Millions could still be left exposed in the next health crisis if governments prepare plans without testing whether ordinary people can actually use them
When a pandemic hits, the instructions can sound simple: stay home, get vaccinated, seek medical help and follow health advice.
- A plan on paper is not enough
- Who gets the vaccine can be as important as how fast it is made
- Africa has already seen the cost of being at the back of the queue
- The first line of defence is often the community
- Trust must be built before the emergency
- Six changes the Commission wants governments to make
- The bigger development issue
For many people, however, it is not that simple.
A market trader who stops working may lose the day’s income. A family living in a single room may have nowhere to isolate a sick relative. Someone without the right identification papers may struggle to access government support. And health advice delivered in a language people do not understand may never reach those who need it.
These are the practical problems that can decide who gets protected and who is left behind when a health emergency strikes.
A new report from The NUS-Lancet PRIME Commission says governments need to confront these realities before the next pandemic.
The Commission studied experiences in 20 countries and found a recurring gap between what governments planned to provide and what people could actually access when health systems came under pressure.
The groups most likely to fall through these gaps included older people, migrants, informal workers, people with disabilities and communities facing discrimination.
The Commission’s message is blunt: the problem is not necessarily that some people are inherently vulnerable. In many cases, the systems around them create the vulnerability.
“What the PRIME Commission found is that people themselves aren’t ‘vulnerable’, but rather, that systems create vulnerability,” said Professor Helena Legido-Quigley, Co-Chair of the Commission.
That finding matters to developing countries where access to healthcare and public services can depend heavily on income, location, employment, documentation and the ability to understand official information.
A plan on paper is not enough
The NUS-Lancet PRIME Commission was established by the National University of Singapore and The Lancet in 2023, following the COVID-19 pandemic, which was associated with about 22 million excess deaths.
Its 41 experts from health, finance and planning backgrounds examined what happened when countries were forced to put their pandemic systems to the test.
The conclusion was that having a plan does not necessarily mean being ready.
Countries may have emergency protocols, laboratories, trained health workers and supplies. But those capabilities can still fail to protect people when demand rises sharply and normal systems come under pressure.
“Most countries had pandemic plans, but these were not tested to be sure they would work for everyone under pressure,” said Right Honourable Helen Clark, Co-Chair of the Commission.
The Commission wants countries to move from simply preparing for a pandemic to what it calls 360° readiness.
That means asking practical questions before a crisis: Can people reach health services? Can they understand the information? Can they afford to stop working? Can emergency assistance reach them? Can health workers identify those at greatest risk? And do people trust the institutions giving them instructions?
Dr Sara Calderón-Larrañaga, first co-author of the Commission, put it simply: “A pandemic plan is only as strong as the systems behind it.”
Who gets the vaccine can be as important as how fast it is made
The Commission’s modelling of a hypothetical influenza A pandemic shows why access matters.
It compared different approaches to vaccine development and distribution.
Fast-tracking vaccine development could cut deaths from 58.5 million to 23.9 million, a reduction of 59 percent, even if richer countries received vaccines first.
But a fairer distribution based on population rather than purchasing power could save another 2.7 million lives, particularly in middle-income countries.
Restoring public confidence in vaccines could save a further 1.9 million lives.
The numbers make an important point.
The next pandemic will not be a contest between science and disease alone. The way vaccines are distributed, the speed at which they reach different populations and the level of public trust could all affect the death toll.
“The influenza pandemic modelling findings unequivocally show that while the status quo will protect many lives, a more equitable approach to vaccine distribution will save millions more,” Professor Legido-Quigley said.
For countries with limited purchasing power, the issue is particularly important. During COVID-19, access to vaccines exposed sharp differences between countries that could secure supplies quickly and those that had to wait.
Africa has already seen the cost of being at the back of the queue
Reacting to the new findings , Dr Githinji Gitahi, Global CEO of Amref Health Africa, said the Commission’s findings should resonate strongly across the continent.
