The Scorecard
What Actually Changed After COVID
A structured audit of institutional, scientific, and political progress from 2020 to 2026 reveals genuine but deeply uneven gains.
When the World Health Organization declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020, the gap between what the world had promised on pandemic preparedness and what it had actually built became impossible to ignore. The cost of that gap was staggering. ◈ Strong Evidence The Global Preparedness Monitoring Board's 2025 report estimates COVID-19 caused over 20 million deaths with cascading disruptions to education, mental health, and global supply chains — and the npj Vaccines journal pegs the global economic losses at $13.8 trillion through 2024. [1][2]
Six years later, the WHO's own assessment, published February 2, 2026, is telling in its honesty: "yes and no." ✓ Established Meaningful progress has been made, the organisation acknowledges, but progress remains "fragile and uneven." [3] That self-assessment deserves to be taken seriously precisely because it comes from an institution with every institutional incentive to declare victory.
The genuine wins are real and worth acknowledging. ✓ Established The Pandemic Fund — a joint WHO/World Bank instrument — has provided $1.2 billion in grants across three funding rounds, catalysing an additional $11 billion to support 67 projects across 98 countries spanning all WHO regions, with investments in surveillance infrastructure, laboratory networks, and workforce training. [3] The WHO Global Influenza Surveillance and Response System now processes over 12 million samples worldwide annually. [3] The International Health Regulations — the legally binding framework governing how nations must report disease outbreaks — were amended in June 2024 and entered into force in September 2025. [4]
The scientific infrastructure inherited from pre-pandemic investment also proved its worth. ✓ Established The NIH spent $17.2 billion in vaccine technology research before 2020, including more than $500 million specifically toward mRNA platform development — the investment that enabled COVID-19 vaccines to reach clinical trials within 66 days of the virus's genetic sequence being published. [2] That platform now underpins the fastest vaccine-development pipeline in history.
And yet: ◈ Strong Evidence a 2024 CIDRAP survey of global health experts found that while 90% believed the world is better prepared for the next pandemic, 75% of the same respondents expected the next major global health challenge to occur within five to 25 years. [5] Better prepared, yes. Safe, no. The GPMB's 2025 report frames the core problem with unusual directness: many countries are "too eager to move on without fully absorbing the lessons of the pandemic," and the world "remains vulnerable to future pandemics due to persistent inequities, mistrust, and underinvestment." [1]
Paper Tigers
Why the Pandemic Agreement May Be Less Binding Than It Appears
The WHO Pandemic Agreement, adopted May 20, 2025, is a historic diplomatic achievement — but its legal architecture is riddled with escape hatches that may render it largely unenforceable.
✓ Established On May 20, 2025, the World Health Assembly adopted the WHO Pandemic Agreement — the first treaty negotiated under Article 19 of the WHO Constitution since the Framework Convention on Tobacco Control in 2003, and only the second ever. One hundred and twenty-four countries voted in favour. [3] It took three years of negotiation, multiple failed deadlines, and a 2024 extension before a text was agreed. The moment was heralded by WHO Director-General Tedros Adhanom Ghebreyesus as a landmark in international health law.
The details are considerably less triumphant. A forensic review published in Health Policy and Planning by researchers examining the treaty's process and legal architecture found that its text is "heavily caveated," with states consistently agreeing to "endeavour to" or "promote" rather than to "commit" to specific actions. ◈ Strong Evidence Article 24 of the agreement explicitly bars the WHO from mandating any actions on states. [6] The same review describes the resulting document as resembling "a list of suggestions rather than a legally binding treaty."
The Case For the Agreement
The Case Against Optimism
The PABS problem is the treaty's central unresolved tension. During COVID-19, wealthy nations that shared pathogen samples early found their genomic data used to develop vaccines that were then priced out of reach of lower-income countries. ◈ Strong Evidence The PABS mechanism was intended to guarantee that nations sharing biological samples for pandemic research receive equitable access to resulting health products. It proved too politically contentious to include in the main treaty text. [7] Without it, the incentive structure that caused vaccine nationalism in 2021 remains structurally unchanged.
The agreement requires 60 ratifications before it enters into force — and it cannot even open for signature until the PABS annex is adopted at the 79th World Health Assembly, expected in 2026. [7] Given that the United States — which has already withdrawn from WHO — will not be among those ratifications, and given that Article 24 explicitly prohibits the WHO from mandating state action, the agreement functions as a framework for voluntary cooperation rather than a binding enforcement mechanism. As the Health Policy and Planning review notes, barriers to implementation include persistent gaps in enforcement, technology transfer, and inclusive implementation. [6] Whether it proves to be a foundation for genuine cooperation or a sophisticated diplomatic exercise will depend on political will that history suggests is difficult to sustain between crises.
