COVID-19 showed how costly an unprepared world is; since then governments have strengthened the international health rules, but average country capacity has stopped improving, aid for health is falling and the new Pandemic Agreement is not yet open for signature.
Updated October 13, 2026. Written from the sources listed below, not independently peer-reviewed.
About 7 million COVID-19 deaths were officially reported worldwide from 2020 to 2023. How many excess deaths does WHO link to the pandemic over those four years?
22.1 million
Excess deaths linked to COVID-19, 2020–2023
Modelled WHO estimate that includes indirect deaths; more than three times the 7.0 million COVID-19 deaths reported. Excess deaths peaked at 10.4 million in 2021.
Data year 2023. Source: World Health Organization, 2026
64 out of 100
Average IHR capacity score (SDG 3.d.1)
Self-assessed by 195 of 196 States Parties. The global average has stayed around 64 since 2021; the least developed countries averaged 49.
Data year 2024. Source: United Nations Statistics Division, 2026
Almost 2×
Health emergency events detected by WHO
WHO detected almost twice as many health emergency events in 2024 as in 2015. The GPMB finds that outbreaks are becoming more frequent and more consequential.
Data year 2024. Source: Global Preparedness Monitoring Board, 2026
Unit: % of deaths
Values as reported in the GPMB 2026 report; only these three years are given. The 2021 figure includes deaths from COVID-19. The GPMB estimates that without the pandemic, infectious diseases would have accounted for only about 11% of deaths.
SDG target 3.d asks all countries, especially developing countries, to strengthen their capacity for early warning, risk reduction and management of national and global health risks. It sets no numerical end point. Its indicator, 3.d.1, rose over the long term from 2015, but the global average has stayed around 64 out of 100 since 2021. In 2024 developed regions averaged 77, developing regions 59 and the least developed countries 49, so the gap the target is meant to close remains wide.
Preparedness capacity is lowest where health systems are weakest: in 2024 the self-assessed IHR capacity score averaged 49 out of 100 in sub-Saharan Africa, the lowest of any region, and in the least developed countries, compared with 76 in Europe and Northern America.
Source: United Nations Statistics Division, 2026In the recent mpox outbreaks, vaccines took 24 to 27 months to reach affected low-income countries, even longer than the 17 months low-income countries waited for COVID-19 vaccines.
Source: Global Preparedness Monitoring Board, 2026Children carried lasting costs of COVID-19: about 80% of the world's children were out of school during the pandemic, and more than 10.5 million children lost a caregiver.
Source: Global Preparedness Monitoring Board, 2026Girls faced added risks: the GPMB cites an estimated 2 to 3 million additional child marriages during the COVID-19 pandemic.
Source: Global Preparedness Monitoring Board, 2026Each country is shaded by its latest available value, so you can see where the gap is widest. Hover or tap a country, search for one, or open the full table.
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Values in points below 100.
Shows 100 minus each country's self-assessed IHR score for health emergency management (planning, response management, logistics), so darker means a bigger gap; scores move in steps of about 7 points, one third of a capability level. It is one of 15 core capacities, not the overall SDG 3.d.1 average, and is self-reported, not independently verified; latest year available per country (2021–2024, mostly 2024; years differ).
Source: WHO e-SPAR self-assessments, via the UN SDG Global Database and Our World in Data. Latest year available per country; years differ.
Values load from Our World in Data. Simplified Natural Earth borders; they imply no position on disputed territories.
Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
LowCOVID-19 was linked to an estimated 22.1 million excess deaths and at its peak reversed nearly a decade of life-expectancy gains; by 2023 overall life expectancy was still slightly below its 2019 level, with the Americas hit hardest. The GPMB finds outbreaks are becoming more frequent and more consequential, and that fair access to vaccines, tests and treatments has declined.
How mature and validated are the available solutions?
ModerateCore tools are well established, from the legally binding IHR to disease surveillance, the strongest of the IHR core capacities worldwide. But the GPMB finds that for many priority pathogens vaccines and treatments do not yet exist or are still in early clinical development, and that it is not yet clear whether newer initiatives such as the Pandemic Fund and the 100 Days Mission are making the world measurably safer.
