Draft, not yet released. In stewardship review. Not indexed until the first approved release.

Executive summary

The edition on a few pages: the abstract, the key messages, the headline finding and what each steward reads in it.

6 min read1 figure0 tables14 notesNR-STRATEGIC-HEALTHSECURITY-GLOBAL-2026-BASELINE

Contents
  1. ·Edition home
  2. ·Executive summary
    1. S.1 Abstract
    2. S.2 Key messages
    3. S.3 Headline finding
    4. S.4 At a glance
    5. S.5 What each steward reads in it
    6. S.6 What this edition is, and is not
  3. 1Health threats cross every line
  4. 2Key findings
  5. 3Systems and sectors at baseline
  6. 4Risks and capability
  7. 5High-consequence outbreak that overlaps reduced financing and thin surveillance
  8. 6Readings from the other desks
  9. 7The 2027 agenda
  10. 8Systems in depth
  11. AMethodology
  12. BData appendix
  13. CReferences and record
  14. ·Complete edition, for print

S.1Abstract

Health security is the capacity to prevent, detect and respond to health threats that cross borders and species. The 2025 and 2026 evidence shows the same mechanisms at work in very different events. An outbreak of Bundibugyo virus disease, declared a public health emergency of international concern in May 2026, had reached 8,116 confirmed cases and 3,924 deaths in the Democratic Republic of the Congo by 27 September 2026, with no licensed vaccine or specific treatment47. The amended International Health Regulations entered into force on 19 September 2025, and 11 of 196 States Parties rejected them4. The annex that the Pandemic Agreement needs was still under negotiation after the 2026 World Health Assembly23. About one in six bacterial infections was resistant to treatment in 20236. Over 60% of emerging infectious diseases reported globally come from animals13. Development assistance for health fell to USD 39 billion in 2025, 51% below its 2021 peak, and the United States left WHO on 22 January 20262221. This baseline reads these events as mechanisms, not as a list. It ranks no country or agency, attributes no outbreak or release and recommends no policy.

S.2Key messages

Six readings that frame the health security baseline, and the eight questions this edition answers, each with its status and source.

  1. Yes: animal origin, drug resistance, immunity gaps and weak water and sanitation recur across events.61013

    Do health threats have common causes?Reported

  2. Across health zones, provinces and borders; one DRC outbreak reached Uganda and a case abroad.2647

    How do outbreaks spread?Reported

  3. Partly: the amended IHR are in force; the Pandemic Agreement annex is not agreed.34

    Is the rulebook in place?Reported

  4. 13.5 million zero-dose children in 2025.8

    How large is the immunity gap?Reported

  5. About one in six infections resistant; data are missing for 48% of countries.6

    How serious is drug resistance?Reported

  6. Aid for health fell to USD 39 billion in 2025.22

    Does money matter?Reported

  7. Emergencies end, and new ones begin; countermeasures lag.547

    What did mpox and Ebola show?Reported

  8. An outbreak that overlaps reduced financing and thin surveillance. SCN-SR08-OUT-01

    What will 2027 test first?Expert input

S.3Headline finding

ReportedEQL 4NRF-STRATEGIC-HEALTHSECURITY-GLOBAL-2026-BASELINE-HLT-003

By 27 September 2026 the DRC had 8,116 confirmed cases of Bundibugyo virus disease and 3,924 deaths across seven provinces, and no licensed vaccine or specific treatment exists.

Figure S.1Bundibugyo virus disease in the DRC, to 27 September 2026
ItemBar, scaled to the largest valueValue
Confirmed cases8,116
Confirmed deaths3,924

Source: ECDC47. Cumulative confirmed counts with a cut-off of 27 September 2026; the outbreak was still active.

The count is large and still rising, and the response rests on tools that are not yet licensed. WHO assessed the risk as high at national and regional levels and low at global level in May 2026, and the Director-General found that the event was not a pandemic emergency24. WHO advised against travel and trade restrictions25.

S.4At a glance

8,116confirmed cases

Ebola, DRC47

11 of 196States Parties

rejected IHR amendments4

13.5million

zero-dose children, 20258

1 in 6infections

resistant, 20236

>60%

emerging diseases from animals13

39USD billion

DAH, 202522

S.5What each steward reads in it

GCRI · KEY T

Technical Truth

The evidence supports reading health security as one connected system.

GRF · KEY M

Public Meaning

For most people a health threat arrives as a closed clinic, a missed vaccine or a drug that no longer works.

GRA · KEY F

Capital Meaning

Readiness implications only. Aid for health has fallen, large funding needs remain for diseases such as tuberculosis, and emergency funds were small against the Ebola response in May 2026.

NEXUS

Synthesis

Health-security risk is well described event by event and thinly measured as a system.

S.6What this edition is, and is not

What this edition is

A baseline: the 2026 state of the world’s health security, One Health and biosecurity systems and the couplings through which it carries risk into other systems. It synthesises published evidence and ranks no country, company or asset.

