# Key takeaways - Even though there were areas of outstanding performance, such as the timely identification of the pathogen, the development of sensitive and specific diagnostics, and the creation of highly interactive networks of public health officials, the most fundamental conclusion of the committee, which applies today, is not reassuring: “The world is ill prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency.”” (Fineberg, 2014, p. 1336) - [[IHR]] fails to specify a basis for virus sharing and vaccine sharing. A glaring gap in the IHR, which has not been remedied, is its lack of enforceable sanctions. For example, if a country fails to explain why it restricted trade or travel, no financial penalties or punitive trade sanctions are called for under the 2005 IHR - Even though WHO was instrumental in pandemic response, it was (and is) limited to several difficulties: - First, WHO is simultaneously the moral voice for health in the world and the servant of its member states, which authorize the overall program and budget. National interests may conflict with a mandate to equitable protect the health of every person on the planet. - Second, the budget of WHO is incommensurate with the scope of its responsibilities. Only 1/4 of the budget comes from member-state assessments, and the rest depends on specific project support from countries and foundations. - Third, the WHO is better designed to respond to focal, short-term emergencies, such as investigating an outbreak of hemorrhagic fever in subSaharan Africa, or to manage a multiyear, steady-state disease-control program than to mount and sustain the kind of intensive, global response that is required to deal with a rapidly unfolding pandemic. - Finally, the regional WHO offices are autonomous, with member states of the region responsible for the election of the regional director, budget, and program. Although this system allows for regional variation to suit local conditions, the arrangement limits the ability of the WHO to direct a globally coherent and coordinated response during a global health emergency. - WHO kept confidentiality of its review expert of emergency-committee members. However, it also raises question about the linkage between the expert with the industry. - WHO failed to acknowledge legitimate criticism, such as inconsistent descriptions of the meaning of a pandemic and the lack of timely and open disclosure of potential conflicts of interest, undermined by the ability of the WHO to respond effectively to unfounded criticism. - The most serious operational shortcoming, however, was the failure to distribute enough influenza vaccine in a timely way. Showing short-fall in global vaccine production capacity and technical delays to reliance on viral egg cultures for production, as well as distribution problems. - Among the latter were variation among wealthier countries and manufacturers in their willingness to donate vaccine, concerns about liability, complex negotiations over legal agreements with both manufacturers and recipient countries, a lack of procedures to bypass national regulatory requirements for imported vaccine, and limited national and local capacities to transport, store, and administer vaccines. - Some recipient countries thought that the WHO did not adequately explain that the liability provisions included in their recipient agreements were the same as the provisions accepted by purchasing countries.