How widely are effective solutions actually used?
LowCapacity is thinnest where it is needed most: in 2024 self-assessed IHR capacity averaged 49 out of 100 in sub-Saharan Africa and the least developed countries, against 76 in Europe and Northern America. The GPMB also finds that vaccines in recent outbreaks reached low-income countries far later than richer ones.
Preparedness scores are self-assessments that are not independently checked, and the reporting tool was revised during the period, so trends need caution. Excess deaths are modelled: WHO estimates that unreported deaths rose from nearly one for each reported COVID-19 death in 2020 to about nine by 2023, largely because testing declined.
International rules have been strengthened: the amended IHR took effect in September 2025 and the UN General Assembly adopted a political declaration on pandemics in October 2026. But the Pandemic Agreement's annex is still under negotiation, with an outcome now expected in May 2027 or at an earlier special session, country capacity has plateaued and aid for health is shrinking.
A pandemic is an infectious disease that spreads across many countries and regions and affects large numbers of people. Being prepared means having the laws, surveillance, laboratories, health workers, supplies, money and public trust in place to spot an outbreak early and respond before it overwhelms health systems. COVID-19 showed the price of the gaps: WHO links it to an estimated 22.1 million excess deaths between 2020 and 2023, and at its peak it erased nearly a decade of gains in life expectancy. The risk has not receded. In 2024 WHO detected almost twice as many health emergency events as in 2015, and the independent Global Preparedness Monitoring Board (GPMB) names climate change, ecological disruption, greater human mobility and armed conflict as forces pushing risk up, while geopolitical fragmentation weakens the joint action that preparedness depends on.
The damage is unevenly shared. Countries with the weakest health systems report the lowest preparedness capacity and wait longest for vaccines, tests and treatments. Children lost schooling and, in millions of cases, a caregiver; routine health care was disrupted; economies shrank; and trust in governments was damaged in ways that have outlasted the emergency. Since COVID-19, governments have amended the International Health Regulations and adopted a WHO Pandemic Agreement. But the agreement cannot be signed until an annex on sharing pathogens and the benefits that flow from them is agreed, and development assistance for health has fallen back to levels last seen in 2009.
No single number shows how ready the world is for a pandemic. Monitoring combines legal obligations, countries' own assessments, independent review and estimates of what past emergencies cost:
IHR capacity (SDG indicator 3.d.1)
Under the International Health Regulations (IHR, 2005), every State Party reports each year on its ability to detect, assess, notify and respond to public health events, using WHO's State Party Self-Assessment Annual Reporting tool (SPAR). Each indicator is rated on five levels and converted to a percentage, and these are averaged into scores out of 100 for 15 core capacities, such as surveillance, laboratories, the health workforce and risk communication. The scores are self-assessed rather than independently verified.
Alert levels under the IHR
WHO's Director-General can declare a public health emergency of international concern (PHEIC). Since amendments took effect in September 2025, a higher alert, a 'pandemic emergency', can also be declared to trigger stronger international collaboration.
Excess mortality
The difference between all deaths that actually occurred and the deaths expected had there been no pandemic. It captures deaths never recorded as COVID-19, for example where testing was scarce, and indirect deaths caused by disrupted health care. WHO calculates it with statistical models, so the figures are estimates rather than counts.
Independent monitoring
The GPMB, set up in 2018 after the West African Ebola epidemic and co-convened by WHO and the World Bank Group, assesses pandemic risk, preparedness and impact with a framework of 90 indicators. Its mandate ends in 2026, and it has asked governments to create a permanent, independent mechanism to continue the work.
What works
The IHR (2005) are a legally binding framework for 196 States Parties, including all 194 WHO Member States. They set out how countries detect, assess and report public health risks and which capacities they must build. Amendments that took effect on 19 September 2025 add a 'pandemic emergency' alert level, require governments to set up National IHR Authorities to coordinate implementation, and strengthen access to medical products and financing on the basis of equity and solidarity.