The US Withdrawal Effect
How the World's Largest Health Funder Walking Away Reshapes Global Risk
The January 2025 US withdrawal from WHO removed approximately 18% of the organisation's total funding at the exact moment it was needed most — triggering immediate surveillance failures with real-world consequences.
✓ Established On January 20, 2025, the United States initiated formal withdrawal from the World Health Organization. The move was not unexpected — the Trump administration had initiated a similar withdrawal in 2020 before the Biden administration reversed it in January 2021 — but its timing, coinciding with the ratification window for the WHO Pandemic Agreement and an active H5N1 epizootic, made it particularly consequential. [8]
The scale of the financial gap is significant. ✓ Established The United States was WHO's single largest financial contributor, providing USD 1.284 billion during the 2022–23 biennium and representing approximately 18% of total WHO funding. WHO's two-year programme budget stands at $6.8 billion; the US was responsible for 22% of mandatory contributions. [8] That is not a gap that can be easily absorbed or replaced — particularly against a backdrop where, as the WHO notes, global funding is already shifting away from health toward defence spending. [3]
The damage, however, is not only financial. In late January 2025, CDC staff were ordered not to communicate with WHO personnel — severing a technical information-sharing relationship that underpins global disease surveillance. ✓ Established Simultaneously, the abrupt termination of USAID grants began to propagate through the global health system with immediate and measurable effects: Africa CDC reported that mpox samples from the Democratic Republic of Congo could not reach laboratories for analysis due to the USAID funding stoppage. [9] The DRC was at the time managing an active mpox outbreak involving a new variant; the inability to rapidly sequence samples is precisely the kind of early-warning failure that allows outbreaks to become pandemics.
◈ Strong Evidence A USAID internal memo cited by Foreign Policy warned that the cuts could cause thousands of new Ebola and Marburg cases, uncontrolled mpox and avian flu outbreaks, and major increases in drug-resistant tuberculosis. [9] That assessment reflects the second-order consequences of surveillance infrastructure collapse: when samples cannot reach labs, when epidemiologists cannot communicate across borders, and when response teams cannot be funded, pathogens do not wait for diplomatic resolution.
The Journal of Global Health analysis is measured in its framing of the debate — acknowledging that some critics of the WHO have raised legitimate concerns about institutional reform and accountability — but concludes that the US withdrawal "creates significant uncertainty for pandemic preparedness, disease surveillance, and health equity programs" and "could leave a significant funding gap for global health initiatives." [8] The framing of the withdrawal as a reasonable response to WHO institutional failures, while a coherent political argument, does not resolve the operational reality: the surveillance and response networks that a reformed WHO would anchor do not function at reduced funding levels while reforms are being negotiated.
H5N1 — The Pandemic Candidate
Nobody Is Talking About Enough
H5N1 avian influenza has expanded from wild birds into US dairy cattle across 17 states, infected at least 71 humans, and produced documented in-host mutations toward better human adaptation — while US disease surveillance infrastructure is being actively dismantled.
Pandemic risk assessment is inherently probabilistic, and there is an ever-present danger of false alarms generating preparedness fatigue. H5N1 has been on pandemic-risk watchlists since a Hong Kong outbreak in 1997. With those caveats stated clearly: the current H5N1 situation is qualitatively different from prior episodes, and the convergence of viral evolution, agricultural spread, and surveillance degradation represents a configuration of risk that public health authorities regard with unusual seriousness.
✓ Established Between March 2024 and July 2025, H5N1 was confirmed in 1,074 US dairy cattle herds across 17 states — a species and a transmission pathway that did not exist in previous H5N1 outbreaks. The FAO/WHO/WOAH joint assessment published in July 2025 documents three separate, independent bird-to-cattle spillover events in the United States. By mid-2025, the outbreak had affected 168 million birds, 1,650+ poultry flocks, and at least 71 confirmed human infections across 13 US states. [10]
The virus's evolutionary behaviour is what concerns specialists most. ✓ Established Johns Hopkins Bloomberg School of Public Health researchers reported in January 2025 that a Louisiana patient who died after H5N1 infection showed evidence that the virus had mutated within the patient toward better human adaptation — mirroring a parallel case in British Columbia, Canada. This in-host mutation dynamic is significant: it represents the virus "learning" to infect human cells more efficiently, even if it has not yet acquired sustained human-to-human transmission capability. [11]
✓ Established As of the July 2025 FAO/WHO/WOAH assessment, H5N1 viruses still lack the capacity for sustained human-to-human transmission — the critical threshold that would define a pandemic. [10] The Genotype D1.1 strain, most frequently detected in North America in 2025, has affected not only wild birds and poultry but domestic cats and marine mammals — an unusually broad mammalian host range. The PMC/Medical Science Monitor review published in July 2025 confirms that H5N1 has now demonstrated airborne transmission in mammals, a prerequisite step toward pandemic potential. [4]
H5N1 is a very dynamic virus that poses a greater and greater threat in terms of spillover and pandemic. We need to double down on limiting H5N1 infections in humans to reduce the opportunity for the virus to learn to infect humans effectively.
