Title page 1

Contents 6

Foreword 4

Acknowledgements 5

Executive summary 12

1. Assessment and recommendations 16

In Brief 17

1.1. Another pandemic is not a question of if, but when 19

1.2. Taking stock of the impact of the COVID-19 pandemic on population health, healthcare systems and economies 23

1.2.1. The detrimental health impact of COVID-19 endures in many OECD countries 23

1.2.2. The COVID-19 pandemic shaped the longer-term trajectory of chronic diseases 23

1.3. Future pandemics will carry a dual toll: Heavy loss of life and deep economic disruptions 25

1.3.1. Unmitigated pandemics cause high mortality and overwhelm healthcare systems 26

1.3.2. When health systems are overwhelmed, economies stumble 29

1.4. Targeted non-pharmaceutical interventions protect population health and economies in the early days of pandemics 30

1.4.1. Lockdowns are the last-resort measures for achieving health and economic goals but can be avoided with robust and timely... 34

1.4.2. Community-based IPC measures are the first line of defence during outbreaks 36

1.4.3. In many cases, a layered approach to implementing NPIs protects population health without adding substantial strain on the economy 38

1.4.4. School closures and international travel restrictions can be avoided 38

1.5. PPR capacity can be greatly strengthened when NPIs are backed by solid foundations 38

1.5.1. Strategic stockpiling offers an important short-term buffer during outbreaks 38

1.5.2. Successfully managing outbreaks also hinges on effective governance, economic and social factors 39

1.6. Investing in PPR capacities delivers dividends far beyond moments of crisis 42

1.6.1. In the OECD, strengthening PPR capacity would require nearly USD PPP 6 per person per year 45

1.6.2. Building a national stockpile is the costliest component of the PPR package 46

1.7. Conclusions 47

References 47

2. The COVID-19 pandemic could have lingering impacts on population health and the economy 53

In Brief 54

2.1. COVID-19 has had an enormous impact on health and societies 56

2.1.1. Mortality burden 56

2.1.2. Mental health and well-being 59

2.1.3. Long COVID 61

2.1.4. Impact on care pathways for non-communicable diseases 61

2.1.5. Social impact 66

2.2. COVID-19 had mixed impacts on lifestyle factors that influence the burden of NCDs 67

2.2.1. Tobacco consumption 69

2.2.2. Harmful alcohol use 70

2.2.3. Diet and physical activity 71

2.3. The OECD SPHeP-NCDs Model is used to assess the lasting impacts of COVID-19 on NCD burden 72

2.3.1. COVID-19s indirect effects on NCDs could shorten life expectancy 74

2.3.2. The lasting impacts of COVID-19 could also increase the future costs associated with NCDs 76

2.4. Conclusions 78

References 79

Annex 2.A. OECD SPHeP NCDs model 93

3. Future pandemics will carry a dual toll: Heavy loss of life and deep economic disruptions 95

In Brief 96

3.1. The next pandemic is inevitable - are we prepared? 97

3.2. Over the last two decades, the global community experienced several large-scale pandemics with profound health and economic... 99

3.3. Why only certain pathogens have pandemic potential? 100

3.4. The OECD SPHeP-PPR model is used to assess the potential health and economic impacts of five pandemic scenarios 107

3.5. Results 114

3.5.1. Health impacts 114

3.5.2. Impact on healthcare system resilience 116

3.5.3. Economic impacts 119

3.6. Conclusions 125

References 125

Annex 3.A. Epidemiological factors that contribute to the pandemic potential of pathogens 136

4. Extreme weather events are reshaping the landscape of communicable diseases 140

In Brief 141

4.1. Extreme weather events are rising across the globe 142

4.2. Extreme weather events create new pathways for communicable diseases to emerge, spread and thrive 144

4.2.1. Extreme weather events are driving the spread of vector-borne diseases 146

4.2.2. Extreme weather events alter the burden of water-borne diseases by impacting the quality, quantity and distribution of water resources 151

4.2.3. Extreme weather events are increasingly recognised as important drivers of food-borne diseases 152

4.2.4. Many pathogens that cause resistant infections are sensitive to extreme weather events 153

4.2.5. Extreme weather events can impact other diseases through indirect channels 154

4.3. Disease surveillance systems can be adapted to consider the rising risks of extreme weather events 154

4.3.1/4.3.2. Building infectious disease surveillance systems that consider the rising burden of extreme weather events requires... 155

