COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN - 1 February 2021 to 31 January 2022
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1 February 2021 to 31 January 2022
COVID-19
STRATEGIC PREPAREDNESS
AND RESPONSE PLAN
1 February 2021 to 31 January 2022
COVID-19
STRATEGIC PREPAREDNESS
AND RESPONSE PLAN
COVID-19 Strategic preparedness and response plan
WHO/WHE/2021.02
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ivCONTENTS
FOREWORD FROM THE DIRECTOR-GENERAL vi
ABOUT THIS DOCUMENT viii
PART I
SITUATION OVERVIEW 2
Epidemiological situation 2
Dynamic and uneven epidemiology is driven by variations in response 4
The epidemiological outlook for 2021 is uncertain 6
Emergence of SARS-CoV-2 variants 6
Accelerated research and innovations 6
Health systems require strengthening 7
Global collaboration and solidarity continues to be critical 7
Key lessons and challenges for 2021 8
PART II
STRATEGIC PREPAREDNESS AND RESPONSE PLAN 10
Strategic objectives 10
National-level preparedness and response 12
Pillar 1: Coordination, planning, financing, and monitoring 13
Pillar 2: Risk communication, community engagement and infodemic management 13
Pillar 3: S
urveillance, epidemiological investigation, contact tracing,
and adjustment of public health and social measures 14
Pillar 4: Points of entry, international travel and transport, and mass gatherings 14
Pillar 5: Laboratories and diagnostics 15
Pillar 6: Infection prevention and control, and protection of the health workforce 15
Pillar 7: Case management, clinical operations, and therapeutics 16
Pillar 8: Operational support and logistics, and supply chains 16
Pillar 9: Maintaining essential health services and systems 16
Pillar 10: Vaccination 17
Adapting the response to changing and special contexts 18
Support for national preparedness and response 19
Translating knowledge into coordinated action 19
Global and regional coordination 21
Research and innovation 25
Strategic global and regional support for health system resilience 27
Prioritizing support to countries 28
Building for the future 29
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN vFOREWORD FROM
THE DIRECTOR-GENERAL
In a little over 12 months the pandemic has claimed more than 2 million lives
and damaged the economic and social fabric of every society. Across the
world the pandemic has thrown existing inequalities into stark relief. Progress
towards the Sustainable Development Goals has stalled, and in some cases
may have reversed. Up to 100 million people have slipped into extreme
poverty – the first rise in global poverty in more than two decades.
Ending the devastation wrought by COVID-19 requires coordinated global
action. In 2020, WHO’s Strategic preparedness and response plan for COVID-19
set out the key actions at national, regional, and global levels needed to
suppress transmission, protect the vulnerable, reduce mortality and morbidity,
and accelerate the development of the tools the world needs to turn the tide
against the disease. Over the past year WHO has been at the centre of an
unprecedented global effort from partners, national authorities, communities
and the private sector to put that plan into action.
Through 157 global, regional, and national offices, WHO has worked with
a broad coalition of partners to generate evidence and leverage expertise
to guide the response, coordinate direct operational and technical support
to drive implementation at the national level, and put the mechanisms in
place to learn and adapt to a dynamic and rapidly evolving situation. Crucially,
the race to develop COVID-19 vaccines, diagnostics and therapies catalyzed
by the Global research roadmap and the Access to COVID-19 Tools (ACT)
Accelerator has delivered results with unprecedented speed.
The world now stands at a pivotal juncture: we need a new plan of action.
The arrival of the first generation of safe and effective COVID-19 vaccines
was a moment of enormous hope, but its arrival has coincided with the
emergence of new challenges, many of which threaten to exacerbate existing
inequities. WHO’s COVID-19 Strategic preparedness and response plan 2021,
and the accompanying Operational planning guidelines, set out the practical,
coordinated action we must collectively take at the national, regional, and
global level to overcome those challenges, address those inequities, and plot
a course out of the pandemic.
The first Strategic preparedness and response plan for COVID-19 united a
global coalition of partners behind a common set of objectives. That solidarity
and unity of purpose has given rise to incredible achievements over the
past 12 months. Countries have been supported to transform national and
subnational COVID-19 preparedness and response capacities. When these
capacities have fallen short, WHO and partners have come together to deliver
solutions. The work done to coordinate and accelerate the development
of vaccines, therapeutics and diagnostics has paid off, but it is now vital
that these tools are used strategically for the global good.
The COVID-19 pandemic is in many respects unprecedented, but in no respect
was it unforeseen. As we focus on our immediate collective response, it is vital
that we learn from the mistakes, missteps and missed opportunities of the past
if we are to avoid repeating them. That means learning from the mistakes of
the HIV pandemic, when it took four decades for the global poor to get access
to the life-saving medicines that were available in high-income countries. It
means learning from the H1N1 pandemic, when the poor gained access to
life-saving vaccines only once the pandemic was over. And it means learning
from the Ebola epidemic in West Africa, which demonstrated that many years
of hard-won development gains can be undone by a large‑scale epidemic when
there is underinvestment in epidemic preparedness and readiness, and that
epidemic control relies on effective community engagement and the trust
communities have in the government and health services.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN viAn uncoordinated, “me-first” approach to vaccination not only condemns
the world’s poorest and most vulnerable to unnecessary risk, it is strategically
and economically self-defeating. Short-termism, and the pursuit of narrow
national self-interest could have disastrous consequences in the medium
term. The continued spread of SARS-CoV-2 around the world hastens the day
that new variants of the virus will emerge with the potential to undermine
the effectiveness of vaccines, therapeutics, and diagnostics; the restrictions
needed to contain SARS-CoV-2 around the world will be unnecessarily
prolonged, leading to increased human and economic suffering in every
country, but hitting the poorest and most vulnerable hardest.