“Africa’s experience of COVID-19, as well as repeated outbreaks of mpox and Ebola teach us that when countries retreat into self-interest during a health emergency, everyone ultimately pays the price,” he said.
During COVID-19, African countries were left at the back of the queue for vaccines, he said, leaving millions exposed and weakening the global response.
The experience showed that vaccine inequality is not simply an African problem.
If a disease continues spreading in one part of the world, it can continue to create risks elsewhere.
Dr Gitahi said the Commission’s estimate that fairer vaccine sharing could save an additional 2.7 million lives in a future pandemic should therefore not be treated as an abstract statistic.“
The real measure of preparedness will not be how quickly the richest countries can protect themselves, but how quickly the world can protect everyone,” he said.
The first line of defence is often the community
The report also puts communities at the centre of pandemic readiness.
That is particularly relevant in Africa, where local health workers, traditional and community leaders and other trusted figures often become the first source of information during an outbreak.
Dr Gitahi said outbreaks do not begin in government conference rooms. They are first experienced in homes, villages, markets and neighbourhoods.
He pointed to Ebola outbreaks in Uganda and the Democratic Republic of the Congo, COVID-19 responses across Africa and Marburg virus disease in Tanzania as examples where trusted local health workers and community leaders have helped communities respond to health threats.
“Communities are the frontline of preparedness,” he said.
That frontline, however, needs investment.
A community health worker cannot build trust without the training, equipment and support needed to do the job. A local health authority cannot maintain confidence if it does not listen to the people it serves.
And a national pandemic plan can quickly lose relevance if it ignores how people actually live.
Trust must be built before the emergency
One of the report’s strongest warnings is about public trust.
During an outbreak, governments may need people to change their behaviour quickly, seek treatment, accept vaccines where appropriate and follow public health measures.
But trust cannot be switched on when the emergency begins.
It has to be built beforehand.
Dr Gitahi said health systems need to listen to communities, respond to everyday needs and involve people in decisions.
“Trust cannot be improvised once an outbreak has begun,” he said.
That means investment in community health systems should not be viewed simply as routine healthcare spending. It is also an investment in the country’s ability to respond when something goes wrong.
Properly trained community health workers, functioning local health services and established relationships between communities and health authorities can provide a foundation for a faster response.
“When communities help shape health systems before an emergency, the trust, relationships and infrastructure needed for an effective response are already in place when a crisis arrives,” Dr Gitahi said.
Six changes the Commission wants governments to make
The Commission has distilled its findings into six calls for action.
Move from preparedness to 360° readiness. Governments should test whether their plans and systems work under pressure, rather than assuming they will.
Give communities a formal role. People who will live through a health emergency should have a say in how response systems are designed.
Cooperate across borders. Countries need stronger arrangements for sharing vaccines and other medical tools during global health emergencies.
Fix the systems that create vulnerability. Governments should tackle barriers such as poor housing, weak social protection, lack of documentation and inaccessible information.
Build trust before a crisis. Public confidence has to be earned through consistent engagement and reliable health services.
Make governments accountable for protection. Pandemic plans should be judged by whether they protect people in practice, not simply whether the documents exist.
The bigger development issue
The report ultimately reaches beyond pandemics.
A person who cannot access health information during an outbreak may also struggle to access other public services.
A family that cannot isolate because of poor housing faces the same housing problem whether there is a pandemic or not.
An informal worker who cannot afford to stop working during an outbreak is also vulnerable to the absence of adequate social protection in normal times.
That is why pandemic readiness is closely tied to development.
It is about the strength of public health systems, the reach of social protection, the quality of communication, the availability of decent housing and the relationship between governments and the communities they serve.
For Ghana and other African countries, the question is not only whether another pandemic will come.
It is whether the systems built today will still work when it does.
The PRIME Commission’s answer is to test those systems now, involve communities in building them and make sure protection does not depend on a person’s income, location, documentation or social position.
As Helen Clark, also a former Prime Minister of New Zealand, put it, governments have a responsibility to protect all their citizens and residents.
The real test of that responsibility will come when the next crisis puts those systems under pressure.
