16 Challenges for Emergency Research Response and Preparedness in Fragile, Weak, and Failed Nation States

Fragile and failed nation states often harbor conditions where emerging and re-emerging infectious disease (EID) outbreaks are likely to occur. Such states may struggle to provide adequate primary health care—hindering detection of new disease events—and often are unable to mount an effective outbreak response. Active conflict and consequences like large-scale displacement of populations increase opportunities for pathogens to emerge and further hinder response. Global efforts to improve capacity for infectious disease response, especially locally based research, have been modestly successful at best in fragile states. While there has been a number of recent efforts to build capacity in fragile states, these efforts must take account of deeper humanitarian obligations, many of them laid out in treaties to which most nation states are parties. Global health actors are working on improvements in governance and EID response in the wake of COVID-19, but the outlook for preparedness and response remains uncertain, particularly in fragile and failed states.