The world remains unprepared for another global pandemic, despite national bright spots, as the 4th Implementation Report of the 100 Days Mission is launched in Cape Town
- Latest 100 Days Mission Implementation Report shows the world remains unprepared for another global pandemic, five years after the COVID-19 Public Health Emergency of International Concern (PHEIC) declaration.
- The 2024 100DM Scorecard reveals limited progress in terms of newly approved diagnostics, therapeutics, and vaccines (DTVs).
- Despite the ongoing mpox PHEIC, there are still no effective point of care diagnostics or treatments for the newly identified clade.
- H5N1 looms as a potential threat, but clarity is needed on the efficacy of current influenza vaccines, therapeutics, and diagnostics against this emerging strain.
- Rwanda’s successful response to the 2024 Marburg outbreak offers hope, demonstrating that the 100 Days Mission is achievable with strong preparation and leadership.
- Experts convene in Cape Town as South Africa begins its G20 presidency, seeking to learn from African outbreak responses and advance harmonisation between national, regional, and global approaches to health security.
Cape Town, South Africa, January 31, 2025 – The International Pandemic Preparedness Secretariat (IPPS) has today published the 4th Implementation Report of the 100 Days Mission (100DM), an initiative aimed at ensuring global access to diagnostics, therapeutics, and vaccines (DTVs) within 100 days of a PHEIC.
The report, unveiled at an event co-hosted with the South African Department of Health, and South African Medical Research Council (SAMRC) in Cape Town, highlights that while there have been bright spots at a national level, the world remains insufficiently prepared for 100 day response to a future pandemic. The report is accompanied by the 2nd iteration of the 100DM scorecard which shows that critical gaps remain, particularly in the development and deployment of diagnostics and therapeutics for diseases with pandemic potential. As the world continues to grapple with evolving threats like the resurgence of Mpox, Marburg and Ebola, and the spread of H5N1 as first human fatalities recorded, the report underscores the urgency of building a robust and equitable R&D ecosystem.
New data from the 2024 Scorecard shows:
- Limited new approvals: Only six new diagnostic tests (for Chikungunya and Ebola) and one therapeutic (Ebola monoclonal antibody treatment) were approved, with no new vaccines for priority pathogens from Scorecard 1.0.
- Early pipeline progress: Seven vaccines entered Phase 1 trials, but only one advanced to Phase 3. The therapeutics pipeline saw just two candidates progress to phase 1 and 2 trials, highlighting limited development for non-COVID pathogens.
- Declines in funding: Non-COVID DTV funding fell by 31% from 2022 to 2023, with sharp decreases for Rift Valley Fever (92%), MERS (84%), and SARS (77%), while overall R&D funding for priority pathogens remains reactive.
- Over-reliance on dominant funding sources: The U.S. government accounted for 60% of global R&D funding (68% excluding COVID-19), highlighting the need for other funders to step in and share both investments and benefits.
For full details, see full analysis from report pg. 18.
The 100 Days Mission Implementation report highlights three key areas for action in 2025 that would ensure the world is better prepared for future outbreaks. The report calls on all stakeholders to work together to:
- Reinvigorate the therapeutics pipeline with a focus on early-stage R&D: Prioritise early-stage research and development to advance therapeutics for priority viral families, ensuring robust pipelines are prepared to address emerging threats.
- Enhance coordination to implement the Diagnostics 100DM roadmap: Collaborate with global partners to implement the 100 Days Mission diagnostics roadmap, improving alignment and advancing innovation across the diagnostics sector.
- Sustain clinical trial infrastructure and strengthen preparatory regulatory approaches: Ensure clinical trial networks remain functional between pandemics and adopt harmonised regulatory approaches to accelerate approvals during emergencies.
Dr Mona Nemer, Chair of IPPS and Chief Science Adviser of Canada, emphasised the urgency of collective action:
“With the world still grappling with the impacts of COVID-19 and the emergence of new threats like H5N1 and mpox, the need for the 100 Days Mission has never been more urgent. Despite progress, significant gaps remain in diagnostics, therapeutics, and vaccines that must be addressed through sustained investment, harmonised regulatory frameworks, and global collaboration. The clock is ticking—now is the time to act decisively to strengthen our collective health security and ensure no country is left behind.”
The report includes a case study on lessons from the mpox response and implications for future 100DM. Drawing on interviews with key informants at global, regional and country level, the case study highlights the competing health priorities, evidence gaps and institutional dynamics that affected the speed of the response, in addition to issues relating to policy and regulatory processes, community engagement and resource allocation and access. (See report pg. 66 for more)
The report also highlights Rwanda’s response to the 2024 Marburg outbreak as a model of 100DM principles in action at a country level. By leveraging pre-established partnerships and rapidly deploying vaccines and therapeutics, Rwanda reduced the outbreak’s fatality rate from 88% to 22.7%. It also enabled trials of vaccines and therapeutics within nine days of the outbreak being declared. (See report pg. 32 for more)
Looking ahead, the IPPS calls on G7 and G20 leaders, with Canada and South Africa respectively assuming their presidencies for 2025, to catalyse global action by:
- Accelerating diagnostic, therapeutic and vaccine R&D for priority pathogens with equity embedded by design
- Agreeing a shared framework for regulatory preparedness in order to increase harmonisation and safely accelerate emergency authorisations.
