It sounds like an improbable fiction: a virulent flu pandemic, source unknown, spreads across the world in 36 hours, killing up to 80 million people, sparking panic, destabilising national security and slicing chunks off the world’s economy.

But a group of prominent international experts has issued a stark warning: such a scenario is entirely plausible and efforts by governments to prepare for it are “grossly insufficient”.

The first annual report by the Global Preparedness Monitoring Board, an independent group of 15 experts convened by the World Bank and WHO after the first Ebola crisis, describes the threat of a pandemic spreading around the world, potentially killing tens of millions of people, as “a real one”.

There are “increasingly dire risks” of epidemics, yet the world remained unprepared, the report said. It warned epidemic-prone diseases such as Ebola, influenza and Sars are increasingly difficult to manage in the face of increasing conflict, fragile states and rising migration. The climate crisis, urbanisation and a lack of adequate sanitation and water are breeding grounds for fast-spreading, catastrophic outbreaks.

“For too long, world leaders’ approaches to health emergencies have been characterised by a cycle of panic and neglect,” said Dr Gro Harlem Brundtland, former prime minister of Norway and co-chair of the board alongside Elhadj As Sy, the secretary general of the International Federation of Red Cross and Red Crescent Societies.

“It is high time for urgent and sustained action. This must include increased funding at the community, national and international levels to prevent the spread of outbreaks. It also requires leaders to take proactive steps to strengthen preparedness coordination mechanisms across governments and society to respond quickly to an emergency.”

The report acknowledges governments and international institutions have taken steps to increase preparedness for outbreaks in the five years since the Ebola crisis in west Africa, but concludes current preparedness is “grossly insufficient”. A growing lack of public trust in institutions in some countries, exacerbated by misinformation, hinders disease control, said the study.

The report’s authors contrast the current Ebola outbreak in the Democratic Republic of the Congo, where a lack of trust between communities and authorities has undermined response efforts, with Uganda, where public health authorities and community officials had a preparedness plan in place when it crossed the border. Cases in Uganda were quickly isolated and detected, reducing further infections.

“The trust between communities and the institutions that serve them is at the core of an emergency response, but it is almost impossible to build trust in the middle of a crisis,” said As Sy.

“Community engagement and trust cannot be an afterthought, it has to be earned. Leaders and public health authorities must work as partners with communities to build that trust. We can’t just show up once a health crisis hits. We need to be there before, during and after.”

Outbreaks could emerge naturally, but there is also a risk of accidental or deliberate release by rogue actors, which could complicate an effective response, they said.

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“Ebola, cholera, measles – the most severe disease outbreaks usually occur in the places with the weakest health systems,” said World Health Organization director Dr Tedros Adhanom Ghebreyesus. “As leaders of nations, communities and international agencies, we must take responsibility for emergency preparedness, and heed the lessons these outbreaks are teaching us. We have to ‘fix the roof before the rain comes.’”

The report noted some recent progress. As of July 2019, 59 countries had developed a national action plan for health security. But not one is fully financed.

The report outlined seven steps to ensure the world’s health system is better prepared for the next health emergency, calling on heads of states to increase funding and for international organisations to build preparedness into funding mechanisms.

“Poverty and fragility exacerbate outbreaks of infectious disease and help create the conditions for pandemics to take hold”, said Axel van Trotsenburg, acting CEO of the World Bank. “Investing in stronger institutions and health systems will promote resilience, economic stability and global health security.”