A recent study commissioned by the
The COVID-19 pandemic is in many respects International Chamber of Commerce
unprecedented, but in no respect was it concluded that even with high vaccine
coverage in high-income countries,
unforeseen. As we focus on our immediate restricted coverage elsewhere would
cost high‑income economies an
collective response, it is vital that we learn from additional US$ 2.4 trillion in 2021
the mistakes, missteps and missed opportunities alone. Yet in the weeks since the first
COVID-19 vaccines were approved,
of the past if we are to avoid repeating them. we have seen countries circumvent
the ACT-Accelerator to make bilateral
deals with manufacturers at the expense of the most vulnerable around
the world. Vaccine equity is not just a moral imperative, it is a strategic and
economic imperative. We call on all countries and partners to give greater
priority to supporting the ACT-Accelerator reach its target to distribute 2 billion
vaccine doses by the end of 2021, through sharing doses, funding the COVAX
mechanism, and by supporting WHO to ensure that every country has the
technical and operational capacity to vaccinate its most vulnerable groups.
The evidence is clear: solidarity, equity, and global leadership are the only
routes out of the pandemic. WHO’s contribution to the COVID-19 Strategic
preparedness and response plan 2021, and the ACT-Accelerator within
it, provides the foundation on which we can build an effective, equitable
response together, and end the acute phase of the COVID-19 pandemic.
Dr Tedros Adhanom Ghebreyesus
WHO Director-General
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN viiABOUT THIS DOCUMENT
WHO published the first COVID-19 Strategic preparedness • Part I of this document gives a brief overview of the
and response plan (SPRP) on 4 February, 2020, four days global epidemiological situation as we enter the first
after the Director-General declared the novel coronavirus quarter of 2021, and summarizes the main challenges
outbreak a public health emergency of international as we look forward.
concern (PHEIC), WHO’s highest level of alarm under • Part II sets out the strategic objectives for 2021, and
international law. As the COVID-19 pandemic evolved, describes the broad response strategy – from national
the SPRP was updated in April 2020 to underline the level to global and regional coordination – through
importance of critical aspects of the public health which we will achieve those objectives together:
response, and support countries to safely and sustainably as individuals, families, communities, countries,
transition out of the severe movement restrictions that regional and international organizations, and as
had been put in place in some countries. partners, in solidarity.
As we enter 2021, it is again important that we take stock In addition, this document is complemented by the
of the evolving epidemiological situation around the COVID-19 Operational plan, which sets out:
world, including the emergence of SARS-CoV-2 variants
of concern, review the lessons learned about the virus • updated Operational planning guidelines to support
and our response, identify the gaps in our knowledge while country preparedness and response, which set out
anticipating the potential challenges ahead, and ensure the key actions and measures to be taken at national
a gender-responsive and equitable response based on and subnational level to ensure a comprehensive
a respect for human rights. We must adapt our strategic and effective response to COVID-19, including the
approach to COVID-19 at national and global levels to plan implementation of new vaccines, therapeutics, and
and support the rapid and equitable deployment of new diagnostics in every country and context, including
tools such as rapid diagnostics and vaccines. the most challenging and under-resourced contexts;
• strategic global and regional priorities to support
COVID-19 will not be the last health threat or emergency – national efforts, organized by response pillar;
many countries have already been forced to manage
concomitant crises. The COVID-19 pandemic is a stark
• global and regional support to accelerate equitable
access to new COVID-19 tools;
reminder that the costs of effective preparedness are
dwarfed by the costs of a failure to prepare. The world • research and innovation priorities under each
response pillar;
now has an opportunity to build on progress made in
2020 and move towards a sustainable future of emergency • key performance indicators for monitoring
preparedness and readiness built on a foundation and evaluation.
of strong and resilient health systems.
This document, the COVID-19 SPRP 2021 is intended to
help guide the public health response to COVID-19 at
national and subnational levels, and to update the global
strategic priorities in support of this effort. This document
was drafted based on the input of colleagues involved in
the COVID-19 response across partners, response pillars,
and at the national, regional, and global levels.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN viiiPART I 1 February 2021 to 31 January 2022 COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 1
SITUATION OVERVIEW
Epidemiological situation
COVID-19 has spread around the world, affecting every Males account for a higher proportion of deaths than
country directly or indirectly (figure 1). Its capacity females (57% of deaths but only 51% of cases), for reasons
for rapid spread means COVID-19 has sometimes that are not completely understood, highlighting the
overwhelmed even the most resilient health systems. need for sex-sensitive and gender-sensitive approaches
As of 7 February 2021, more than 105 million cases had to response. Women are at an increased risk of
been reported worldwide, and more than 2.2 million SARS‑CoV-2 infection, and are often disproportionately
people were reported to have died (figure 2). In addition, affected by the social and economic implications of
increasing indirect mortality has been documented response measures. These impacts include, but are
worldwide as health systems disruptions associated with not limited to, a loss of sexual and reproductive health
the pandemic and response measures have impacted services, increased expectations to deliver unpaid care
care for other health conditions. at home and in the community, and a steep rise in the
incidence of gender-based violence. These periods of peak
The pandemic continues to evolve. The number of cases
demand for social protection and refuge services coincide
and deaths globally continue to increase. In the most
with periods that these services have been significantly
recent week for which data are complete (the week
curtailed due to COVID-19. In countries that report data
commencing 1 February 2021), almost 90 000 deaths
disaggregated by social determinant of health such as
were reported globally, and more than 3 million new cases
ethnicity, occupation, education, living conditions, and
(figure 2). However, these headline figures obscure marked
income, there notable disparities in terms of exposure,
variation amongst WHO regions (figure 3), amongst
vulnerability, access to health services, and health
countries, and within countries. Trends in incidence and
outcomes in the context of COVID-19.
mortality are downwards or stable in many countries,
but these trends may not reflect the real evolution of the
epidemic in countries where testing capacity is limited. In
countries experiencing rapid rises in incidence, capacities
for case investigation, contact tracing, and quarantine are
often put under additional pressure.