4.4. Conclusions 157

References 157

5. Community-based infection prevention and control measures are the first line of defence during outbreaks 165

In Brief 166

5.1. A primer on community-based IPC measures: What are they and why they are important? 167

5.2. Critical gaps undermine the implementation of community-based IPC measures 169

5.2.1. All OECD Members and accession countries deployed all 4 community-based IPC measures as part of their COVID-19 response 169

5.2.2. The centrality of community-based IPC measures is widely recognised but more needs to be done to fill the gaps in implementation 170

5.3. Community-based IPC measures are vital to safeguard population health 174

5.3.1. Improve hand hygiene 175

5.3.2. Encourage wearing face masks 179

5.3.3. Enhance respiratory etiquette 180

5.3.4. Enhance indoor ventilation 181

5.4. Improving compliance with community-based IPC measures enhances the effectiveness of these interventions over time 182

5.4.1. Compliance ebbs and flows during/after disease outbreaks and pandemics 183

5.4.2. Sociodemographic characteristics influence compliance 183

5.4.3. Knowledge and awareness can motivate greater compliance 183

5.4.4. Disinformation has become an important source of non-compliance 184

5.4.5. Risk perceptions and personal beliefs can impact compliance 184

5.4.6. Societal norms influence health behaviours 185

5.5. OECD countries can deploy a wide range of policies to promote compliance with community-based IPC measures in the long term 185

5.5.1. Provide clear guidelines and policy advice to promote best practices 186

5.5.2. Ensure adequate access to supplies and materials 190

5.5.3. Financial incentives 191

5.5.4. Design and implement effective community-based IPC programmes 192

5.5.5. Improve public awareness and understanding 193

5.5.6. Behavioural nudges 196

5.5.7. Set up routine monitoring and evaluation systems 201

5.5.8. Ensuring sustainable funding for community-based IPC programmes 202

5.5.9. Build trust in public institutions 204

5.6. Conclusions 206

References 207

Annex 5.A. List of countries participated in the 2023-2024 OECD Survey on Maintaining Infection Prevention and Control in the Community 218

Annex 5.B. Community-based IPC Implementation Dashboard 220

Annex 5.C. List of influenza pandemic preparedness plans from G7 countries included in the OECD analysis 225

Notes 225

6. Learning from COVID-19 to improve pandemic preparedness indices for future health crises 226

In Brief 227

6.1. The importance of pandemic preparedness and response 228

6.2. A guide to pandemic preparedness and response indices: What they are, how they work and why they matter? 230

6.2.1. Why and how is a country's ability to respond to an emerging pandemic measured? 230

6.2.2. Pandemic preparedness and response indices are important to understand national health security 232

6.3. To what extent did pandemic preparedness and response indices reflect countries' "performance" during COVID-19? 238

6.3.1. Which aspects of preparedness were most related to performance? 241

6.4. The importance of understanding population vulnerability during a pandemic 242

6.4.1. What is vulnerability and why does it matter in the context of pandemic preparedness and response? 242

6.4.2. How can we measure the vulnerability of populations to a new pandemic? 242

6.5. Room for development: What can be improved in pandemic preparedness and response indices? 244

6.5.1. How can existing indices be strengthened for future pandemics? 246

6.6. Conclusions 247

References 248

Annex 6.A. The Global Health Security Index (GHSI) utilises open-source data to benchmark a country's health security capacity 252

Annex 6.B. The Joint External Evaluation (JEE) measures country-specific status and progress in developing capacity to prevent, detect and... 254

Notes 255

7. Targeted non-pharmaceutical interventions play a key role in safeguarding population health and the economy in the early phases of... 256

In Brief 257

7.1. Non-pharmaceutical interventions are key to safeguarding population health and the economy in the early days of pandemic outbreaks 258

7.2. The varied paths of NPI roll-out during the COVID-19 pandemic 259

7.2.1. Physical distancing measures 260

7.2.2. Temporary school closures 262

7.2.3. Teleworking arrangements 264

7.2.4. Community-based infection prevention and control (IPC) measures 266

7.2.5. Domestic and international travel restrictions 266

7.3. Why do some people follow public health guidelines during pandemics while others ignore them? 270

7.4. Estimating the health and economic consequences of NPIs 272

7.4.1. The OECD model aims to replicate how decision makers manage disease outbreaks in real time 272

7.4.2. Disease surveillance and early warning systems are the cornerstone of PPR efforts 277

7.4.3. Wastewater surveillance has emerged during COVID-19 as a useful tool to bolster disease surveillance capacity 278

7.5. Results 282

7.5.1. Impact on population health 282

7.5.2. Impact on the economy 288

7.5.3. Health and economic co-benefits 291

7.6. Conclusion 293

References 294

Annex 7.A. Impact of non-pharmaceutical interventions 303

Notes 304

8. Investing in pandemic preparedness and response capacities delivers dividends far beyond moments of crisis 305

In Brief 306

8.1. When pandemics strike, countries with stronger PPR systems are better positioned to respond and safeguard population health and... 307