Limits
WHO has no authority to compel countries to act, so the rules work only as far as governments apply them through national laws and budgets, and the new provisions have not yet been tested in a pandemic emergency.
What works
Spotting unusual illness early and confirming it in a laboratory gives authorities time to respond. Surveillance is the strongest of the 15 IHR core capacities, with a global average score of 80 in 2024, and the GPMB suggests faster detection may have stopped a larger share of outbreaks from growing into large epidemics.
Limits
Capacity is far lower in sub-Saharan Africa and the least developed countries, and early detection helps only if findings are shared quickly across borders and acted on. The laws and policies needed to implement the IHR are among the weakest capacities worldwide, with an average score of 55.
What works
Medical countermeasures save lives once they reach people. The Pandemic Agreement provides for a Global Supply Chain and Logistics Network to help get pandemic products to all countries, and the GPMB calls for regional manufacturing backed by technology transfer and for equity conditions on publicly funded research.
Limits
Development has not meant access: mpox vaccines took 24 to 27 months to reach affected low-income countries, and the GPMB finds equitable access to countermeasures has declined. For many priority pathogens, vaccines and treatments do not yet exist or are still in early clinical development.
What works
Dedicated money lets countries prepare between crises and act in the first days of an outbreak. The Pandemic Fund, one of several mechanisms set up in recent years, finances preparedness, and WHO's Contingency Fund for Emergencies provides money to start a response quickly.
Limits
Much of this money depends on pledges that donors renew at their discretion, and development assistance for health has fallen back to levels last seen in 2009. The GPMB calls for standing commitments to the Pandemic Fund, a minimum of US$100 million in the Contingency Fund, pre-arranged 'Day 0' surge financing and ring-fenced national preparedness budgets.
What works
Public health measures work only if people understand and accept them. Risk communication and community engagement are part of what countries report on under the IHR, and the UN political declaration of October 2026 calls for empowering communities.
Limits
The GPMB finds that recent emergencies damaged trust in governments, civil liberties and democratic norms, and that trust in government has been slow to recover amid polarisation. Broad measures also carried heavy costs: about 80% of the world's children were out of school during COVID-19.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
As its name says, the mission aims to have tests, treatments and vaccines ready for use within 100 days of a new pandemic threat being identified. The GPMB lists it with the Pandemic Fund, the Africa CDC and the African Vaccine Manufacturing Accelerator among initiatives created in response to unequal access to countermeasures, but notes it is not yet clear that these investments are making the world measurably safer.
Since September 2025 WHO can declare a 'pandemic emergency', a level above a public health emergency of international concern, and governments must designate National IHR Authorities to coordinate their work under the regulations. How well these tools perform will only become clear in a real emergency.
Initiatives such as the African Vaccine Manufacturing Accelerator aim to build production in regions that waited longest for COVID-19 and mpox vaccines. The GPMB and the 2026 UN political declaration both call for more local and regional manufacturing, which the GPMB says depends on technology transfer, a trained workforce and harmonised regulation.
As its own mandate ends, the GPMB proposes a permanent, independent mechanism that would track pandemic risk, use AI for risk modelling and early warning under human oversight, and report to the World Health Assembly and through it to the UN General Assembly. It cautions that without safeguards and effective governance such tools could reduce rather than strengthen health security.
Coordination gap
The agreement, adopted in May 2025, opens for signature only once governments adopt an annex on pathogen access and benefit sharing (PABS), and enters into force after 60 ratifications. Under PABS, participating manufacturers would give WHO rapid access to a target of 20% of their real-time production of pandemic vaccines, treatments and tests. Talks that began in July 2025 had not concluded by October 2026.
Coordination gap
Pandemic response depends on countries sharing information and supplies, yet the GPMB warns that growing geopolitical fragmentation, nationalism and commercial self-interest are weakening joint action. Eleven of the 196 IHR States Parties rejected the 2024 amendments, so the earlier rules still apply to them.