Figure 1 Geographical distribution of reported COVID19 cases as at 13 February 2021
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the
World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers
or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 2Most COVID-19 cases are in younger adults, but the risk SARS-CoV-2 transmission is highly clustered, with
of death from COVID-19 increases steeply with age. Over the majority of transmission events estimated to come
80% of deaths occur in individuals over the age of 65 years from a relatively small number of cases. Transmission
old, with a case fatality ratio of more than 10% in that age mainly occurs among close contacts of infected persons
group. However, 16% of all deaths occur in individuals in indoor spaces, and can be amplified in enclosed
aged between 15 and 64 years old. Comorbidities settings with poor ventilation. Secondary attack rates
including non-communicable diseases (NCDs) also are higher in household settings (recent estimates from
significantly increase the risk of death, and there may two meta-analyses suggest household secondary attack
be other factors that influence the outcomes of COVID-19 rate is approximately 17–21%), and outbreaks have been
that are yet to be understood, especially in low-resource reported from a number of settings, including long-term
and humanitarian settings for which there is a lack of living facilities, prisons, religions or social events, and
comparative data. food processing plants.
At the population level, the mortality rate increases with Health workers have been hit hard by COVID-19. Data
increasing COVID-19 incidence. from WHO’s case database of 33 million records shows
that health workers account for 7.7% of cases worldwide,
The best way to reduce mortality is therefore to suppress
although that figure masks wide variation amongst
incidence. There is now growing evidence that a post-
countries, and changes over time. Based on WHO
COVID-19 condition characterized by fatigue and
data, in the first three months of the pandemic, health
cognitive impairments is not only affecting patients that
worker infections slightly exceeded 10% of reported
have been hospitalized, but also a proportion of patients
cases, declining to less than 5% by early June 2020 and
from every age cohort that had mild or moderate
to approximately 2.5% by September 2020. In addition,
disease. In some cases this condition prevents patients
the heavy burden placed on health workers involved
from returning to their previous activities. The underlying
in the response and within the wider health system has
mechanism of persistent or relapsing symptoms remains
had a negative impact on their health and wellbeing.
to be understood.
Figure 2 Reported weekly COVID19 cases and deaths to 13 February 2021
4m
2m
0
Jan 1 Apr 1 Jul 1 Oct 1 Jan 1
100k
50k
0
Jan 1 Apr 1 Jul 1 Oct 1 Jan 1
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 3Dynamic and uneven epidemiology is driven by variations in response The pattern of SARS-CoV-2 transmission in countries Policies to mitigate the negative socio-economic impacts over time broadly resembles one of four scenarios, driven of public health and social measures also have an primarily by marked variation in the implementation of important role in supporting population compliance evidence-based public health and social measures (figure with, and the thus the success of, the response. For many 4). The increase in transmission intensity observed during populations living in situations characterized by poverty the final quarter of 2020 was driven primarily by increased and vulnerability, the enforcement of strict public health social mixing precipitated by the premature, rapid and and social measures in the absence of effective policies to simultaneous (rather than step-wise) lifting of public counterbalance their negative impacts on economic, social health and social measures; a lack of critical resources and mental wellbeing may constitute an unsustainable for infection prevention, such as masks and water; and and untenable burden. the absence of robust public health infrastructure to detect cases and quarantine and support contacts in order to break chains of transmission. Engagement with and empowerment of communities and individuals to manage their own risk by adjusting behaviours and following public health and social measures remains critical to the success of the response. However, misinformation, disinformation, a lack of context-appropriate and culturally-appropriate information, and inconsistent public messaging have, in some situations, undermined the effectiveness of evidence-based response measures and individual risk-reducing behaviours. The role of civil society organizations has proven pivotal in responding to COVID-19 and mitigating the impact of the pandemic. Figure 3 Weekly COVID19 cases to 13 February 2021 by WHO region 1 February 2021 to 31 January 2022 COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 4
Transmission rates in low-resource and humanitarian Analysis of worldwide socio-behavioural data highlights
settings are likely to be underestimated due to reporting several broad trends, including a decrease in confidence
limitations. In settings such as informal settlements and that individual actions can influence the control of the virus;
camps, living conditions including overcrowding, poor increasing fatigue and accumulating health consequences
ventilation and limited access to water and sanitation can related to health service disruptions as the pandemic
contribute to transmission. Health service disruptions in all becomes more protracted; increasing stress and other
settings, including essential sexual and reproductive health mental health consequences caused by uncertainty about
services, have been substantial, and barriers on both the future, increasing economic pressures on households,
the supply and demand sides have increased, resulting and a reduction in trust of government responses. These
in higher morbidity and mortality from all causes. trends indicate an increasing toll on the mental, social,
and economic wellbeing of individuals and communities.
