Six Years on: Persistent Structural Gaps in COVID-19 Pandemic Policy and Implications for Future Global Health Crises

Abstract Six years after the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) as a global pandemic, several key scientific and policy questions remain unresolved— an unsettling state of affairs given the inevitability of future pandemics. This Perspective examines five domains in which progress toward durable pandemic preparedness has stalled—not for lack of scientific innovation, but owing to fragmented data sharing, uneven translation of evidence into policy, and the erosion of public health decision-making by political pressures. These unresolved issues cluster across five domains central to pandemic response: non-pharmaceutical interventions (NPIs), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origins, vaccination strategy, information integrity, and socio-political trust. The origins of SARS-CoV-2 remain unresolved, and although NPIs such as masking, school closures, and lockdowns were deployed at unprecedented scale, their real-world effectiveness proved difficult to quantify systematically, yielding evidence that has remained fragmented and insufficiently actionable for future policy planning. Vaccination strategies have been persistently challenged by SARS-CoV-2 evolution, waning immunity, and enduring inequities in global access, revealing gaps not in vaccine science itself but in the speed, coordination, and equity of policy implementation. In parallel, fragmented communication and the spread of misinformation have complicated public health responses, while socio-political pressures have, in some settings, constrained the translation of evidence into policy. In this Perspective, a cross-domain framework of measurable pandemic preparedness metrics is suggested to address these gaps. This framework integrates scientific, operational, and governance indicators to enable continuous assessment of readiness across the full course of a pandemic. Closing the scientific and policy questions gaps that were apparent amid the COVID-19 pandemic will require not only new vaccines or therapeutics, but also sustained global cooperation, transparent risk communication, institutional trust-building, and systematic approaches to countering misinformation. Without such reforms, many of the structural vulnerabilities observed during the COVID-19 pandemic are likely to persist, with implications for the effectiveness of responses to future global health crises.