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Review
. 2025 Apr 30;7(2):112-126.
doi: 10.35772/ghm.2025.01018.

Overview of global governance, capacity, and health systems implication of pandemic prevention, preparedness, and response: A narrative review and descriptive analysis of open-source data

Tetsuya Miyamoto  1 , Masami Fujita  1 , Masahiko Hachiya  1 , Yuta Yokobori  1 , Kenichi Komada  1 , Hitoshi Murakami  1   2
Affiliations
Review

Overview of global governance, capacity, and health systems implication of pandemic prevention, preparedness, and response: A narrative review and descriptive analysis of open-source data

Tetsuya Miyamoto et al. Glob Health Med. .

Abstract

The COVID-19 pandemic has highlighted the importance of pandemic prevention, preparedness, and response (PPPR) in global health. This review first examined global health governance (GHG) for PPPR, identifying its core-satellite structure. Key GHG functions include rule-setting, resource mobilization, medical countermeasures (MCMs) supply, surveillance and data/pathogen sharing with rapid response, and One Health. Major gaps exist in global collaboration, enforcement of the International Health Regulations (IHR), and the World Health Organization's (WHO) capacity. The most urgent issue is pathogen access and benefit-sharing (PABS). Second, the PPPR capacity across world regions were assessed using two public datasets: eSPAR and GHS Index. Sub-Saharan Africa requires urgent support to strengthen most PPPR aspects, while epidemiological and laboratory surveillance, infection prevention and control (IPC), and regulatory functions need improvement in low- and middle-income countries (LMICs) in various regions outside Europe. Japan, with its strong PPPR capacity, is well-positioned to assist. Lastly, the review explored the link between PPPR and health systems strengthening (HSS). PPPR must be firmly integrated into HSS to ensure resilience, equity, inclusiveness, continuity of care, and sustainability. Core health system components - service delivery, workforce, health information systems, MCMs access, and governance - along with communication and trust-building, effectively contribute to PPPR. However, pandemic exceptionalism and the over-securitization of PPPR and health security may hinder coordination. The enhanced GHG for PPPR, led by the empowered WHO, should effectively facilitate and coordinate technical assistance to LMICs to strengthen their PPPR capacities and promote PPPR-HSS integration by bringing together the often-divided health security and HSS communities.

Keywords: IHR core capacities; Universal Health Coverage (UHC); global health governance; health security; health systems; pandemic prevention; preparedness and response (PPPR).

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Map of WHO Regions. Data Source: WHO MiNDbank (https://extranet.who.int/mindbank). AMR: Americas Region; AFR: African Region; EUR: European Region; EMR: Eastern Mediterranean Region; SEAR: South-East Asia Region; WHO: World Health Organization; WPR: Western Pacific Region.
Figure 2.
Figure 2.
Trend of total average score (%) of 15 IHR core capacities reported by eSPAR by WHO Regions and Japan (2021-2023). IHR: International Health Regulations; eSPAR: Electronic State Parties Self-Assessment Annual Reporting; AMR: Americas Region; AFR: African Region; EUR: European Region; EMR: Eastern Mediterranean Region; SEAR: South-East Asia Region; WHO: World Health Organization; WPR: Western Pacific Region.
Figure 3.
Figure 3.
Trend of total average score (%) of six GHS Index categories by WHO Regions and Japan (2019 and 2021). GHS: Global Health Security; AMR: Americas Region; AFR: African Region; EUR: European Region; EMR: Eastern Mediterranean Region; SEAR: South-East Asia Region; WHO: World Health Organization; WPR: Western Pacific Region.
Figure 4.
Figure 4.
Contributions of health systems components and functions to pandemic prevention, preparedness, and response (PPPR). MCMs: medical countermeasures; PPE: personal protective equipment; UHC: Universal Health Coverage.
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