Figure 4 Epidemic curves in countries conform to four distinct patterns driven by variations in the implementation
of public health and social measures
Sporadic cases and clusters rapidly controlled Major outbreak brought under sustained control
Case incidence
Case incidence
Time Time
Major outbreak controlled, and subsequently resurgent Intense transmission
Case incidence
Case incidence
Time Time
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 5The epidemiological outlook for 2021 Accelerated research and innovations
is uncertain
The Global research roadmap, launched in February 2020
and regularly updated since, provided the platform
Looking ahead through 2021, substantial epidemiological
to launch what, in under a year, has become a global
uncertainties remain. Vaccines, where available, are likely
biomedical research effort unparalleled in history.
to reduce severe disease and death, but their impact on
Pre‑empting the need to simultaneously stimulate
the dynamics of transmission is still largely unknown.
large‑scale production and put in place the capacity to
It is unlikely that vaccines will have a significant impact
ensure the global implementation of these tools, WHO
on the pandemic trajectory in the first half of 2021.
and partners launched the Access to COVID-19 Tools (ACT)
To date, there are hundreds of seroepidemiology studies Accelerator in April 2020. In the final quarter of 2020 the
of SARS-CoV-2 that have been published using a variety world saw the first evidence that these efforts had borne
of methods and varying in quality. The duration of fruit in the form of new vaccines and diagnostics with
immunity is not yet completely understood; in most the potential to turn the tide of the pandemic.
countries and communities, naturally acquired immunity
A growing number of vaccines have now announced
is low, and may wane after several months, and there
and published safety and efficacy results from phase
is therefore still a large global population susceptible
3 placebo-controlled trials. The efficacy of these products
to SARS-CoV-2 infection. WHO is working with more
has far exceeded the minimum efficacy of 50% established
than 100 countries on standardized seroepidemiology
by WHO in early 2020. WHO, through its Strategic Advisory
study methodologies. With different levels and duration
Group of Experts on Immunization (SAGE), has issued
of immunity among different populations, we may see
recommendations for the use of several vaccines, and
different epidemic cycles. High-transmission settings will
will continue to evaluate candidates on the basis of its
continue to suffer the most marked impacts on health
population prioritization recommendations and ethical
(direct and indirect), economy, and society.
values framework for COVID-19 vaccines.
For therapeutics, the WHO-coordinated Solidarity Trial
Emergence of SARS-CoV-2 variants collects and analyses the results of clinical trials to
provide evidence-based recommendations for the clinical
Viruses constantly change through mutation, and so management of patients. Interim results published in
the continual emergence of new variants of SARS-CoV-2 October 2020 that showed all four of the treatments
has been expected. The vast majority of mutations are evaluated (remdesivir, hydroxychloroquine, lopinavir/
neutral, and have no measurable effect on transmission, ritonavir and interferon) had little or no effect on overall
or on the type and severity of clinical disease caused by mortality, initiation of ventilation, nor duration of hospital
infection. However, some mutations can arise that confer stay in hospitalized patients. Corticosteroids are the one
an adaptive advantage to the virus, giving rise to variants treatment so far found to have a significant clinical benefit
of concern. Such changes may enable the virus to spread among patients with severe or critical disease in terms
more easily in certain conditions, may alter some of the of reduced mortality. The Solidarity Trial continues to
clinical characteristics of the disease, and/or reduce the evaluate other treatments for inclusion, including newer
effectiveness of medical countermeasures including antivirals, immunomodulators, and anti-SARS CoV-2
vaccines, therapeutics and diagnostics. monoclonal antibodies.
Throughout 2020 and during the first quarter of 2021, PCR tests remain the gold standard of SARS-CoV-2
WHO has tracked and assessed the risk associated with the diagnostic testing for accuracy, but other types of tests
emergence of a number of specific mutations and variants of have also been developed, including rapid antigen
concern identified around the world. Research and modeling detection tests, which are faster, easier to administer
is ongoing to determine the impact of specific mutations and (especially in remote locations) and considerably cheaper
variants of concern on transmission; disease presentation than laboratory-based molecular assays. Although they
and severity; and the potential impact on diagnostics, are not a replacement for PCR tests, they can be used in
vaccines, and therapeutics. WHO is working with partners a variety of different settings, and provide an important
and through the SARS-CoV-2 Virus Evolution Working boost to testing capacity. Three such tests have now
Group to track and assess the level of risk associated with received EUL from WHO.
mutations based on potential impacts on public health.
It is clear that the longer and more widely SARS-CoV-2
circulates, the more opportunities it has to adapt, and the
greater the threat to our ability to test, treat and vaccinate
for COVID-19. In addition, mechanisms for the surveillance
of mutations in susceptible animals and associated risks for
people in contact with these animals have been promoted
jointly by the WHO, the Food and Agriculture Organization,
and the World Organisation for Animal Health.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 6The urgency and commitment with which the scientific Global collaboration and solidarity
community, supported by the global industry, rose to
the challenge of developing vaccines, diagnostics and continues to be critical
therapeutics in 2020 must now be matched by equally
strong commitment from the global community to ensure The first Strategic preparedness and response plan helped
these new technologies are distributed fairly and equitably to bring together a global coalition of partners, and that
to where they are needed most. Investments are also solidarity and unity of purpose has given rise to incredible
critical so that communities are adequately informed achievements over the past 12 months. Countries have
and engaged in a gender-sensitive, equity-oriented and been supported to rapidly strengthen national and
inclusive manner. With communities fully engaged and subnational COVID-19 preparedness and response
actively participating through the full cycle of planning, capacities. When these capacities have fallen short,
delivery, and assessment for new biomedical tools, partners have come together to find and deliver solutions.
demand for these tools can be increased, leading to Hundreds of millions of items of vital personal protective
widespread and effective uptake and use. Research and equipment reached health workers at the forefront of
innovations in diagnostics, therapeutics, and vaccines the response; vital medical supplies including oxygen
will continue to be critically important for reducing and other essential medicines have been distributed
transmission, morbidity, and mortality in 2021, and to save lives; and international medical teams have
their continued development must be accelerated. supported more than 12 000 intensive care beds in health
systems that might otherwise have been overwhelmed.