8.2. The OECD SPHeP Costing Tool is used to quantify the investment requirements for strengthening PPR capacities 311

8.2.1. Building a national stockpile for PPE and hygiene supplies 316

8.2.2. Strengthening the implementation of physical contact-reducing NPIs 316

8.2.3. Enhancing wastewater surveillance 318

8.3. Results 319

8.3.1. Strengthening PPR capacity in the OECD will cost nearly USD PPP 6 per capita each year 319

8.3.2. Investments made during the preparedness phase can help reduce costs incurred during the response phase 320

8.3.3. Building a national stockpile is the costliest component of the PPR package 321

8.3.4. How do OECD estimates change depending on the PPR capacity at the start-up period? 323

8.4. The OECD analysis broadly aligns with cost estimates generated by previous works 324

8.5. Conclusions 327

References 328

Annex 8.A. PPR investment estimates under different assumptions of start-up PPR capacities 332

Annex 8.B. The scope of previous works estimating the investment requirements for strengthening PPR capacities 334

9. Strategic stockpiling is key for timely and effective pandemic preparedness and response strategy 335

In Brief 336

9.1. Introduction 337

9.2. Strategic stockpiling is an important short-term buffer for pandemic preparedness and response 338

9.3. National stockpiling policies vary, but common practical considerations apply 338

9.3.1. Strategic planning and risk assessment 343

9.3.2. Governance model and management 343

9.3.3. Funding/reimbursement arrangements 345

9.3.4. Inventory management and logistics 345

9.4. Regional EU stockpiles are an example of co-ordinated strategic stockpiling 346

9.5. Stockpiling policies face several challenges 349

9.6. Conclusions 350

References 351

Annex 9.A. Examples from selected countries 356

Notes 361

Table 1.1. Summary of key characteristics of the NPIs included in the OECD analysis 30

Table 1.2. Key design features of components of the PPR package 43

Table 2.1. In its early stages, COVID-19 disrupted care pathways for NCDs 61

Table 2.2. Shifts in major NCD risk factors during COVID-19 from projected levels 68

Table 3.1. Key determinants of epidemic trajectory and course of infection 102

Table 3.2. Key modelling parameters used in the OECD analysis to model five pandemic scenarios 112

Table 4.1. Extreme weather events impact the patterns of many communicable diseases 144

Table 4.2. Example list of vector-borne diseases and pathogens 146

Table 4.3. Arboviruses that are considered to be clinically important in European countries 147

Table 5.1. Summary findings: Effectiveness of community-based IPC measures by infection type 175

Table 5.2. Sample recommendations for community-based IPC interventions 188

Table 5.3. Sample cost estimates for various ventilation interventions 192

Table 5.4. Example approaches that can be used to improve hand hygiene in public places 199

Table 5.5. Sample messages included in the WHO COVID-19 message library to promote compliance with community-based IPC measures 200

Table 5.6. Sample methods and approaches to routine monitoring and evaluation of community-based IPC interventions 201

Table 6.1. Pandemic preparedness and response indices are used to assess and benchmark the health security capacities of a country 232

Table 6.2. Preparedness indices measure a variety of public health themes 236

Table 6.3. Country rank varies by pandemic preparedness and response index 238

Table 6.4. Predictive strength of pandemic preparedness and response indices and per cent change in life expectancy 240

Table 6.5. Measures of vulnerability against pandemics encompass a range of factors 242

Table 7.1. Summary of key characteristics of the NPIs included in the OECD analysis 273

Table 8.1. Key design features of components of the PPR package 313

Table 9.1. Progress towards enhancing SNS capacity to meet 90 days of need for pandemic response 342

Table 9.2. RescEU capacities for stockpiles, as of June 2024 347

Boxes 20

Box 1.1. Extreme weather events are reshaping the landscape of communicable diseases 20

Box 1.2. Global progress on pandemic preparedness and response since COVID-19 21

Box 1.3. From daily habits to hospital wards: How COVID-19 reshaped the NCDs burden 23

Box 1.4. The SPHeP-PPR model quantifies the health and economic impact of pandemics 25

Box 1.5. Wastewater surveillance can enable early action, bolstering the effectiveness of disease surveillance systems and the implementation... 32

Box 1.6. Community-based IPC measures are the first line of defence during pandemics 37