— Johns Hopkins Bloomberg School of Public Health analysis, January 2025The risk calculus is uncomfortable. ◈ Strong Evidence Of the 992 confirmed human H5N1 cases reported globally between 2003 and November 2025 — across 25 countries — approximately 48%, or 476 individuals, died. [10] This figure reflects a surveillance bias toward severe, hospitalised cases and almost certainly overstates the true infection fatality rate — mild infections are systematically undercounted. Nevertheless, even if the true fatality rate is a fraction of 48%, a pathogen combining even moderate lethality with pandemic-level transmissibility would represent a civilisational-scale event. COVID-19, with an infection fatality rate estimated at approximately 0.5–1% across age groups, caused $13.8 trillion in economic damage. The arithmetic of a more lethal pathogen acquiring human-to-human transmission is not reassuring.
Against this backdrop, the simultaneous degradation of the US disease surveillance infrastructure — CDC communication restrictions with WHO, USAID funding cuts affecting global monitoring networks, and reduced investment in influenza surveillance — represents a collision between a plausible near-term pandemic threat and a deteriorating early-warning system.
| H5N1 Risk Factor | Current Assessment | Notes |
|---|---|---|
| Mammalian spillover breadth | Cattle, domestic cats, marine mammals — unusually broad host range for 2025 Genotype D1.1 | |
| In-host adaptive mutation | Documented in Louisiana and British Columbia cases; virus showing capacity for human-adaptive evolution | |
| Sustained human-to-human transmission | As of July 2025 FAO/WHO/WOAH assessment, this critical threshold has not been crossed | |
| Surveillance infrastructure integrity | USAID cuts, CDC-WHO communication restrictions, and US WHO withdrawal actively reducing early-warning capacity |
The Conditions Are Intensifying
Climate Change, Zoonotic Spillover, and the Structural Drivers of Pandemic Risk
The ecological and demographic conditions that produced COVID-19 have not been addressed — and several are measurably worsening, creating a baseline pandemic risk environment more dangerous than 2019.
COVID-19 was not a random event. It was the predictable output of a set of structural conditions — accelerating deforestation and land-use change bringing humans into contact with novel wildlife reservoirs; global urbanisation concentrating transmission-amplifying populations; climate change altering the geographic range of disease vectors; and an industrial livestock system that functions as an incubator for zoonotic pathogens. ◈ Strong Evidence The npj Vaccines analysis published in Nature in November 2023 describes the risk of another pandemic as "ever-present and potentially increasing due to urbanization and climate change." [2] None of these structural drivers has been meaningfully reversed in the six years since COVID emerged.
✓ Established In 2023, the WHO identified climate change as the greatest threat to human health, specifically citing its impact on vector-borne infections, changing pathogen transmission patterns, and increased risk from emerging pathogens. [4] The mechanism is multi-pathway: warming temperatures expand the geographic range of Aedes mosquitoes (dengue, Zika, yellow fever); changing precipitation patterns affect the ecology of rodent populations that serve as hantavirus reservoirs; melting permafrost has the theoretical potential to release ancient pathogens; and heat stress in agricultural animals suppresses immune function, potentially facilitating viral evolution in livestock populations.
The H5N1 situation in US dairy cattle illustrates the agricultural pathway with particular clarity. ◈ Strong Evidence The FAO/WHO/WOAH assessment documents that three separate, independent bird-to-cattle spillover events occurred in the United States — suggesting not a single transmission chain but a systemic vulnerability in how industrial dairy operations intersect with wild bird populations. [10] A livestock system that confines large numbers of genetically similar animals in conditions of proximity creates optimal conditions for viral amplification and cross-species adaptation.
The WHO is now formally re-examining its Public Health and Social Measures (PHSM) recommendations in light of COVID-19 lessons. ✓ Established A new WHO Collaborating Centre for PHSM effectiveness research was designated in August 2024, with the WHO PHSM Knowledge Hub launched in April 2024, and a research agenda set for completion by 2030. [12] The six-year timeline for reviewing and systematising lessons from COVID's non-pharmaceutical interventions reflects the genuine complexity of the task — but also illustrates the pace at which institutional learning operates relative to pathogen evolution.