Crucially, the work done to coordinate and accelerate
Health systems require strengthening the development of vaccines, therapeutics and
diagnostics has paid off. It is now vital that these tools
Ending the COVID-19 pandemic means suppressing are used strategically and equitably. An uncoordinated,
transmission and reducing morbidity and mortality “me first” approach to vaccination not only condemns
in every country and in every context, no matter how the world’s poorest and most vulnerable to unnecessary
challenging, through an evolving combination of risk, it is strategically and economically self-defeating.
preparedness, risk management, ensuring the safe delivery Communities must be consulted and should be actively
of high-quality health services, vaccination and other new involved in decision-making. Women, including from
tools, and the implementation of public health measures marginalized groups, must be meaningfully engaged at
whilst strengthening public health capacities. Limiting the all level of decision-making. No community should be left
indirect health consequences associated with the pandemic behind. Short-term thinking, and the pursuit of narrow
context requires careful planning and coordinated action national self-interest could have disastrous consequences
to ensure ongoing delivery of essential health services in the medium term. The continued spread of COVID-19
for all conditions. Based on experiences with prior around the world hastens the day that new SARS-CoV-2
emergencies, indirect morbidity and mortality may in the variants will emerge to undermine the effectiveness of
end exceed that from COVID-19 itself. Particularly in low vaccines, therapeutics, and diagnostics; the restrictions
capacity and humanitarian settings, effective delivery needed to contain COVID-19 around the world will be
of services and interventions will require strategic shifts, unnecessarily prolonged, leading to increased human
investments, and partner support to foundational health and economic suffering in every country, but hitting
system capacities including financing; data management, the poorest and most vulnerable hardest. Up to 100
collection, and analysis; workforce planning, management million people may have already slipped back into
and development; clinical care; logistics and supply chain extreme poverty in 2020: the first rise in global poverty
management. WHO continues to work with countries in more than two decades. A study commissioned by
across many programs to strengthen health systems, and the International Chamber of Commerce concluded that
the ACT-Accelerator Health Systems Connector provides a even with high vaccine coverage in high-income countries,
complementary anchoring framework through which these restricted coverage elsewhere would cost high-income
investments can be prioritized, coordinated, and delivered economies an additional US$ 2.4 trillion in 2021 alone.
by a global coalition of partners. While the ACT-Accelerator The evidence is clear: solidarity and equity are the only
is specifically oriented to the delivery of resources for routes out of the pandemic.
COVID-19, with proper planning, many of the capacity
gains associated with response efforts can be transmuted
into longer-term gains in health system effectiveness
and resilience, particularly in vulnerable settings. Overall,
maintaining population trust in the capacity of the health
system to safely and equitably meet essential needs and
to control infection risk in health facilities is key to ensuring
appropriate care-seeking behavior and adherence to public
health advice. Robust and well-prepared health systems are
capable of rapidly limiting direct mortality and potentially
mitigating indirect mortality altogether.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 7Key lessons and challenges for 2021
• Epidemiology is dynamic and uneven, in some • Public health and social measures to control
contexts uncertain due to a lack of data, driven COVID-19 can have considerable social and economic
by variable public health responses and further costs, and must be risk-based, regularly reviewed
complicated by variants of concern; however, on the basis of robust and timely public health
many countries continue to suppress transmission intelligence, effectively communicated, and enabled
using available tools. by targeted measures to ameliorate the socio-
economic costs of participation.
• Health care systems and workers have saved
countless lives but are under extreme pressure in • Global, regional, and national supply chains
many countries in terms of capacity and capabilities, and market mechanisms have been disrupted
financial resources and access to vital commodities and unable to meet demand, with implications
and supplies including medical oxygen. Ensuring for the implementation of surveillance, infection
continuity of essential health services and building prevention and control, case management, and
resilient health systems remains essential not the maintenance of essential health services.
only to mitigate the impact of COVID-19, but
also to ensure readiness for other concurrent • The infodemic of misinformation and
disinformation, and a lack of access to credible
and future health emergencies. Leveraging and
information continue to shape perceptions and
strengthening primary and emergency care ensures
undermine the application of an evidence-based
adequate and sustainable quality and distribution
response and individual risk-reducing behaviours.
of a multidisciplinary workforce, providing high-
However, empowered, engaged, and enabled
quality and safe services for both COVID-19 case
communities have played a key role in the
management and essential services.
control of COVID-19.
• Surveillance systems are finding it hard to cope
• Comprehensive preparedness and emergency
with high force of infection in some countries.
response systems to protect populations from
Case and cluster investigations, contact tracing and
disease outbreaks, natural and human-made
supported quarantine of contacts remain insufficient
disasters, armed conflict, and other hazards, remain
in most countries; this is even more pronounced
fundamentally underinvested in many countries.
in settings where testing capacities are limited.
The costs of effective preparedness are dwarfed
• Communities have experienced an erosion of by the costs of a failure to prepare.
social cohesion, limited access to education, and
reduced income and security. They are struggling • Science has delivered answers, evidence-based
guidance and solutions including vaccines, new
with the implementation and consequences of
diagnostics, and therapeutics. Production of these
public health and social measures designed to limit
tools is being scaled up, and strong mechanisms
transmission. Fear of infection, reduced ability to
exist for equitable delivery. However, in some cases
pay, and movement restrictions have contributed
demand and utilization is suboptimal, and equity
to significantly reduced utilization of health services
is under threat.
in some contexts.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 8PART II 1 February 2021 to 31 January 2022 COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 9
STRATEGIC PREPAREDNESS
AND RESPONSE PLAN
Goal: End the COVID-19 pandemic, and build resilience and readiness for the future.