What it is not

Not a health-security ranking, a threat attribution, a clinical or public-health guideline, a biosafety disclosure or an assessment of any government, laboratory or health agency. Outbreak response, laboratory oversight and treaty compliance rest with competent authorities.

What comes next

National, regional and sector evidence feeds the 2027 health security edition through the federation. Each edition reports what changed against this baseline: observations, source revisions, method changes, scenario updates and corrections.

Notes

Numbers are the edition’s reference numbers, so a note reads the same in every chapter. The full list, with every source and its licence, is in Annex C. Annex C, references

  1. 47ECDC (ed.), Ebola disease outbreak caused by Bundibugyo virus, Democratic Republic of the Congo, update of 30 September 2026 (cases up to 27 September 2026: 8,116 confirmed and 3,924 deaths; seven provinces; 63 of 167 health zones; Uganda 20 confirmed cases). European Centre for Disease Prevention and Control, Stockholm. Observation year 2026. Accessed 2026-11-03.back
  2. 4WHO (ed.), Amended International Health Regulations enter into force, news release of 19 September 2025 (11 of 196 States Parties rejected; pandemic emergency level; National IHR Authorities). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  3. 2WHO (ed.), WHO Member States agree to extend negotiations on the Pathogen Access and Benefit Sharing annex, news release of 1 May 2026 (resumed sixth meeting 27 April to 1 May 2026; seventh meeting 6 to 17 July 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
  4. 3WHO (ed.), Seventy-ninth World Health Assembly daily update, 19 May 2026 (decision to continue the annex negotiations; outcome to the Eightieth Assembly in May 2027 or a special session in 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
  5. 6WHO (ed.), WHO warns of widespread resistance to common antibiotics worldwide, news release of 13 October 2025 on the Global antibiotic resistance surveillance report 2025 (data year 2023; 104 reporting countries). World Health Organization, Geneva. Observation year 2023. Accessed 2026-11-03.back
  6. 13WHO (ed.), One Health, fact sheet (Quadripartite; over 60% of emerging infectious diseases reported globally come from animals). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  7. 22IHME (ed.), Financing Global Health 2025, news release of 15 July 2025 (development assistance for health USD 39 billion in 2025; USD 80 billion peak in 2021; US financing down 67%), read through a syndicated release. Institute for Health Metrics and Evaluation, Seattle. Observation year 2025. Accessed 2026-11-03.back
  8. 21US Department of Health and Human Services (ed.), HHS Fact Sheet: U.S. Withdrawal from the World Health Organization (Executive Order 14155 of 20 January 2025; effective 22 January 2026), hosted on the CDC site. HHS, Washington. Observation year 2026. Accessed 2026-11-03.back
  9. 10WHO (ed.), Cholera, fact sheet (451,499 cases and 7,870 deaths reported from 47 countries in 2025). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  10. 26WHO (ed.), Disease Outbreak News 2026-DON612, 3 July 2026 (1,481 confirmed cases and 454 deaths; one imported case in France). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
  11. 8WHO (ed.), Immunisation coverage, fact sheet (WUENIC estimates for 2025, released 15 July 2026). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  12. 5WHO (ed.), Fifth meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024, statement published 30 October 2025 (Director-General determination of 5 September 2025). World Health Organization, Geneva. Observation year 2025. Accessed 2026-11-03.back
  13. 24WHO (ed.), WHO Director-General’s opening remarks at the media briefing on Ebola outbreak in DRC and Uganda, 20 May 2026 (Bundibugyo virus; not a pandemic emergency; Contingency Fund for Emergencies). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back
  14. 25POST-CLOSE, context only: WHO (ed.), Disease Outbreak News 2026-DON607, 13 June 2026 (695 confirmed cases; risk assessment; continental response plan June to November 2026). World Health Organization, Geneva. Observation year 2026. Accessed 2026-11-03.back

Cite this summary

Valadbaygi, S. (Ed.). (2026). Executive summary: Executive summary. In Strategic Systems Report 2026: Health Security, One Health and Biosecurity (Baseline Edition 2026, Report No. NR-STRATEGIC-HEALTHSECURITY-GLOBAL-2026-BASELINE) [Draft under review]. The Global Centre for Risk and Innovation (GCRI).

Every citation form of the whole report, BibTeX and RIS included, is on the edition home. Cite this report

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Sector signature

The sectors behind Health Security, One Health and Biosecurity.

A reading aid: the sectors the findings run through and how strongly they depend on each other.

Select corners · hover lines6 / 15 relations

Signature

Health and its partners

Health gives workforce for operations to infrastructure (0.3), farm labour to food (0.3) and utility workforce to water (0.2).

W · E · I · F · H · B

Sectors
4 of 6
Relations
6 of 15
Coupling
0.42 share of total

Strongest relations in play

  • Water → Food · irrigation0.8
  • Food → Health · nutrition0.7
  • Infrastructure → Water · pipes, dams and treatment works0.6
  • Water → Health · drinking water and sanitation0.7
Teaching values for a typical city-region, not measurements for any place. Coupling is the summed strength of the relations in play, as a share of all fifteen.
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