Pandemic preparedness and response: a survey among experts from High-and Low-Middle-Income Countries about the "100 Days Mission"

Vanessa Pencelli^1*Ralf Clemens¹Mihai Alexandru Bica¹Sue Ann Costa Clemens^1,2

• ¹Institute for Global Health, Laboratory of Santa Chiara, University of Siena, Siena, Italy
• ²Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, England, United Kingdom

The "100 Days Mission" (100DM) designed by the Coalition for Epidemic Preparedness Innovations (CEPI) represents an ambitious new concept in vaccine development for effective pandemic preparedness, response, and to overcome inequalities. We aimed to identify potential obstacles for the success of the 100DM by conducting a survey among experts in vaccinology and public health from both High-Income Countries (HICs) and Low-Middle-Income Countries (LMICs).A descriptive cross-sectional study using a semi-structured online survey was submitted to 116 experts from both LMICs and HICs. Data collected were analyzed quantitatively and qualitatively. Differences in responses between LMICs/HICs respondents are described. The overall response rate was 73.2% (85/116): 74% (57/77) from HICs and 69.2% (27/39) from LMICs. LMICs respondents (14/27; 51.9%) were more confident in the 100DM´s success than HICs (15/57; 26.3%) and on impact to overcome inequalities (15/27; 55.6% vs 19/57, 33.3%). Almost all experts from both LMICs and HICs considered political will and governance as well as sufficient sustainable funding as the most important success prerequisites, followed by trustful collaborations HICs/LMICs and public/private as well as continuous training and capabilities building. Establishing vaccine candidate libraries, enhancing and sustaining surveillance capabilities, and establishing laboratory and clinical trial site networks should be prioritized. This is the first prospective survey on the 100DM´s feasibility involving external stakeholders from both HICs and LMICs. Experts from LMICs are more confident in the success of the 100DM than those from HICs. Political will/good governance and sustainable financing are core for implementation success. The technical innovation part of the 100DM should prioritize the development of prototype vaccines and operational aspects over more long-term initiatives with impact. To realize CEPI´s vision, global stakeholders must set priorities and commit to focused, coordinated actions. Achieving early wins through short-term, high-impact deliverables, and actionable policy reforms is essential, not only to build confidence but also to sustain momentum and avoid stakeholders' fatigue. This strategic prioritization underpins the initiative's long-term success.