The Equity Fault Line
Why the Next Pandemic Will Again Devastate the Global South First
The structural inequities that turned COVID-19 into a global catastrophe for low-income nations remain unresolved — and the failure to finalise the Pathogen Access and Benefit-Sharing mechanism means vaccine nationalism has an institutional basis to repeat itself.
When wealthy nations locked up COVID-19 vaccine supply through bilateral advance purchase agreements in 2020 and 2021 — before the WHO's COVAX facility could deliver meaningful quantities to lower-income countries — the failure was not a moral aberration. It was the rational, predictable output of a global health system structured around national interest rather than collective security. ◈ Strong Evidence The GPMB's 2025 report identifies COVID-19's "cascading effects" — including disruptions to routine immunisation, maternal health services, HIV treatment, and tuberculosis management — as falling disproportionately on lower-income populations already operating with constrained health system capacity. [1]
The Pandemic Agreement's unresolved PABS mechanism is not merely a technical detail. ◈ Strong Evidence The MDPI scoping review concludes that the agreement faces "critical legal, governance, and equity challenges" and that its success depends fundamentally on resolving PABS — the mechanism intended to ensure that nations sharing pathogen samples receive equitable access to resulting health products. Without it, the incentive for lower-income nations to rapidly share pathogen sequences with international networks — the act that enabled COVID-19 vaccine development to begin within days of the Wuhan sequence being published — is structurally compromised. [7]
The world remains vulnerable to future pandemics due to persistent inequities, mistrust, and underinvestment. Despite advances in science and technology, many countries are too eager to move on without fully absorbing the lessons of the pandemic.
— Global Preparedness Monitoring Board, 2025 Annual ReportThe US withdrawal from WHO compounds the equity problem in ways that extend beyond headline funding figures. ✓ Established USAID-funded programs provided the operational backbone for disease surveillance in many low-income countries — the sample transport logistics, the laboratory reagents, the epidemiological field teams. When Africa CDC reported that mpox samples from the DRC could not reach laboratories due to USAID cuts, [9] it illustrated that the equity fault line in pandemic preparedness runs not through treaty text but through logistics infrastructure. A surveillance network is only as strong as its least-funded node — and the least-funded nodes are invariably in the countries that face the highest pathogen spillover risk.
◈ Strong Evidence The Pandemic Fund's achievements — $1.2 billion in grants catalysing $11 billion across 98 countries — represent genuine progress against this backdrop, with the WHO reporting that 121 countries now have national public health agencies for health emergency prevention, preparedness, and response. [3] But the Pandemic Fund's resources are orders of magnitude smaller than USAID's global health budget, and institutional capacity — a functioning national public health agency — does not substitute for the operational funding that makes surveillance actually happen.
What Individuals Can Actually Do
An Evidence-Based Personal Preparedness Framework That Goes Beyond Stockpiling Masks
The most effective individual pandemic preparedness actions are neither dramatic nor expensive — they involve vaccination, medication planning, information hygiene, and community investment that pays dividends well before any pandemic begins.
Individual pandemic preparedness suffers from a marketing problem: the actions that actually work are mundane, while the actions that feel preparatory — stockpiling N95s, building bunkers, panic-buying hand sanitiser — provide psychological comfort while contributing minimally to resilience. The evidence base for individual action points consistently toward a different set of priorities.
◈ Strong Evidence The WHO's 2026 assessment describes staying current on vaccinations, maintaining medication supplies, building community mutual-aid networks, and following trusted public health sources as the most evidence-supported ways to reduce personal pandemic impact. [3] Each of these merits specific attention.
Medication continuity planning is perhaps the most underrated individual preparedness action. During COVID-19, supply chain disruptions caused significant shortages of common prescription medications — not because the drugs were being used to treat COVID-19, but because manufacturing concentration in specific geographic regions was disrupted. Maintaining a 30-to-90-day supply of essential prescription medications (in consultation with prescribing physicians), understanding which medications have generic equivalents, and identifying alternative pharmacies in advance addresses a documented vulnerability from the 2020–2021 period without requiring special expertise or significant expense.