Strategic objectives
We collectively know much more now than we did one year ago. We have developed operational and scientific
solutions, but the majority of countries have not yet applied that knowledge and those solutions comprehensively
or consistently. In 2021 we must redouble our efforts and adapt our response and capacities to achieve six key
strategic public health objectives:
• Suppress transmission through the implementation of effective and evidence-based public health
and social measures, and infection prevention and control measures, including detecting and testing
suspected cases; investigating clusters of cases; tracing contacts; supported quarantine of contacts;
isolating probable and confirmed cases; measures to protect high-risk groups; and vaccination.
• Reduce exposure by enabling communities to adopt risk-reducing behaviours and practice infection
prevention and control, including avoiding crowds and maintaining physical distance from others;
practicing proper hand hygiene; through the use of masks; and improving indoor ventilation.
• Counter misinformation and disinformation by building resilience through managing the infodemic,
communicating with, engaging, and empowering communities, enriching the information eco-system
online and offline through high-quality health guidance, and by communicate risk and distilling
science in a way that is accessible and appropriate to every community.
• Protect the vulnerable through vaccination, ensuring vaccine deployment readiness in all countries
and all populations, by communicating, implementing, and monitoring COVID-19 vaccination
campaigns, by engaging health workers, and by building vaccine acceptance and demand based
on priority groups, taking into account gender and equity perspectives to leave no one behind.
• Reduce mortality and morbidity from all causes by ensuring that patients with COVID-19 are
diagnosed early and given quality care; that health systems can surge to maintain and meet the
increasing demand for both COVID-19 care and other essential health services; that core health
systems are strengthened; that demand-side barriers to care are addressed; and by ensuring
that all priority groups in every country are vaccinated.
• Accelerate equitable access to new COVID-19 tools including vaccines, diagnostics and
therapeutics, and support safe and rational allocation and implementation in all countries.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 10Figure 5 Public health and social measures are supported by multiple response pillars
2 Reduce exposure 3 Protect the vulnerable
Counter misinformation and Build vaccine acceptance;
disinformation; communicate, Exposure Ensure vaccine deployment
engage with, enable and educate
readiness;
communities about risk reduction:
mask use; hygiene; physical Communicate, implement,
distancing; avoiding crowds; and monitor vaccination
indoor ventilation. 3 campaign.
2
Transmission 1 Infection and disease
Reduce mortality and
1 Suppress transmission 4 morbidity from all causes,
and save lives
Prevent virus in high-risk settings; 4 Early diagnosis and care;
Detect and test suspected cases; Manage clinical pathways;
Investigate clusters, including Increase health care capacity;
through use of genomic tools;
Ensure health workforce
Trace contacts; Mortality is trained and protected;
Quarantine and support contacts; Guarantee access to essential
commodities: personal
Communicate and implement
protective equipment;
time-limited measures to reduce
biomedical supplies; oxygen;
potentially infectious contact;
and therapeutics;
Prevent amplification events;
Vaccinate priority groups.
Manage points of entry;
Vaccinate priority groups.
To achieve our collective strategic
objectives we must intervene to break
the cycle of transmission-exposure-
National, regional and global response support structure infection-transmission/mortality. The key
interventions and capacities to weaken
and break each of the links in this chain
are shown above under headings 1–4.
Risk communication, community engagement
Surveillance, epidemiological investigation,
The precise nature and form that these
contact tracing, and adjustment of public
public health and social measures take
and protection of the health workforce
Case management, clinical operations,
will and should differ between countries,
Maintaining essential health services
and transport, and mass gatherings
and between subnational areas
Points of entry, international travel
(RCCE) and infodemic management
Infection prevention and control,
within countries, according to context
Coordination, and capacities. However, all of these
Laboratories and diagnostics
planning, financing interventions and capacities must be
health and social measures
and monitoring underpinned and facilitated by a multi-
disciplinary national and/or subnational
Operational support response structure. The success of every
and logistics, and intervention is supported and enabled
and therapeutics
supply chains by multiple pillars of the response.
These national response structures are
and systems
Vaccination
supported in turn by global operational
Research and and technical support platforms,
innovation including a cross-cutting research
and innovation pillar at the global
and regional level.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 11National-level preparedness and response
For the purposes of national level planning and The updated guidelines are also available on the
coordination, the high-level COVID-19 SPRP 2021 retains COVID-19 Partners Platform. As of January 2021, more
the same core structure and rationale as the SPRP for 2020 than 170 countries have national COVID-19 preparedness
(figure 5), with a number of key additions and adaptations and response plans, and more than 125 countries are
in response to lessons learned over the past 12 months, using the COVID-19 Partners Platform to do the following:
and to address new challenges in the year ahead. These
adaptations include the addition of vaccination as a vital • update plans and progress pillar by pillar in line
with the most recent guidance;
tool to reduce morbidity and mortality; an emphasis on
ensuring the capacities are in place in all countries to • collaborate with UN agencies and implementing
equitably deploy COVID-19 vaccines, novel diagnostic partners to plan and coordinate key actions at national
and therapeutics; a risk-management framework for and subnational levels;
SARS‑CoV-2 variants; and an increased recognition that • engage with community-based and civil society
mental health and psychosocial support is an integral organizations, including strengthening community-
component in public health emergency response that led research, response and inclusive participation
must be addressed across a range of response pillars, in decision-making, planning, monitoring, and
including case management, risk communication and accountability processes;
community engagement, and the maintenance of safe • work collaboratively and transparently with donors to
and accessible essential health services. We must adapt share plans and resource needs (in terms of finances,
our collective response to face new threats, and we must supplies, and personnel), and report key areas of
do so with a renewed sense of urgency. progress and challenges.