- Enhancing collective health security by expanding biosafety, biosecurity and pre-clinical capabilities
With just two years left in its mandate, the IPPS remains committed to working with all partners to drive systemic change and ensure that the lessons of COVID-19 and subsequent outbreaks result in a safer, more prepared world.
ENDS
About the International Pandemic Preparedness Secretariat (IPPS):
IPPS is an independent, time-limited entity formed to catalyse scientific exchange and facilitate multidisciplinary engagement in support of the 100 Days Mission and accelerated DTV development. The Secretariat seeks to empower the community of implementation partners to maintain ambition, continuity and accountability towards the achievement of the 100 Days Mission.
About the 100 Days Mission:
Launched in 2021, the 100 Days Mission seeks to minimize the impact of pandemics by ensuring diagnostics, therapeutics, and vaccines are ready for global deployment within 100 days of an outbreak. The implementation of the initiative is led by the IPPS in collaboration with governments, academia, and international organisations.
For media inquiries and interviews, contact Ashley Giles (a.giles@ippsecretariat.org)
Download the Scorecard 2.0 visual
Download the standalone Mpox case study chapter
Learn more at ippsecretariat.org
Dr Mona Nemer, Chair of IPPS and Canada’s Chief Science Adviser said: “With the world still grappling with the impacts of COVID-19 and the emergence of new threats like H5N1 and mpox, the need for the 100 Days Mission has never been more urgent. Despite progress, significant gaps remain in diagnostics, therapeutics, and vaccines that must be addressed through sustained investment, harmonised regulatory frameworks, and global collaboration. The clock is ticking—now is the time to act decisively to strengthen our collective health security and ensure no country is left behind.”
Dr Victor Dzau, Co-Chair of IPPS Science and Technology Expert Group (STEG) and President of the U.S. National Academy of Medicine said: “The findings of this report underline the critical importance of reinvigorating our global response systems. The challenges outlined—limited R&D coordination, fragmented funding, and insufficient regulatory harmonisation—must be met with unified and sustained action. Only through strategic collaboration across governments, industry, and scientific communities can we build resilient systems that ensure equitable and timely access to lifesaving diagnostics, therapeutics, and vaccines. The time for collective action is now—failure to act risks leaving the world unprepared for the next pandemic.”
Shingai Machingaidze, Co-Chairs of IPPS Science and Technology Expert Group and Head of Africa Strategy and Engagement at CEPI said: “The challenges highlighted in this report reaffirm the critical need for global collaboration and equitable approaches to pandemic preparedness. Strengthening diagnostics, therapeutics, and vaccine pipelines must go hand-in-hand with supporting regional leadership and harmonised regulatory frameworks. Africa’s response to emerging threats, like Rwanda’s rapid containment of the Marburg virus, demonstrates that with the right investments and partnerships, the 100 Days Mission is achievable. Now is the time to commit to sustained readiness and ensure no region is left behind.”
Professor Ntobeko Ntusi, President and CEO of the South African Medical Research Council said: “The SAMRC is honoured to be collaborating with IPPS and the National Department of Health to launch the 100 Day mission report on the continent. The location is fitting not only due to the hosting of the G20 but also due to the disproportionate infectious disease burden in Africa, which most often bears the brunt of new outbreaks. This meeting in Cape Town provides an opportunity to bring Africa’s role in pandemic response to the fore and to encourage greater investment and participation of the continent in the global R&D agenda, including the development, testing and roll out of effective and context-appropriate DVTs.”
Dr Jeremy Farrar, Chief Scientist at WHO said: “The findings of the 4th Implementation Report underscore the critical importance of robust, sustained and inclusive clinical trial ecosystems in advancing global health security. The example set by Rwanda in swiftly initiating therapeutic and vaccine trials during the Marburg outbreak demonstrates the power of preparedness and partnerships to save lives and improve outcomes. To truly realise the 100 Days Mission, we must prioritise investments in sustained trial capacity that is in permanent use to address everyday clinical issues and build trust as part of functioning health care systems in each region of the globe and which can pivot in an emergency. We look forward to supporting countries to apply the new WHO guidance on clinical trials to achieve this.”
Dr Richard Hatchett, CEO of CEPI said: “Throughout history, societies have had a natural propensity to forget the epidemic traumas and suffering that have come before us. With 2024 a ‘banner year for viruses’ – which saw outbreaks of notable diseases expand in scale and geographic reach and evolve their patterns of transmission – we cannot re-enter this cycle of ‘panic and neglect’ that has so often haunted our response.”
