The COVID-19 pandemic highlighted that having preparedness plans in place does not always guarantee an effective response to a public health emergency. To identify lessons learned and propose improvements for future crises, the NUS-Lancet PRIME Commission has published a report in The Lancet that outlines a new approach to pandemic readiness focused on equity and the effective protection of all populations.
The Commission, established by the National University of Singapore and The Lancet, brought together 41 international and national experts from fields including public health, medicine, economics, planning and community engagement. Among them was Dr Alberto García-Basteiro, Head of the Preventive Medicine and Epidemiology Department at Hospital Clínic Barcelona and researcher at ISGlobal, the only Commission member affiliated with a Spanish institution.
From preparedness on paper to real-world readiness
One of the report's key messages is that pandemic preparedness should not be limited to protocols, infrastructure or theoretical plans. The authors advocate for a model of "pandemic readiness" that assesses whether systems are truly capable of protecting people when faced with the pressures of a real health emergency.
To reach its conclusions, the Commission analysed evidence and experiences gathered in 20 countries worldwide. The findings show that during the pandemic many people were excluded from essential protective measures, including access to vaccines, social support programmes and public health information, despite such measures being included in preparedness plans.
Systems, not people, create vulnerability
The report concludes that many of the inequalities observed during health crises stem from structural weaknesses in health, social and institutional systems.
Older adults, migrant workers, people with disabilities and communities facing different forms of discrimination encountered barriers that limited their access to essential services and resources. According to the Commission, these situations do not arise from an inherent vulnerability of individuals but rather from failures within the systems designed to protect them.
"Pandemic preparedness cannot be limited to having generic plans and capacities on paper. We must ensure that preparedness strategies include actions and protection mechanisms that reach the most vulnerable populations," says Dr Alberto García-Basteiro.
More equitable vaccine distribution could save millions of lives
The Commission also analysed several scenarios of a future influenza pandemic using epidemiological modelling. The results indicate that the rapid development of vaccines could substantially reduce global mortality.
Furthermore, the authors conclude that a more equitable distribution of vaccines, based on population needs rather than countries' purchasing power alone, could save millions of additional lives, particularly in middle-income countries.
According to the report, global readiness for future pandemics should rest on four key pillars: access to vaccines and other medical countermeasures, equitable allocation of resources, public trust and international cooperation.
Six recommendations for 360-degree pandemic readiness
Based on its findings, the NUS-Lancet PRIME Commission has proposed a roadmap to help governments and institutions strengthen their capacity to respond to future health emergencies. Its key recommendations include:
- Moving from traditional preparedness towards comprehensive 360-degree pandemic readiness.
- Embedding community participation in planning and decision-making processes.
- Strengthening international cooperation to improve global responses.
- Addressing systemic weaknesses that create vulnerability.
- Promoting governance based on trust and transparency.
- Establishing clear protection commitments and accountability mechanisms.
The authors emphasise that these measures would not only improve responses to future pandemics but also strengthen health and social systems in dealing with other public health emergencies.
Reference:
Calderón-Larrañaga S, Bakhti R, Etemadi M, Fakih L, Vandeskog HO, Shrestha P, He S, Chua AQ, Heymann D, Tangcharoensathien V, Mahendradhata Y, Cook AR, Engebretsen E, Eshete MT, García-Basteiro AL, Rando K, Adeyi O, Fukuda-Parr S, Lee K, Wamoyi J, Haldane V, Jung AS, Rahman-Shepherd A, Schenck M, Tian M, Hsu LY, Ng ISL, Valderas JM, Leo YS, Lee V, Nordström A, Kazatchkine M, Teo YY, Clark H, Legido-Quigley H; NUS–Lancet PRIME Commission on Pandemic Readiness Authors. The NUS-Lancet PRIME Commission: transforming pandemic readiness for equity. Lancet. 2026 Sep 26;408(10561):1211-1274. doi: 10.1016/S0140-6736(26)01146-3. Epub 2026 Sep 20. PMID: 42764017.
