Simulation exercises, scenarios, and preparedness in global health governance after COVID-19

This article focuses on preparedness for the future in global health governance and explores a possible trajectory of development in this regard. Drawing on long-term ethnographic research on simulations and scenarios in global health, it specifically examines the World Health Organisation’s (WHO) longstanding work with simulation exercises and relatively recent engagement with scenarios during the COVID-19 pandemic. Based on a detailed analysis of these two activities, specifically their process, purpose, and problem, we argue that two distinguishable patterns of preparedness are visible. Whereas preparedness in the WHO’s simulation exercises is centered on protecting vital systems from future, catastrophe-inducing collapse as a result of a threat or emergency, preparedness in the organisation’s work with scenarios is centered on influencing ‘ecosystems of change’ that shape future spaces of operation. We conclude by discussing what a potential shift in attention from protecting vital systems to influencing ecosystems of change could mean for global health governance moving forward.