Foreword 3

Acknowledgements 4

Executive summary 11

1 Assessment and recommendations 15

  In Brief 16

  1.1. Another pandemic is not a question of if, but when 18

  1.2. Taking stock of the impact of the COVID-19 pandemic on population health, healthcare systems and economies 22

  1.3. Future pandemics will carry a dual toll: Heavy loss of life and deep economic disruptions 24

  1.4. Targeted non-pharmaceutical interventions protect population health and economies in the early days of pandemics 29

  1.5. PPR capacity can be greatly strengthened when NPIs are backed by solid foundations 37

  1.6. Investing in PPR capacities delivers dividends far beyond moments of crisis 41

  1.7. Conclusions 46

  References 46

2 The COVID-19 pandemic could have lingering impacts on population health and the economy 52

  In Brief 53

  2.1. COVID-19 has had an enormous impact on health and societies 55

  2.2. COVID-19 had mixed impacts on lifestyle factors that influence the burden of NCDs 66

  2.3. The OECD SPHeP-NCDs Model is used to assess the lasting impacts of COVID-19 on NCD burden 71

  2.4. Conclusions 77

  References 78

  Annex 2.A. OECD SPHeP NCDs model 92

3 Future pandemics will carry a dual toll: Heavy loss of life and deep economic disruptions 94

  In Brief 95

  3.1. The next pandemic is inevitable – are we prepared? 96

  3.2. Over the last two decades, the global community experienced several large-scale

  pandemics with profound health and economic consequences 98

  3.3. Why only certain pathogens have pandemic potential? 99

  3.4. The OECD SPHeP-PPR model is used to assess the potential health and economic impacts of five pandemic scenarios 106

  3.5. Results 113

  3.6. Conclusions 124

  References 124

  Annex 3.A. Epidemiological factors that contribute to the pandemic potential of pathogens 135

4 Extreme weather events are reshaping the landscape of communicable diseases 139

  In Brief 140

  4.1. Extreme weather events are rising across the globe 141

  4.2. Extreme weather events create new pathways for communicable diseases to emerge, spread and thrive 143

  4.3. Disease surveillance systems can be adapted to consider the rising risks of extreme weather events 153

  4.4. Conclusions 156

  References 156

5 Community-based infection prevention and control measures are the first line of defence during outbreaks 164

  In Brief 165

  5.1. A primer on community-based IPC measures: What are they and why they are important? 166

  5.2. Critical gaps undermine the implementation of community-based IPC measures 168

  5.3. Community-based IPC measures are vital to safeguard population health 173

  5.4. Improving compliance with community-based IPC measures enhances the effectiveness of these interventions over time 181

  5.5. OECD countries can deploy a wide range of policies to promote compliance with community-based IPC measures in the long term 184

  5.6. Conclusions 205

  References 206

  Annex 5.A. List of countries participated in the 2023-2024 OECD Survey on Maintaining Infection Prevention and Control in the Community 217

  Annex 5.B. Community-based IPC Implementation Dashboard 219

  Annex 5.C. List of influenza pandemic preparedness plans from G7 countries included in the OECD analysis 224

  Notes 224

6 Learning from COVID-19 to improve pandemic preparedness indices for future health crises 225

  In Brief 226

  6.1. The importance of pandemic preparedness and response 227

  6.2. A guide to pandemic preparedness and response indices: What they are, how they work and why they matter? 229

  6.3. To what extent did pandemic preparedness and response indices reflect countries’ “performance” during COVID-19? 237

  6.4. The importance of understanding population vulnerability during a pandemic 241

  6.5. Room for development: What can be improved in pandemic preparedness and response indices? 243

  6.6. Conclusions 246

  References 247

  Annex 6.A. The Global Health Security Index (GHSI) utilises open-source data to benchmark a country’s health security capacity 251

  Annex 6.B. The Joint External Evaluation (JEE) measures country-specific status and progress in developing capacity to prevent, detect and rapidly respond to public health threats 253

  Notes 254

7 Targeted non-pharmaceutical interventions play a key role in safeguarding population health and the economy in the early phases of pandemics 255

  In Brief 256

  7.1. Non-pharmaceutical interventions are key to safeguarding population health and the economy in the early days of pandemic outbreaks 257

  7.2. The varied paths of NPI roll-out during the COVID-19 pandemic 258

  7.3. Why do some people follow public health guidelines during pandemics while others ignore them? 269

  7.4. Estimating the health and economic consequences of NPIs 271

  7.5. Results 281

  7.6. Conclusion 292

  References 293

  Annex 7.A. Impact of non-pharmaceutical interventions 302

  Notes 303

8 Investing in pandemic preparedness and response capacities delivers dividends far beyond moments of crisis 304 In Brief 305

  8.1. When pandemics strike, countries with stronger PPR systems are better positioned to respond and safeguard population health and the economy 306

  8.2. The OECD SPHeP Costing Tool is used to quantify the investment requirements for strengthening PPR capacities 310

  8.3. Results 318

  8.4. The OECD analysis broadly aligns with cost estimates generated by previous works 323

  8.5. Conclusions 326

  References 327

  Annex 8.A. PPR investment estimates under different assumptions of start-up PPR capacities 331

  Annex 8.B. The scope of previous works estimating the investment requirements for strengthening PPR capacities 333

9 Strategic stockpiling is key for timely and effective pandemic preparedness and response strategy 334

  In Brief 335

  9.1. Introduction 336

  9.2. Strategic stockpiling is an important short-term buffer for pandemic preparedness and response 337

  9.3. National stockpiling policies vary, but common practical considerations apply 337

  9.4. Regional EU stockpiles are an example of co-ordinated strategic stockpiling 345

  9.5. Stockpiling policies face several challenges 348

  9.6. Conclusions 349

  References 350

  Annex 9.A. Examples from selected countries 355

  Notes 360