bank and World Health Organization (WHO) propose that low- and middle-income governments and donor countries should invest $31.1 billion each year for PPR. We analyse, based on the projected economic growth of countries between 2022 and 2027, how likely it is that low- and middle-income country governments and donors can mobilize the estimated funding. Methods We modelled trends in economic growth to project domestic health spending by low- and middle-income governments and official development assistance (ODA) by donors for years 2022 to 2027. We modelled two scenarios for countries and donors – a constant and an optimistic scenario. Under the constant scenario we assume that countries and donors continue to dedicate the same proportion of their health spending and ODA as a share of gross domestic product (GDP) and gross national income (GNI), respectively, as they did during baseline (the latest year for which data are available). In the optimistic scenario, we assume a yearly increase of 2.5% in health spending as a share of GDP for countries and ODA as a share of GNI for donors. Findings Our analysis shows that low-income countries would need to invest on average 37%, lower-middle income countries 9%, and upper-middle income countries 1%, of their total health spending on PPR each year under the constant scenario to meet the World Bank WHO targets. Donors would need to allocate on average 8% of their total ODA across all sectors to PPR each year to meet their target. Conclusions The World Bank WHO targets for PPR will not be met unless low- and middle-income governments and donors spend a much higher share of their funding on PPR. Even under optimistic growth scenarios, low-income and lower-middle income countries will require increased support from global health donors. The donor target cannot be met using the yearly increase in ODA under any scenario. If the country and donor targets are not met, the highest-impact health security measures need to be prioritized for funding. Alternative sources of PPR financing could include global taxation (e.g., on financial transactions, carbon, or airline flights), cancelling debt, and addressing illicit financial flows. There is also a need for continued work on estimating current PPR costs and funding requirements in order to arrive at more enduring and reliable estimates.