Information hygiene is a pandemic preparedness action that most people do not frame as such. ◈ Strong Evidence The GPMB's 2025 report identifies "mistrust" alongside inequity and underinvestment as one of the three core vulnerabilities leaving the world exposed to future pandemics. [1] The practical implication is that identifying, in advance, which information sources you will trust during a high-uncertainty outbreak — WHO situation reports, the CDC (with awareness of its current institutional constraints), established public health institutions, and peer-reviewed rapid publications — reduces the probability of making poor individual decisions based on social media misinformation at a moment of stress. The time to evaluate information sources is before the crisis, not during it.
⚖ Contested The Global Health Security Index did not accurately predict which countries would respond effectively to COVID-19 — high-scoring wealthy nations, including the United States and United Kingdom, often performed poorly while some lower-scoring nations with prior outbreak experience, including Taiwan and South Korea, fared considerably better. [5] The implication for individuals is similarly counterintuitive: living in a wealthy country with nominally advanced health infrastructure does not guarantee effective pandemic response. Personal and community-level preparedness matters independently of national infrastructure quality.
2. Medication supply: Discuss a 30–90-day supply with your prescribing physician. Know the generic name of each medication. Identify alternative dispensing pharmacies.
3. Information sources: Bookmark WHO situation reports (who.int/emergencies), your national public health authority, and CIDRAP (cidrap.umn.edu). Follow credentialled epidemiologists on professional networks with awareness of platform-specific bias.
4. Community network: Know two neighbours well enough to exchange needs during a quarantine or supply disruption. Identify local mutual-aid organisations.
5. Basic supply resilience: A two-week supply of non-perishable food and water addresses a documented vulnerability from COVID lockdown periods — not because society will collapse, but because supply disruptions of this duration are historically common in outbreak scenarios.
The community dimension of individual preparedness deserves particular emphasis. The most consistent finding from post-COVID research on community resilience is that social capital — the density and quality of relationships within a geographic community — was a stronger predictor of pandemic outcome than many structural factors. Individuals who had pre-existing relationships with neighbours, who participated in local organisations, and who had established communication channels with their communities were better positioned to access support during lockdowns, share accurate information, and coordinate mutual assistance. Building those relationships before the next pandemic is the highest-return preparedness investment most individuals can make — and it has significant co-benefits for mental health and social wellbeing in non-pandemic conditions.
The 5–25 Year Window
A Clear-Eyed Assessment of Where Pandemic Risk Actually Stands
The preparedness paradox — real institutional progress meeting real institutional fragility — resolves into a set of specific near-term risks and a framework for thinking about personal and collective readiness that is more useful than either optimism or panic.
The question of whether the world is better prepared for the next pandemic than it was in 2019 has a defensible answer: yes, and meaningfully so in specific domains. The question of whether those improvements are sufficient to prevent a repeat of COVID-19's human and economic toll is different, and the honest answer is: probably not, in the scenarios that matter most.
◈ Strong Evidence Ninety percent of global health experts surveyed by CIDRAP in 2024 said the world is better prepared for the next pandemic — while 75% of the same cohort expected the next major global health challenge within five to 25 years. [5] That 5–25 year window, interpreted alongside the current H5N1 epizootic, the degradation of US surveillance infrastructure, and the structural drivers of emerging infection risk, is not a source of comfort. It is a planning horizon.
The preparedness paradox at the centre of this report resolves into a specific structural problem: the institutions created to coordinate pandemic response have made genuine progress — the Pandemic Fund, the IHR amendments, the 121 national public health agencies, the genomic surveillance networks — while the political will and financial architecture needed to make those institutions operational is simultaneously being degraded. The WHO Pandemic Agreement represents the most sophisticated pandemic governance instrument in history, and it may not enter into force for years, the US will not be a party to it, and even if it does enter into force its enforcement provisions are explicitly limited by Article 24's prohibition on mandating state action.
Reasons for Qualified Optimism
Reasons for Structural Concern
For individuals, the actionable implication of this assessment is straightforward to state even if it runs against human psychological tendencies: prepare now, when there is no pandemic, because the preparation that matters most — vaccination, medication planning, community relationships, information hygiene — requires neither crisis nor catastrophe to execute. The absence of an active emergency is not evidence that preparation is unnecessary. It is the optimal condition in which to do it.
The WHO's Post-COVID preparedness framework, the IHR amendments in force since September 2025, the Pandemic Fund's $12.2 billion in mobilised capital, the mRNA platform awaiting deployment — these represent genuine assets. The question is whether the political architecture needed to deploy them rapidly and equitably will be in place when they are needed. The answer to that question is being shaped right now, in decisions about WHO funding, treaty ratification, PABS negotiation, and surveillance infrastructure investment. It is not a question being decided solely by governments. It is also being decided by the informed public pressure — or its absence — that shapes what governments do.