Abstract Global health systems have demonstrated strong capacity for rapid outbreak containment. However, across recent health emergencies, including Ebola, COVID-19, and Mpox. These responses have repeatedly been associated with large-scale disruptions to routine essential health services and excess non-outbreak mortality, particularly among women and children. This paper examines how prevailing pandemic preparedness policies and financing arrangements can be redesigned to achieve effective outbreak containment while maintaining continuity of essential primary health care. Drawing on documented experiences across multiple outbreaks and settings, the analysis traces a consistent causal pathway through which interpretations of International Health Regulations obligations and donor financing requirements prioritize centralized containment capacities without corresponding safeguards for peripheral service delivery. These policy and financing priorities trigger resource reallocation away from community-level services, reduce health care utilization, and contribute to preventable mortality from routine causes. We describe this recurring pattern as an “Equity Catastrophe,” reflecting its disproportionate impact on socioeconomically marginalized populations during health emergencies. The paper identifies key structural drivers of this outcome and proposes three targeted policy reforms aimed at strengthening preparedness while protecting essential health services. These recommendations are directed at national governments, global normative institutions, and international financing partners involved in pandemic preparedness and response.
Bai-Sesay et al. (Thu,) studied this question.