Box 2.1. Defining excess mortality 57

Box 2.2. Non-communicable diseases influenced various COVID-19 outcomes 58

Box 3.1. The risk of new pandemic outbreaks is high 97

Box 3.2. Characteristics of disease outbreaks 101

Box 3.3. HPAI is a looming public health threat 103

Box 3.4. Transmission rates associated with various coronaviruses vary, underscoring the complex interplay of viral characteristics, environmental... 103

Box 3.5. Pandemic influenza 105

Box 3.6. The risk of EVD outbreaks in most OECD countries remains low but possible 106

Box 3.7. Measles remains a leading cause of vaccine-preventable deaths globally 107

Box 3.8. The OECD SPHeP-PPR Model 107

Box 4.1. The role of the environment in the One Health framework 143

Box 4.2. Exploring the links between extreme weather events and communicable diseases: Definitions 145

Box 4.3. The European Union's EWRS monitors extreme weather events that could amplify communicable disease risks 156

Box 5.1. The 2023-2024 OECD survey on Maintaining Infection Prevention and Control Measures in the Community 168

Box 5.2. Estimating the precise impact of community-based IPC interventions is challenging 174

Box 5.3. Improving hand hygiene in healthcare settings is highly effective and cost-effective 176

Box 5.4. In the United States, the "Clean Air in Buildings Challenge" provides recommendations and guidelines to improve indoor ventilation... 187

Box 5.5. Belgium's new regulatory framework on indoor air quality sets clear definitions and standards for good air quality 187

Box 5.6. France puts forward a novel hygiene measure framework for preventing infectious diseases in the community 189

Box 5.7. A school-based programme in Australia used air purifiers and high efficiency particulate air filters to facilitate safe return to in-person... 191

Box 5.8. School-based interventions can consider using vocal, visual and interactive elements to enhance their effectiveness 196

Box 5.9. e-Bug Project in the United Kingdom uses gamification strategies to promote healthy IPC behaviours among children and young people 197

Box 5.10. Employee wellness programmes can consider team-based activities and rewards to promote better compliance 198

Box 5.11. Behavioural nudges are an integral part of Ireland's approach to enhancing hand hygiene in public spaces 199

Box 6.1. A resilience framework is utilised as a starting point to understand a country's ability to deal with shocks, such as pandemics 229

Box 6.2. The WHO's International Health Regulations provide a legal framework for the establishment of countries' pandemic preparedness and... 231

Box 6.3. Leading international organisations created a framework to assess the economic and health vulnerabilities associated with pandemics 234

Box 6.4. While there are a variety of indicators to measure vulnerable populations, less visible populations are often overlooked 243

Box 7.1. Korea's efforts to keep education resilient during COVID-19 263

Box 7.2. Estonia built on its digital head start to promote teleworking practices during COVID-19 266

Box 7.3. Domestic travel restrictions as pandemic control: Italy's colour-coded system 267

Box 7.4. The NPIs included in the OECD analysis can counter the health and economic impacts of pandemic outbreaks 272

Box 7.5. France used wastewater surveillance to support its pandemic response capacity 279

Box 7.6. Wastewater surveillance can serve as a valuable tool for supporting disease surveillance systems 280

Box 7.7. Testing, tracing and tracking efforts are a core tool in the pandemic response toolbox 285

Box 8.1. The global community has been taking steps to shift the paradigm on PPR financing 307

Box 8.2. The EU/EEA countries set a new precedent for strengthening regional strategies to strengthen PPR capacities 309

Box 8.3. Estimating the cost of investing in interventions that bolster country-level PPR capacities 311

Box 8.4. The OECD analysis broadly aligns with previous works that estimated the investment requirements for strengthening PPR capacities 325

Box 9.1. United States' Strategic National Stockpile 340

Box 9.2. Assessment of stockpiling systems in the EU, in the context of antimicrobial resistance 344

Box 9.3. EU Civil Protection Mechanism - rescEU stockpiling reserves 346

Infographics 10

Infographic 1. Key facts and figures 15

Annex Table 5.A.1. Countries participating in the 2023-2024 OECD survey on Maintaining Infection Prevention and Control Measures in the... 218

Annex Table 5.B.1. Dashboard on the implementation of policy options to promote community-based IPC programmes in OECD Member and... 220

Annex Table 5.C.1. List of national influenza pandemic preparedness plans reviewed by the OECD 225

Annex Table 6.B.1. The early warning surveillance indicator assesses the effectiveness of a public health surveillance system in detecting... 254

Annex Table 8.B.1. Previous works that quantified the cost of PPR 334

Annex Table 9.A.1. Examples of stockpiling policies for pandemic preparedness and response 356