NEW YORK – September 26, 2026 (STL.News) More than six years after COVID-19 was declared a pandemic and exposed weaknesses in health systems worldwide, governments and public health organizations still face a difficult question: What will it take to prevent another dangerous outbreak from becoming a global catastrophe?
That question returned to the international stage Friday at the United Nations General Assembly in New York, where governments gathered for the second High-Level Meeting on Pandemic Prevention, Preparedness and Response.
The meeting came three years after the first high-level meeting in 2023 and amid efforts to strengthen disease surveillance, laboratories, health workforces, vaccine manufacturing, international rules and financing intended to prepare countries for future health emergencies.
The World Health Organization said COVID-19 was associated with more than 20 million excess deaths between 2020 and 2023 and more than $10 trillion in economic losses.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus told the meeting that the world has made progress since COVID-19 but remains vulnerable.
Asked whether the world is better prepared today, Tedros gave a deliberately mixed assessment: “Yes and no.”
The answer reflects the central problem facing pandemic preparedness.
Scientists now possess powerful tools for detecting and analyzing emerging pathogens. Governments have created new financing mechanisms. International health regulations have been strengthened, and countries adopted the WHO Pandemic Agreement in 2025.
But significant gaps remain in surveillance, laboratories, health systems, financing and access to vaccines, medicines and diagnostic products.
Preventing the next pandemic therefore will not depend on one scientific breakthrough.
It will depend on how quickly the world can detect a threat, determine what it is, understand how it spreads and respond while the number of infections is still manageable.
Early detection can determine what happens next
An emerging infectious disease does not begin as a pandemic.
It begins with infections.
The opportunity to contain the threat is greatest when case numbers are still small. Once widespread community transmission becomes established across multiple countries, containment becomes substantially more difficult.
That makes disease surveillance a foundation of pandemic prevention.
Doctors, hospitals, and clinical laboratories remain critical because they may be the first to recognize an unusual illness or cluster of cases. But public health agencies increasingly supplement conventional surveillance with other technologies.
One of those tools is wastewater monitoring.
The U.S. Centers for Disease Control and Prevention operates the National Wastewater Surveillance System, which provides infrastructure for monitoring infectious diseases by testing sewage.
Wastewater surveillance has an important advantage: It does not depend on every infected person visiting a doctor or receiving a diagnostic test.
People infected with certain pathogens can shed detectable biological material into wastewater. Monitoring sewage can therefore indicate that an infectious disease is circulating within a community.
Wastewater information, however, has limitations and must be interpreted alongside other evidence.
That is particularly clear with avian influenza A(H5).
CDC says an H5 detection in wastewater can indicate that animals or humans may be infected, but wastewater testing cannot determine whether the virus came from a human, an animal, or an animal product such as milk from an infected cow.
Therefore, an H5 wastewater detection does not establish that people in the surrounding community are infected.
Public health and agricultural authorities investigate detections to determine what may be producing the signal.
That illustrates a fundamental principle of modern pandemic preparedness: No single surveillance system provides all the answers.
Wastewater, hospital admissions, laboratory testing, veterinary surveillance and epidemiological investigations can provide different pieces of the same picture.
Avian influenza shows surveillance in action
Highly pathogenic avian influenza remains one of the pathogens U.S. authorities closely monitor.
In its Sept. 4 surveillance update, covering data through Aug. 29, CDC reported that its influenza surveillance systems showed no indicators of unusual influenza activity in people, including avian influenza A(H5).
CDC and state and local health departments monitor people exposed to infected birds, poultry, dairy cattle, and other animals.
Between September 2025 and Aug. 29, 2026, CDC monitored at least 5,000 exposed people and tested at least 156 for novel influenza A.
Looking across the longer period beginning in February 2022, CDC reported at least 33,200 people monitored and at least 1,340 tested through Aug. 29, 2026.
CDC’s wastewater surveillance page, updated Sept. 18, also states that no human-to-human spread of H5N1 has been identified in the United States.
Those findings should not be interpreted as a prediction about what virus will cause the next pandemic.
Instead, the H5 response demonstrates why pandemic surveillance increasingly involves human health agencies, veterinarians, agriculture departments, laboratories, and environmental surveillance at the same time.
Pandemic prevention begins with animal health
Many emerging infectious disease threats involve pathogens that can move between animals and humans.
That connection drives the growing emphasis on One Health, an approach that recognizes the relationship among human, animal, and environmental health.
A dangerous pathogen may first attract attention in livestock or wildlife rather than in a hospital.
Veterinarians, agricultural laboratories and wildlife surveillance programs can therefore become part of an early-warning network.
That matters because every additional day of warning can provide health authorities more time to investigate a pathogen before sustained transmission among people develops.
The objective is not to predict every animal virus that could someday threaten humans. That would be impossible.
The objective is to create surveillance networks that can identify unusual events early enough to investigate them.
