Assess the current state of global public health surveillance and response infrastructure, document the degradation of institutional capacity in most countries, and quantify the cost of this fragmentation in terms of pandemic response delays and ineffectiveness.

Analysis of WHO disease surveillance data (PROMED, GISAID), country-level health expenditure data from World Bank and OECD, and case study analysis of COVID-19 response timelines across 40 countries. Benchmarking against pre-2000 public health capacity models.

Global pandemic preparedness has deteriorated since 2020 despite $10B+ in post-COVID health security funding. Only 38 of 195 countries have functional disease surveillance systems integrated with laboratory networks. Average time from symptom onset to global notification for novel pathogens is 40-60 days — down from 7-10 days before budget cuts in the 1990s.

Public health workforce has declined 35% in real terms in most low-income countries as health systems prioritized clinical treatment over prevention.

The 2023 mpox outbreak revealed that 70% of affected countries could not independently confirm cases; diagnosis depended on sending samples to reference labs in London, Paris, and Atlanta — creating 2-3 week delays in outbreak detection.