The inevitable evolution and emergence of new Broader mechanisms currently in place to assess national
SARS‑CoV-2 variants poses a significant risk of preparedness capacities through the International Health
undermining the effectiveness of new vaccines even Regulations (IHR; 2005) monitoring and evaluation
before they become widely available. The key to ending framework are being adapted to further strengthen
the pandemic lies in achieving the strategic public health understanding of critical gaps in COVID-19 preparedness
objectives of this updated COVID-19 SPRP 2021 in every and response capabilities. A supplementary questionnaire
community in every country. The only effective response on relevant capacities and indicators has been sent to IHR
is a comprehensive response implemented by all countries (2005) State Parties through the 2020 State Parties Annual
with every tool at their disposal, backed by a global Reporting (SPAR) process, and the results will be used
support system that ensures every country has every to strengthen COVID-19 preparedness and response.
tool at their disposal, including vaccines.
Within the framework of the COVID-19 SPRP 2021
COVID-19 has exposed systemic weaknesses in global and the Operational plan, WHO recommends that all
and national health systems and health security countries conduct a substantive gender, equity and
mechanisms. We are now faced with a generational inclusion analysis, in line with existing human rights
opportunity, and a moral obligation, to make investments frameworks, to subsequently inform programming
in health systems and health security that will not only under the SPRP 2021. In line with WHO’s commitment
have immediate benefits in terms of COVID-19, but also to gender equality, health equity and human rights, these
lasting benefits in terms of our collective global health dimensions should be mainstreamed in operations from
security, and an enduring improvement in the health the outset, from baseline assessment, design, planning
and prosperity of societies. and implementation to ensure gender-responsive and
equity‑oriented programming, monitoring, impact
Ending the COVID-19 pandemic means controlling assessment and reporting. Successful implementation
transmission in every country and in every context, of the SPRP lies in meaningful participation, collaboration
no matter how challenging. Ultimately we will bring and consultation with subpopulations experiencing
about that control through an evolving combination poverty and social exclusion, frontline workers including
of vaccination, other new technologies, and public female healthcare workers, women-led organizations,
health interventions, all of which have and will require affected communities including women and adolescent
investments in health system capacities that are girls, and those facing vulnerabilities, discrimination and
foundational not only for health security, but also for additional barriers to access services. This process should
universal health coverage and primary health care. be done with a view to ensure linkages to other services,
The key actions required to enable all necessary national including safety and care, therapeutics and vaccines, with
preparedness and response interventions and capacities gender balance and inclusion approaches in participation
are set out in the Operational planning guidelines to and coordination structures.
support country preparedness and response. The updated
guidelines, including the addition of the tenth pillar
covering COVID-19 vaccination, are included in the
Operational plan that complements this document.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 12Achieving the strategic public health objectives Pillar one plays a crucial role in ensuring coherence
of the updated COVID-19 SPRP 2021 at the national and operational alignment throughout all pillars of the
level depends on the consistent and comprehensive response at national and subnational level, and serves
implementation of context-appropriate public health as the platform for ongoing decision making and course
and social measures at the local level, the introduction correction on the basis of public health intelligence
and deployment of new tools, and the simultaneous provided by a comprehensive monitoring system.
maintenance of essential health services and systems At country level, a multisectoral, whole of government
to reduce mortality from all causes, supported by a coordination mechanism and knowledge hub that brings
multi-disciplinary preparedness, readiness and response together critical people and information is required to
structure based on the following ten interconnected inform, monitor and review (including through intra-action
technical and operational pillars. reviews) national responses.
Within this framework, WHO recommends that all As the pandemic continues countries may need to
countries conduct a substantive gender, equity and re-orient budget processes and health financing
inclusion analysis, in line with existing human rights arrangements to sustain the capacity to prevent,
frameworks, to subsequently inform programming address and respond to COVID-19 and other health
under the SPRP 2021. In line with WHO’s commitment threats in the short, medium, and longer-term, while
to gender equality, health equity and human rights, these maintaining essential services. WHO and partners will
dimensions should be mainstreamed in operations from support countries to a) identify and prioritize investments
the outset, from baseline assessment, design, planning according to efficiency and impact; b) ensure that funds
and implementation to ensure gender-responsive and flow smoothly and managers are enabled to directly
equity-oriented programming, monitoring, impact receive and flexibly use these resources to deploy tools;
assessment and reporting. Successful implementation c) implement rapid resource mapping and expenditure
of the SPRP lies in meaningful participation, collaboration tracking to support policy adaptation and bolster
and consultation with subpopulations experiencing accountability; d) learning and knowledge sharing (using
poverty and social exclusion, frontline workers including COVID-19 experience to advise on health investment).
female healthcare workers, women-led organizations,
affected communities including women and adolescent Pillar 2: Risk communication,
girls, and those facing vulnerabilities, discrimination and
additional barriers to access services. This process should
community engagement (RCCE)
be done with a view to ensure linkages to other services, and infodemic management
including safety and care, therapeutics and vaccines, with Risk communication and community engagement including
gender balance and inclusion approaches in participation infodemic management are integral to the success of
and coordination structures. responses to health emergencies. The evidence is clear:
communities play a role in preventing and controlling
Pillar 1: Coordination, planning, epidemics, and communities must be listened to in
financing, and monitoring order to address demand-side barriers to health service
utilization, and in order to inform measures to mitigate the
More than 170 countries now have a COVID-19 socio-economic impact of COVID-19 control interventions.