Genomic sequencing changed outbreak surveillance
Another major advance is genomic sequencing.
Sequencing lets scientists examine pathogens’ genetic material and compare samples from different patients, locations, and time periods.
During an outbreak, that information can help researchers track changes in a pathogen and investigate how it is spreading.
WHO launched its Global Genomic Surveillance Strategy for Pathogens with Pandemic and Epidemic Potential in 2022.
Its principal measure of success is ambitious: By 2032, all 194 WHO member states should have, or have access to, timely genomic sequencing for pathogens with pandemic and epidemic potential.
But sequencing equipment alone does not create an effective surveillance network.
Countries also need systems that can collect appropriate samples, perform laboratory diagnostics, analyze sequencing results, and share information quickly enough to influence public health decisions.
That means genomic surveillance depends on infrastructure and trained workers as much as it depends on technology.
Scientists must also prepare for the unknown
Governments cannot assume that the next pandemic will be caused by a pathogen already recognized as dangerous.
WHO has long used the term Disease X as a preparedness concept representing the possibility that a serious international epidemic could be caused by a pathogen not currently known to cause human disease.
Disease X is not the name of a virus circulating somewhere in the world.
It represents uncertainty.
That uncertainty has encouraged researchers to prepare by studying groups and families of pathogens rather than waiting for a completely new virus to emerge.
This strategy could give scientists a head start.
If researchers already understand the biology of related viruses, have prototype vaccines or diagnostic technologies available and have established laboratory and clinical-trial networks, the response to a newly discovered pathogen could potentially begin much faster.
The objective is not to predict the identity of the next pandemic virus.
It is to avoid starting from zero when one emerges.
The race for a vaccine begins before an emergency
COVID-19 demonstrated that vaccines can be developed much faster than traditional vaccine-development timelines once suggested.
The Coalition for Epidemic Preparedness Innovations, or CEPI, has established an even more ambitious objective known as the 100 Days Mission.
Its goal is to make it possible to develop a safe, effective vaccine against a newly identified pandemic threat in about 100 days.
That would require considerable preparation before an emergency occurs.
Researchers need adaptable vaccine platforms. Scientists need information about virus families that could produce future threats. Clinical-trial networks need to be prepared to begin studies rapidly.
Manufacturing capacity is equally important.
Developing a successful vaccine in a laboratory is not the same as producing hundreds of millions or billions of doses and distributing them internationally.
A pandemic response therefore requires planning for research, regulatory review, manufacturing and distribution before the crisis arrives.
Vaccines are also only part of the medical response.
Diagnostic tests are needed to identify infections. Therapeutics can reduce severe illness. Hospitals need medicines, oxygen and protective equipment. Health workers need infection-control systems that protect both patients and staff.
Pandemic preparedness is a chain, and failure in one part can weaken the entire response.
Local health systems are a global defense
International agreements and sophisticated laboratories receive substantial attention in pandemic preparedness discussions, but the first sign of a new outbreak may appear in an ordinary medical facility.
A patient could arrive at a community hospital with an unusual respiratory illness.
A laboratory technician could notice an unexpected test result.
A local health department could discover that several patients attended the same event or worked at the same facility.
That makes local public health infrastructure part of international health security.
Hospitals need the capacity to handle sudden increases in patients. Laboratories require equipment, supplies, and trained personnel. Health departments need epidemiologists and investigators.
Supply chains must also be resilient enough to provide protective equipment, diagnostic materials, medicines and other essential products during sudden increases in global demand.
A sophisticated international warning system has limited value if the communities receiving the warning lack the personnel or equipment needed to respond.
Pandemic preparedness requires sustained financing
Financing presents another persistent challenge.
Emergency spending is politically easier to justify when hospitals are filling with patients and an outbreak dominates the news.
Preparedness spending is different.
Governments are being asked to spend money on laboratories, surveillance systems, workers and equipment for an emergency that may not happen during the current budget cycle.
The Pandemic Fund was established in 2022 to help address chronic underinvestment in pandemic prevention, preparedness and response, with a focus on low- and middle-income countries.
As of 2026, its portfolio covered 67 projects in 128 countries.
The fund reports that it has awarded $1.4 billion in grants through its first three funding rounds. Those grants have mobilized another $10.1 billion in domestic and international resources, producing a total portfolio of approximately $11.5 billion.
Projects focus on disease surveillance, laboratory systems, and the health workforce.
That investment is significant, but international health organizations continue to warn that preparedness financing remains fragmented and inadequate in many countries.
International health rules have changed
The legal framework governing international health emergencies has also changed since COVID-19.
WHO member states adopted amendments to the International Health Regulations in 2024.
For most States Parties, those amendments entered into force on Sept. 19, 2025.
Among the most significant changes was the creation of a new alert level called a pandemic emergency.