Implementation gap
Development assistance for health has fallen back to levels last seen in 2009, and its share of total aid has dropped. Preparedness funding relies heavily on discretionary pledges, and money for the first days of a response is not reliably available when an outbreak starts.
Implementation gap
In 2024 the least developed countries averaged 49 out of 100 on IHR capacity, against 77 in developed regions. Worldwide, the weakest areas were preparedness for chemical events (53) and the laws and policies needed to implement the IHR (55).
Technology gap
For many priority pathogens, vaccines and treatments do not yet exist or remain in early clinical development, and the GPMB finds that gaps in research pipelines and manufacturing concentrated in a few places both limit access. It calls for publicly funded research agreements to include technology transfer to regional manufacturers.
Knowledge gap
Preparedness scores are self-assessed, and reported COVID-19 deaths (7.0 million) were less than a third of the estimated 22.1 million excess deaths. The GPMB, the main independent monitor, ends its mandate in 2026 and has asked governments to set up a permanent replacement.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
Which measures of preparedness, beyond self-assessed scores, actually predict how well a country limits deaths and disruption in an emergency, and how can they be checked independently?
How can a system for sharing pathogen samples and data guarantee timely, fair access to the resulting vaccines, tests and treatments without slowing the rapid sharing that early research depends on?
Which public health and social measures protect health while doing least harm to children's education, livelihoods and mental health, and how can authorities keep public trust when evidence is still uncertain?
Which financing arrangements, from pre-agreed triggers to ring-fenced national budgets, can release funds within days of an outbreak and keep preparedness funded in the years between crises?
Stay up to date with the vaccines recommended for you, and during an outbreak follow guidance from your national public health authority rather than unverified sources.
Misleading health information spreads fastest in a crisis and erodes trust. Before passing on a claim about an outbreak, check it against a public health agency or an established news outlet.
Preparedness budgets are easiest to cut when no crisis is visible. Ask your elected representatives how your country funds preparedness at home and abroad, and where it stands on the IHR amendments and the Pandemic Agreement.
Health workers, laboratory staff, data analysts, logisticians and communicators can join emergency reserve or volunteer schemes where they exist, or support organisations that strengthen health systems in low-income countries.
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World Health Organization, published 2026
WHO's summary of its 2026 statistics report (published 13 May 2026). Source of the modelled estimate of 22.1 million excess deaths in 2020–2023 against 7.0 million reported COVID-19 deaths, the 2021 peak of 10.4 million, the rising ratio of unreported to reported deaths, and the reversal and uneven recovery of life expectancy.
United Nations Statistics Division (data from WHO e-SPAR), published 2026
Official UN progress summary for target 3.d with IHR self-assessment data for 2024: 195 of 196 States Parties reporting, a global average of about 64 since 2021, scores by core capacity (surveillance 80, chemical events 53, legal instruments 55) and by region and country group.
Global Preparedness Monitoring Board, published 2026
Independent assessment launched in May 2026, the Board's final report. Source of the rise in health emergency events since 2015, the infectious-disease share of global deaths (2000, 2015, 2021), the return of development assistance for health to 2009 levels, mpox and COVID-19 vaccine delays for low-income countries, gaps in vaccines and treatments, effects on children and trust, and recommendations on financing, manufacturing and monitoring.
World Health Organization (news release, 19 September 2025), published 2025
Source of the entry into force of the 2024 IHR amendments, the new 'pandemic emergency' alert level, National IHR Authorities, the 196 States Parties and the 11 that rejected the amendments.
World Health Organization (news release, 20 May 2025), published 2025
Source of the adoption of the WHO Pandemic Agreement, the requirement that it opens for signature only after the PABS annex is adopted, the 60 ratifications needed for entry into force, the 20% production target under PABS and the planned Global Supply Chain and Logistics Network.
World Health Organization (news release, 12 October 2026), published 2026
Source of the UN General Assembly's adoption of the political declaration on 12 October 2026, its priorities, and the status of the PABS annex, whose outcome is expected at the World Health Assembly in May 2027 or an earlier special session.