preparedness and response plan based on the nine Engagement with communities via community-based
operational and technical pillars set out in WHO’s first and civil society organizations at the grassroots level
Strategic Preparedness and Response Plan, with more is essential to find sustainable solutions and empower
than 180 countries reporting that they have a functional communities. Communities must be involved in co-
COVID-19 response coordination mechanism such designing solutions, and behavioral and social science as
as an Emergency Operations Centre (EOC; EOCs help well as community feedback should guide the adaptation
facilitate information sharing for strategic decisions, of those solutions over time. As we move to a critical phase
including across EOCs within the global EOC-NET). The of the response when vaccines and other biomedical
updated Operational planning guidelines to support country tools become available, trust building, and engagement
planning in the Operational plan that accompanies and of communities becomes even more critical. As COVID-19
complements this document will enable countries to tools such as vaccines are rapidly and equitably deployed,
adapt response plans for 2021, with WHO’s support when sustaining healthy behaviors, removal and mitigation
required. In addition, the COVID-19 Partners Platform of demand‑side barriers to health service access, and
enables countries to work with WHO, UN partners, adherence to recommended public health and social
implementing partners and donors to plan, coordinate, measures will remain critical to suppressing transmission,
and finance activities collaboratively in real time. reducing exposure, protecting the vulnerable, and
reducing morbidity and mortality from all causes. Providing
individuals and communities with actionable, timely and
credible health information online and offline remains
a key priority for successful implementation of activities
across all pillars of the response.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 13Pillar 3: Surveillance, epidemiological It is important to increase sequencing of SARS-CoV-2
viruses within surveillance activities, as well as using
investigation, contact tracing, and adjustment
strategic sequencing of targeted groups to better
of public health and social measures understand SARS-CoV-2 transmission and to monitor for
Disease surveillance and the public health capacities the emergence of variants. Where possible, established
to identify, isolate and treat cases, trace and quarantine systems such as the Global Influenza Surveillance
contacts, and implement and adjust public health and and Response System (GISRS) should be leveraged,
social measures, are the backbones of the COVID-19 and Genomic Surveillance Regional Networks will be
response and the keys to suppressing transmission critical. A global risk monitoring framework is being
until vaccines are widely and equitably available. In the developed and implemented that will use all available
long term, these capacities may also be key to eliminate epidemiological, clinical and laboratory data to provide
transmission and swiftly control reintroductions, in a dynamic assessment of mutations and variants
addition to having broader benefits for public health. of concern and recommended actions to take.
Public health intelligence about epidemiology, health Transparent and timely sharing of information about
system capacity and utilization, and risk factors and the epidemiological situation and health system responses
vulnerability provides the evidential basis for targeted by all countries will facilitate a coordinated global effort
interventions. The decision to introduce, adapt or lift to suppress transmission of SARS-CoV-2.
public health and social measures should be based
primarily on a situational assessment of the intensity Pillar 4: Points of entry, international travel
of transmission and the capacity of the health system and transport, and mass gatherings
to respond, but must also consider the effects these
measures may have on the general welfare of society Risk mitigation measures that should always be
and individuals. Data stratified by sex, age and other in place include advice to travellers, including for
important factors are critical to identify trends, gaps, self‑monitoring of signs and symptoms; surveillance
and disparities in order to adjust public health and social and case management at the point of entry and across
measures and adapt health systems to address disparities. borders; capacities and procedures for international
Collection and analysis of disaggregated data is central contact tracing; and environmental controls and public
to a Human Rights Based Approach to Data (HRBAD). health and social measures at points of entry and
onboard conveyances. WHO will continue to support
Stopping the spread of SARS-CoV-2 means ensuring countries to ensure that these measures are in place,
that all cases are promptly and effectively diagnosed, with an increasing emphasis on building capacity at
isolated and receive appropriate information and care, points of entry and in border communities with benefits
and that the close contacts of all cases are rapidly for international health security that extend beyond
identified so that they can be quarantined and medically COVID-19. In addition, risk mitigation measures that
monitored for symptoms. For this to be successful, should be implemented if necessary, based on a prior
testing capacities need to be strengthened everywhere, risk assessment, include exit and entry screening for signs
including in low capacity and humanitarian settings. and symptoms; targeted testing of international travellers;
Sustained quarantine efforts are all the more important quarantine for international travellers (applied with
with the emergence of SARS-CoV-2 variants of concern. respect for their dignity, human rights and fundamental
Case investigation, identification of the source of freedoms), and selective travel restrictions. The use
infection and monitoring of contacts is also critical to of testing in international travelers should be informed
understanding transmission patterns, and are essential by a thorough risk assessment, in a targeted manner,
tools for post-introduction monitoring of COVID-19 andprovided resources are not diverted from high-risk
vaccines. In addition, close links between national level groups and settings. WHO will continue to work with
surveillance structures and monitoring of health system partner organizations representing aviation, maritime,
capacity and performance in terms of all-cause mortality, border, trade and tourism sectors to develop guidance,
and all-cause hospitalization and hospital occupancy are joint statements of support, monitor the measures
needed to calibrate the application of public health and taken by governments and private entities that impact
social measures. This is particularly pertinent in settings international travel and trade.
where testing capacities are limited, and where disease
surveillance is not optimal due to lack of resources,
conflict and insecurity, humanitarian displacement
and other factors.
1 February 2021 to 31 January 2022
COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN 14You can also read