Dr Ifedayo Adetifa, CEO of FIND said: “Early diagnosis is critical for health security because it provides essential data required to inform the public health actions required to stop the spread of disease. The delayed progress towards equitable access to much needed diagnostics compromises our ability to respond to pandemic threats. FIND’s Pathogen Diagnostics Readiness Index shows only one of the top 20 high-risk pathogens has sufficient diagnostic tools available. Working in collaboration with partners like IPPS, FIND is committed to strengthening diagnostic surveillance and response systems to contain disease outbreaks thus improving pandemic preparedness.”
Dr David Reddy, Director General of IFPMA said: “The success of our response to the next pandemic will depend on preserving what worked well in the last pandemic and addressing what did not. The innovative pharmaceutical industry successfully brought forward novel vaccines and therapeutics during the COVID19 pandemic, at unprecedented speed and scale. Through its Berlin Declaration, the industry has outlined how equitable access can be better addressed in the next pandemic, and the 100 Days Mission Implementation Report serves as another reminder of how we must partner around these principles to better prepare for future pandemics.”
Jimmy Rosen, CEO of READDI, Inc said: The latest Implementation Report’s sobering headline underscores the importance of the work being done by IPPS and its collaborators. Five years ago, the response to the emergence of COVID-19 proved that, when the need is urgent, governments, philanthropy and industry can accelerate the discovery and development of life-saving therapeutics. Once again, due to H5N1 bird flu and other actively circulating viruses, the threat level is rising. Let’s work together to develop easily accessible medicines that reduce severe illness, hospitalization and death, and keep schools and economies functioning.
James Anderson, Chair of INTREPID Alliance and Executive Director of Global Health at the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) said: “It’s not a matter of ‘if’ but ‘when’ we may face the next infectious disease outbreak with epidemic or pandemic potential. Antiviral treatments play a key role in managing emerging outbreaks and reducing the impact on families and communities. While progress has been made, critical gaps currently exist in the antiviral R&D pipeline. INTREPID Alliance is steadfast in our commitment to the 100 Days Mission and work to build the Therapeutics Coalition, ensuring that the private sector is integrated sustainably into global preparedness efforts to strengthen our defenses against future outbreaks.”
John-Arne Røttingen, CEO of Wellcome, said: “In the last year alone we saw a number outbreaks of emerging infectious diseases, including bird flu (H5N1), mpox and Marburg. Lessons learnt from these and COVID-19 are vital to predict and prevent future pandemics. Global health security also requires robust responses to endemic diseases at its core. Partnerships between the public and private sector, and working with policymakers on a local, national and global level are essential to strengthen health security and develop effective preparedness measures. Achieving the ambitious goals of the 100 Day Mission will depend on global cross-sector collaboration and investing in R&D capabilities for vaccines, diagnostics and therapeutics for infectious diseases.”
Professor Lucy Chappell, Chief Scientific Adviser at the Department of Health and Social Care (DHSC), UK Government said: “The 4th Implementation Report highlights both the progress made and the urgent gaps that remain in our collective pandemic preparedness. As we reflect on its findings, the UK reaffirms its commitment to the 100 Days Mission and to strengthening global health security through investment in diagnostics, therapeutics, and vaccines. This report is a timely reminder of the work still to be done as South Africa assumes the G20 presidency—a crucial opportunity to unite globally around the shared goal of readiness and equity in the face of future health emergencies.”
Dr Lindsay Keir, Director of the Science and Policy Advisory Team at Impact Global Health, said: Pandemic preparedness is everyone’s business. The 100 Days Mission Scorecard, developed by Impact Global Health (previously Policy Cures Research) in partnership with IPPS, is a critical tool for objectively assessing our collective readiness to respond to a pandemic threat. This year the Scorecard reveals minimal progress: reductions in R&D funding, modest increases in approved products, limited progression of candidates in development and no significant changes to R&D enablers that could help us develop new tools faster. Our pandemic response remains largely reactive, putting us all at risk. We must intensify our efforts to rethink product development for pandemic threats, ensuring we have the necessary tools to act faster when an outbreak hits, to save lives and protect livelihoods.
Eloise Todd, Executive Director and co-founder of Pandemic Action Network said: “We know what we need to do to stop outbreaks becoming pandemics – but only a few countries are doing it. Rwanda responded swiftly to Marburg, and Africa CDC is working hard to tackle mpox – but world leaders are still woefully unprepared to deal with threats hidden in plain sight, such as the persistence of H5N1 and the increase in zoonotic diseases we expect to see fuelled by climate change. The 4th Implementation Report of the 100 Days Mission highlights critical areas for action, and Pandemic Action Network stands ready to work with partners to turn these ideas into action.”