Ilona Kickbusch has proposed to analyze this space along three dimensions, namely “global health governance” (refers to “those institutions and processes of governance which are related to an explicit health mandate”), “global governance for health” (refers to “those institutions and processes of global governance which have a direct and indirect health impact”) and “governance for global health” (refers to “the institutions and mechanisms established at the national and regional level to contribute to global health governance and/or to governance for global health”) [7]. Many players have been involved, centered on the WHO and the World Bank because they represent the main sources of health expertise and development financing, respectively. In addition, a number of United Nations (UN) specialized agencies, funds, and programmes within the UN system, such as Food and Agriculture Organization (FAO), World Meteorological Organization (WMO), United Nations Environment Programme (UNEP), United Nations Population Fund (UNFPA), United Nations Development Programme (UNDP), have been playing important and various roles in global health. Global health governance also includes a wide variety of actors within the private sector and civil society. Some of those actors (e.g., the Bill & Melinda Gates Foundation) have become highly prominent in recent years. The leading role of global governance is still the international mechanism established by various sovereign countries [8], while more flexible informal international mechanisms also play an increasingly important role in setting the global health governance agenda.

Factors related to the capabilities for emergency preparedness include the capacity of the public health agency or the government to mobilize human, physical, and financial resources, to identify, prepare, and deploy staff, and to implement response operations and communicate with the public [9]. The WHO and its member states have recognized the significance of having a central location for emergency preparedness and response, aligning with the International Health Regulations (IHR) (2005) and Global Health Security Agenda. The WHO Department of Global Capacities, Alert, and Responses established the Public Health Emergency Operation Center (PHEOC) network in 2012 to promote best practices and support PHEOC capacity building among member countries. In 2020, the WHO requested the activation of the United Nations Crisis Management Policy by the UN Secretary-General, the highest level of crisis alert and the first activation for a health-related event. This policy activation enables the WHO to chair the COVID-19 Crisis Management Team and to coordinate UN strategies, policy decisions, and plans. In 2021, the WHO set up a new hub in Berlin, WHO Hub for Pandemic and Epidemic Intelligence, to ensure better global coordination in response to potential epidemics in the future. Meanwhile, some national strategies have also been developed to strengthen the capacity for emergency preparedness and response. For instance, Japan’s Ministry of Health, Labor, and Welfare established the Infectious Disease Emergency Specialists training in 2015, involving various national institutes with a broad range of expertise in health emergencies. In China, the Ministry of Emergency Management was established in 2018, with the overarching responsibility of preparing for and responding to natural and man-made disasters.

Surveillance of communicable diseases covers communicable diseases and the pathogens attributable to the diseases. It includes both passive and active surveillance, such as syndromes, events, and other relevant factors such as drug sales and school attendance [10]. Based on surveillance data, timely and appropriate feedback facilitates early warning before, or early, in the epidemic/outbreaks of communicable diseases to inform the risk of spatial-temporal incidence and subsequent countermeasures. In 1968, the WHO underlined the significance of communicable diseases surveillance at the 21st World Health Assembly. Accordingly, countries started to establish surveillance and early warning systems for communicable diseases. The National Notifiable Diseases Surveillance System has been established in the United States to monitor infectious diseases, bioterrorism, and some non-communicable diseases, with electronic laboratory reporting for laboratory findings [11]. In China, the National Notifiable Diseases Reporting System achieves real-time and online reports of notifiable infectious diseases, recording the demography, clinical diagnosis, and epidemiological data of the cases. Similarly, the European Centre for Disease Prevention and Control has established the European Surveillance System in the European Union / European Economic Area. Additionally, modern surveillance systems use early warning technology to identify unusual increases in the incidence rate of certain communicable diseases beyond the normal level. They often incorporate spatial and temporal statistical alerts, custom querying, user-defined alert notifications, geographical mapping, remote data capture, and event communications [12]. Furthermore, the WHO established the Global Public Health Intelligence Network, which utilizes the non-governmental media data for early warning.

The development of evaluation tools has played an increasingly crucial role in generating scientific evidence to understand the global reality and identify gaps and priorities in infectious disease control (Additional file 2). In 2007, the WHO proposed six core “building blocks” in its health system framework after the release of the World Health Report 2000 [13], which attempted to evaluate the performance of health systems for countries/territories around the globe and improve understanding of what a good health system should be. The WHO has also developed the IHR Monitoring and Evaluation Framework [14] to monitor progress according to the requirements of the IHR. Under the framework, the Self-Assessment Annual Reporting tool [15] has been designed for mandatory reporting, which quantifies a country’s progress in developing the capabilities of the 13 areas required in the IHR. In 2020, the WHO further developed the COVID-19 Strategic Preparedness and Response Monitoring and Evaluation Framework [16] to provide guidance for the COVID-19 response. An abundance of technical guidance has also been in place for managing infectious diseases. In 2020, the WHO released the road map and sustainability framework for neglected tropical disease (NTD) [17] to further guide the shift from a disease-specific approach to an integrated approach that cuts across all 20 NTD groups. In addition, a number of tools have been developed for the measurement of infectious disease control, such as the Global Burden of Disease tool [18], which opens up an era of the composite evaluation of disease burden and serves as one of the most recognized tools for quantifying global health losses from diseases, injuries, and risk factors, and the Performance of Veterinary Services Pathway, which provides data resources for the analysis of gaps and capacities in zoonotic diseases control.

The most fundamental approach to infectious disease prevention and control is to enhance health system resilience. A health system, as modularized by the WHO, consists of six core components or “building blocks” [19]. Firstly, leadership/governance and health information systems serve as the basis for the other blocks. Local and central governments’ leadership, intergovernmental coordination, infectious disease-related legislation, and information communication are identified as key factors for risk management against infectious diseases [20]. Secondly, flexible, accessible financing is important for maintaining a resilient health system that is prepared for infectious disease prevention and control. In 2019, according to the statistics from Global Health Expenditure Database [21], the Domestic General Government Health Expenditure (GGHE-D) reached a global average of USD 26.9 billion, and the expenditure on infectious and parasite diseases took up 35.12% of the total GGHE-D. Health system strengthening and sector-wide approaches draw an overall increasing investment worldwide and in 2020 reached USD 5.5 billion, or 9.95% of the total spending [22]. Thirdly, the role of health workforce for a competent health system has been emphasized as central during the COVID-19 pandemic [23]. Finally, access to health products, technology, and service delivery, as the immediate outputs of a health system [24], constitute people’s direct impression and experience of the health system, calling for strengthening of human-centric healthcare delivery. Along the road, primary health care (PHC) is deemed “the engine for Universal Health Coverage (UHC)” [25] and essential to ensure a resilient health system because it is effective in reducing infectious disease mortality and improving health outcomes [26].