The cost of the COVID-19 pandemic remains unknown. Lives directly lost to the disease continue to mount, while related health, livelihood and wellbeing impacts are still being felt, and the wider ramifications across society, politics and the economy are yet to fully materialise. What is known about these costs though, is that they have been unequally distributed both within and between countries.

Preparedness plans proved inadequate in many settings – especially when it came to protecting those most vulnerable, including those marginalised by geography, poverty, or exclusion along the lines of religion, ethnicity or gender. The top-down, surge-style, biomedically- dominated and technologically-driven preparedness approach that has dominated global health thinking and which was propelled into action with COVID-19 was found wanting not only on the grounds of effectiveness, but also of social justice. This presents both a challenge and an opportunity for a convergence of the preparedness and development agendas.

Drawing on a growing body of social science evidence, this report contends that securing health in the face of today’s uncertain disease threats in often unpredictable settings means making social, economic and political priorities as core to the preparedness agenda as biological and technological ones. The authors present here a framework for a vision of pandemic preparedness for the real world – one that accepts that context is paramount, embraces inclusivity and justice, shifts power centres and rejects simplistic, one-size-fits-all solutions.