WHO says the designation is intended to promote stronger international collaboration when a public health threat has escalated beyond the conditions associated with a public health emergency of international concern and risks becoming, or has become, a pandemic with widespread consequences.
The amendments also established National IHR Authorities to coordinate implementation and added provisions concerning access to health products and financing.
But the amendments do not apply identically to every IHR State Party.
WHO reports that 11 of the 196 IHR States Parties rejected the 2024 amendments. Those states continue to apply previous versions of the regulations unless they withdraw their rejection.
The sovereignty issue is also important.
WHO states explicitly that countries retain the sovereign right to implement their own health policies. Under the International Health Regulations, WHO serves as the secretariat and has no authority to compel countries to act.
The Pandemic Agreement is not yet in force
A separate international initiative also emerged from the lessons of COVID-19.
The World Health Assembly adopted the WHO Pandemic Agreement in May 2025 after more than three years of negotiations.
The agreement addresses areas including pandemic prevention, preparedness, health systems, research and development, supply chains and more equitable access to vaccines, therapeutics and diagnostics.
However, adoption of the agreement did not immediately make it binding international law.
A major component remains unfinished.
Countries are continuing negotiations over the proposed Pathogen Access and Benefit-Sharing system, commonly known as PABS.
The proposed system is intended to facilitate rapid sharing of biological materials and genetic sequence information involving pathogens with pandemic potential while also creating mechanisms for sharing benefits, including vaccines, therapeutics and diagnostics developed through their use.
WHO member states concluded the eighth meeting of the negotiating group on Sept. 18, 2026.
Negotiations advanced, but the PABS annex was not completed.
At Friday’s UN high-level meeting, WHO said it expects to consider the PABS annex at the World Health Assembly in May 2027.
The annex must be adopted before the Pandemic Agreement can proceed through the next stages toward ratification and eventual entry into force.
That means one of the most important pieces of the post-COVID international pandemic framework remains unfinished as of Sept. 26, 2026.
Trust can determine whether preparedness works
Pandemic preparedness also involves something you can’t manufacture in a laboratory: public trust.
During a new outbreak, scientists will inevitably face uncertainty.
They may initially know little about how easily a pathogen spreads, which groups face the greatest risk, how severe the disease is, or which treatments work.
Recommendations may change as evidence develops.
Public health agencies therefore need to communicate not only what scientists know but also what they do not yet know.
That requires distinguishing preliminary evidence from established facts and explaining why recommendations change when new information becomes available.
At Friday’s UN meeting, governments specifically emphasized strengthening trust in health systems and institutions and improving community engagement as components of pandemic preparedness.
Without public cooperation, even sophisticated surveillance and medical technologies may have limited effect.
The world is better equipped but still vulnerable
Measurable progress has been made since the beginning of COVID-19.
Genomic surveillance has expanded.
Wastewater monitoring provides another way to identify infectious-disease activity.
Researchers are working on vaccine technologies that could potentially be adapted rapidly to newly emerging pathogens.
Countries have amended the International Health Regulations.
The Pandemic Fund is financing surveillance, laboratories, and workforce development.
Governments have negotiated the WHO Pandemic Agreement, although its PABS annex and subsequent ratification process remain unfinished.
Yet WHO itself says significant weaknesses remain.
Surveillance and laboratory capacity are uneven. Financing remains fragmented. Health systems in many countries remain vulnerable to sudden demand surges. Access to medical products can differ dramatically among countries.
Those weaknesses matter because pathogens do not need every country to be unprepared.
They need opportunities to spread.
Preventing a pandemic ultimately means buying time
No preparedness system can guarantee that another pandemic will never occur.
A pathogen may spread before infected people show symptoms. A new disease may initially resemble familiar illnesses. Travelers can cross continents before health authorities recognize an outbreak.
The realistic objective, then, is not to eliminate every possible infectious-disease threat.
It is building enough layers of protection so dangerous outbreaks become harder to spread.
Animal surveillance can identify unusual infections.
Doctors and laboratories can recognize unexpected disease clusters.
Wastewater monitoring can provide another warning signal.
Genomic sequencing can help identify and characterize a pathogen.
Public health investigators can determine how infections are spreading.
Scientists can begin with vaccine platforms and research developed before the emergency.
Manufacturers can prepare to produce vaccines, diagnostics, and treatments.
Hospitals and health departments can respond while case numbers remain manageable.
International information sharing can warn other countries before the pathogen arrives.
Each layer provides something extraordinarily valuable during an emerging infectious-disease crisis:
time.
The world cannot know where the next dangerous pathogen will emerge, what it will be, or when it will appear.
But it can determine how prepared it will be when that happens.
The ultimate success of pandemic prevention may not be measured by how effectively the world responds to another global catastrophe.
It may be measured by the catastrophe that never occurs — because a dangerous pathogen is discovered, identified, and contained before a local outbreak ever has the opportunity to become the next pandemic.
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