World leaders are “gambling with their children’s and grandchildren’s health and wellbeing” by failing to prepare for a future pandemic, a new report warns. Amid surging cases of H5N1 bird flu in mammals, and an mpox outbreak in central Africa, two senior stateswomen have said the lack of preparation had left the world vulnerable to “devastation”. Helen Clark, former prime minister of New Zealand, and Ellen Johnson Sirleaf, former president of Liberia, were co-chairs of the Independent Panel for Pandemic Preparedness and Response, which was set up by the World Health Organization (WHO) in 2020. At a World Health Assembly in May 2021, the panel set out a series of recommendations to change how the world tackled pandemic threats and avoid mistakes made during the Covid-19 response. Today, they said that at the current rate of preparation, the world would probably be overwhelmed by any new pandemic threat. “This is not the time to gamble. Inaction is a dangerous political choice,” they wrote in a new report, accusing leaders of shifting focus “to more politically pressing issues”. The three years since their first recommendations are “a dangerously long time to leave gaping holes in the national, regional and international systems meant to protect 8 billion people”, they said The H5N1 bird flu outbreak, which is affecting rising numbers of mammals including dairy cattle in the US, “portends an influenza pandemic the world is nowhere near ready to manage”, the report warned. Meanwhile, a new deadlier form of mpox has led to children dying in the Democratic Republic of the Congo, where there is little access to testing and no access to vaccines. “The worst could be around the corner – these should be seen as canaries in the mine,” said Clark. “We need to be prepared for something that could happen at any time and re-energise leaders around getting the right arrangements in place globally and nationally.” The report warns of a lack of efficient systems that low and middle-income countries can rely on for access to drugs and vaccines in the event of a new pandemic. Surveillance systems lack rigour, and there is “a dangerous gap in trust between countries, within countries, and within communities”. International finance is insufficient, and countries struggling with debt and high interest rates are not investing enough domestically. There has been some progress, the report notes, such as agreement earlier this month to amend International Health Regulations to improve the speed at which information is shared, and to formalise the definition of a pandemic emergency. However, Clark said those changes would need to be fully implemented, and called for more transparency on countries’ levels of preparation, an independent monitoring body, and a formal group of world leaders working on pandemic prevention. Changes to the structure of the WHO might be needed, she suggested. She said: “The funds now available pale in comparison to the needs, and high-income countries are holding on too tightly to traditional charity-based approaches to equity. “The pandemic agreement is vital and must succeed but has yet to be agreed. In short, if there were a pandemic threat today – such as if H5N1 began to spread from person to person – the world would probably again be overwhelmed.” “There were lessons to be learned from Ebola in West Africa,” said Johnson Sirleaf. “Just five years later, having not applied those lessons, there were lessons to be learned again from Covid. There is no need to keep learning. Instead of gambling, leaders can make practical decisions and apply those lessons.”