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Catastrophic Contagion


The Johns Hopkins Center for Health Security, in partnership with WHO and the Bill & Melinda Gates Foundation, conducted Catastrophic Contagion, a pandemic tabletop exercise at the Grand Challenges Annual Meeting in Brussels, Belgium, on October 23, 2022. The extraordinary group of participants consisted of 10 current and former Health Ministers and senior public health officials from Senegal, Rwanda, Nigeria, Angola, Liberia, Singapore, India, Germany, as well as Bill Gates, co-chair of the Bill & Melinda Gates Foundation. The exercise simulated a series of WHO emergency health advisory board meetings addressing a fictional pandemic set in the near future. Participants grappled with how to respond to an epidemic located in one part of the world that then spread rapidly, becoming a pandemic with a higher fatality rate than COVID-19 and disproportionately affecting children and young people. Participants were challenged to make urgent policy decisions with limited information in the face of uncertainty. Each problem and choice had serious health, economic, and social ramifications. 


the future to protect lives and national economies. Political leaders, in addition to health leaders, must be at the table during exercises to respond effectively during the next pandemic. Countries should establish a global network of professional public health leaders who can work together to improve epidemic preparedness and response and strive for consensus on scientific issues in advance of the next major outbreak. There is no existing worldwide professionalized network of public health preparedness and response leaders who can work together between and during epidemics to better prepare all countries and provide mutual aid and sharing of best practices during serious epidemics. Establishing an international network of national public health leaders, along the lines of the professionalized “Pandemic Corps” referred to in our exercise, could substantially help countries save lives and livelihoods during major epidemics and recover more quickly. Political leaders, who are entrusted with keeping their citizens safe, could benefit from consensus views offered by such a group, rather than having to make impromptu, high consequence policy decisions when lives are at stake during dangerous outbreaks. Countries should prioritize efforts to increase trust in government and public health; improve public health communication efforts; increase the resiliency of populations to misleading information; and reduce the spread of harmful misinformation. In future pandemics, we should continue to expect even more major disruptions from misinformation and disinformation. The WHO can be a globally trusted source, and it can share science and public health information widely, but we should not expect it alone to combat or put a stop to the spread of this mis- and disinformation. Countries need to collaborate to anticipate that threat and prepare to combat it with their own laws and procedures. Just as many types of economic and societal harms can be anticipated and accounted for in pandemic preparedness plans, so too can predictable false or misleading health messaging. Concertedly exploring ways to address this phenomenon on a national level in advance of the next pandemic will be crucial to saving lives. WHO member states should strengthen international systems for sharing and allocating scarce public health resources. Groundbreaking global collaborations, such as the ACT-Accelerator and COVAX, were launched during the COVID-19 pandemic. However, public health leaders still lack confidence in current approaches to fairly allocate medical countermeasures during a future pandemic. Even if there were a global commitment around equity for all countries, implementing equitable allocation will continue to be very difficult in the future, especially if there are practical challenges and special requirements like refrigeration or IV administration. Empowering all regions of the world to save lives during a pandemic would increase equitable access to life-saving treatments and vaccines. Therefore, we need to build up manufacturing, distribution, and administration capacities around the world, paying particular attention to countries with poor infrastructure. This should happen now, rather than during a growing pandemic. It is clear from Catastrophic Contagion that even after the terrible impact of COVID-19, more preparedness work needs to be done, new decisions need to be made, and additional resources committed. We need to expand the limits of our ability to respond.

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