To better prepare for the next pandemic, or even better, to prevent it, WHO is launching an initiative to help countries ensure they have the systems and capacities in place to speed up every aspect of their management of emerging threats, from response and recovery.
The Preparedness and Resilience for Emerging Threats initiative, or PRET for short, is launching first with a focus on respiratory pathogens.
On 24-26 April, WHO will host a global meeting on PRET to usher in the new era of pandemic preparedness and initial focus on respiratory pathogen pandemic preparedness. Expected outputs from the meeting include a global Call to Action and a global roadmap for implementation.
PRET’s new approach
PRET focuses on improving pandemic preparedness for groups of pathogens based on their mode of transmission. It recognizes that there are three tiers of systems and capacities relevant for pandemic preparedness: those that are cross-cutting for all or multi-hazards, those that are relevant for groups of pathogens (respiratory, arboviruses etc.), and those that are specific to a pathogen.
The aim is to strengthen existing systems and capacities, and to fill gaps. This approach avoids siloes, promotes coherence and efficiency, and helps streamline actions at the time of a pandemic.
With the ever-present risk of an influenza or other respiratory pathogen pandemic, PRET’s first module looks at pandemic preparedness for respiratory pathogens. PRET will develop more modules for other pathogen groups as we move forward. Each module is intended to be a living document so that new learnings and innovations are incorporated over time.
PRET fits in the broader context
As a technical initiative, PRET strengthens pandemic preparedness for groups of pathogens in line with World Health Assembly resolutions 58.5, 74.7 and 75.7. These resolutions call for WHO to provide technical guidance and support to strengthen preparedness and response. A One Health lens is applied in PRET recognizing that most new pathogens originate first in animals, and that preventing, preparing and responding to emerging threats requires multi-sector action.
PRET operates under the aegis of the International Health Regulations (IHR), which is a critical international legal instrument for managing public health emergencies. The IHR sets out the core capacities that countries need to be able to detect and respond effectively. The technical actions in PRET are mapped to the IHR core capacities, grouped according to five subsystems for health emergency preparedness, response and resilience (HEPR).
Critically, in December 2021, WHO’s 194 Member States started a process to draft and negotiate a new legally binding convention, agreement, or other international instrument (CA+) on pandemic preparedness and response, which is commonly referred to as a ” Pandemic Accord.” This process is driven by the need to ensure communities, governments, and all sectors of society – within countries and globally – are better prepared and protected, in order to prevent and respond to future pandemics. As a technical initiative, PRET’s integrated approach to preparedness for groups of pathogens corresponds to and helps operationalize the objectives and provisions of the proposed CA+.
PRET focuses on strengthening and sustaining preparedness systems and health system resilience; monitoring of capacity building efforts; and promoting a whole-of-government and whole-of-society approach for pandemic planning. As PRET modules are designed to be living documents, they will adapt to the direction set by Member States through the Pandemic Accord. See the figure outlining PRET’s fit within the broader context.
PRET and other preparedness planning processes
PRET recognizes that there are three tiers of systems and capacities relevant for pandemic preparedness: those that are cross-cutting for all or multi-hazard, those that are relevant for groups of pathogens, and those that are specific to a pathogen. Among the many planning processes needed, WHO encourages countries to develop national action plans for health security (NAPHS) to strengthen cross-cutting core capacities for all/multi-hazard preparedness. Applying a disease-focused lens to preparedness, PRET is synergistic with NAPHS. Together, PRET and NAPHS should be reflected in national, regional and global investments to strengthen preparedness. As new financing mechanisms for pandemic preparedness become available, such as the Pandemic Fund, articulating the cross-cutting and pathogen-focused systems and capacities that need to be strengthened and the gaps that need to be filled will help streamline resourcing.
Pathogen-specific preparedness elements
To support countries and partners to develop and update pandemic plans, PRET builds on and supersedes WHO guidance such as Pandemic Influenza Risk Management. Within pandemic plans that take the new PRET integrated approach, it is important to articulate the pathogen specific systems and capacities needed. For respiratory pathogens (PRET Module #1), examples include the specific medical countermeasures needed for influenza or the specific public health and social measures needed for MERS coronavirus.
The pandemic plans also need to align with existing pathogen specific frameworks and instruments. A key example is the Pandemic Influenza Preparedness (PIP) Framework, which requires countries to share influenza viruses with pandemic potential with the Global Influenza Surveillance and Response System (GISRS) and for manufacturers using GISRS to share benefits in return.
The PRET approach offers technical efficiency recognizing the evolving landscape for governance, financing, and systems to prepare for emerging infectious disease threats. For each group of pathogens, PRET enables us to prepare for both pathogens with known pandemic potential such as influenza, and as yet unknown or ‘Pathogen X,’ which will require us to rapidly adjust existing systems and capacities for response.
WHO will continue to work with Member States and a range of experts on pandemic preparedness through PRET.
