Pandemic preparedness and response: exploring the role of universal health coverage within the global health security architecture

In response to the COVID-19 pandemic, a suite of international initiatives has been developed to strengthen and reform the global architecture for pandemic preparedness and response (PPR), including proposals for a pandemic treaty, financial intermediary fund, and mechanisms for equitable access to medical countermeasures, among others. These proposed initiatives seek to draw upon critical lessons gleaned from the ongoing crisis by addressing gaps in health security and traditional public health functions. However, to date, there is insufficient consideration of the vital role of universal health coverage and robust primary health care in sustainably, equitably, and efficiently safeguarding health systems from future public health threats. The international community must not repeat the mistakes of past health security efforts that ultimately fueled the COVID-19 catastrophe – in particular, by overlooking the importance of coherent, multisectoral health systems. This paper outlines major (though often neglected) gaps in PPR, and identifies opportunities to reconceptualize health security by scaling up universal health coverage. We then propose a comprehensive set of recommendations to help inform the development of key PPR mechanisms across three themes – legal governance, financing mechanisms, and supporting initiatives. By synthesizing approaches that simultaneously strengthen global health architecture for both health security and universal health coverage, we aim to provide tangible solutions that equitably meet the needs of all communities while ensuring resilience to future pandemic threats.