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Protecting the world from infectious disease threats: now or never
  1. Cyrus Shahpar,
  2. Christopher T Lee,
  3. Colby Wilkason,
  4. Marine Buissonnière,
  5. Amanda McClelland,
  6. Thomas R Frieden
  1. Resolve to Save Lives, an initiative of Vital Strategies, New York City, New York, USA
  1. Correspondence to Dr Cyrus Shahpar; cshahpar{at}

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Whether by microbial mutation, movement across borders, or man-made biological release, a new health threat is inevitable, unpredictable and potentially devastating. For the first time, the world now has a clear picture of how prepared countries are for this potentially catastrophic event. When the international evaluation team left Haiti in July 2019, one hundred countries had completed a Joint External Evaluation (JEE) of health emergency readiness. The JEE is a voluntary, externally validated assessment of 19 technical areas required to prevent, detect and respond to health emergencies. This milestone, in addition to the ongoing uncontrolled Ebola epidemic in the Democratic Republic of Congo, makes this an opportune time to take stock of both the status of the world’s preparedness and of what needs to be done to make the world safer.

When the JEE process began in 2016, many doubted that countries would be willing to openly share information, or that the evaluations would be consistent. Fortunately, these concerns were unfounded: countries—including nearly every country in Africa—were eager to participate and openly shared detailed information on their strengths and weaknesses. International teams, using standard measures, created a consistent rating system.1 The results are in. JEEs have documented that, despite the certainty that the world will face another epidemic challenge at least as great as recent outbreaks of severe acute respiratory syndrome, H1N1 influenza, Middle East respiratory syndrome, Ebola and Zika, most countries remain woefully underprepared to manage large-scale epidemic disease threats.

The first 100 JEEs lead to three overarching conclusions. First, no country is fully prepared to manage disease epidemics (figure 1).2 Second, the number of preparedness gaps, and the resulting to-do list of actions to take to fill them, is overwhelming: more than 7000 priority tasks await action. Third, JEEs have diagnosed preparedness gaps well, but …

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