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• Long COVID, economic fallout persist
• US withdrawal from WHO threatens future global health
• Experts say world is ill-prepared for next 'Disease X'

Five years after COVID-19 was declared a pandemic, experts worry the world has still not learnt its lessons, saying it is a question of when - not if - a deadly, new "Disease X" strikes.

Scientific for an unknown or hypothetical pathogen, could cause an international epidemic or pandemic that again sweeps the world - and health experts are united in believing one will come.

The in the United States, mpox outbreaks in African countries and respiratory infections in China have all raised questions over the strength of global health systems.

In 2022, a panel set up by the World Health Organisation (WHO) found that the world is no better prepared for a new pandemic than it was when coronavirus emerged in 2019 - and may actually be in a , given the economic toll.

So what lessons were learnt from COVID-19 and what are the worst-hit countries doing to guard against any re-run?

The impact of COVID-19

The International Monetary Fund estimates that COVID-19 cost the global economy nearly , with losses made worse by a lack of preparedness.

From shattered economies to overwhelmed healthcare systems, the impacts of the pandemic continue to be felt.

The WHO estimates that nearly were associated with COVID. About 400 million people have had long COVID, costing countries billions in lost productivity and increased health and social welfare costs.

According to the International Labour Organization, were lost in 2020, the year a global pandemic was declared. The ILO estimates that $3.7 trillion was lost in labour income.

What global measures have been taken since COVID?

The Pandemic Fund, hosted by the World Bank, was set up in September 2022 to finance pandemic prevention policies in low- and middle-income countries.

It is the first fund of its kind and has already raised from rich countries and charitable foundations.

However, in a 2023 , the Global Pandemic Preparedness Monitoring Board said attempts to fund pandemic prevention were "woefully inadequate, inefficient, uncoordinated".

The WHO's 194 members have been in talks for two years to draw up a pact to before and in a pandemic.

A new treaty is meant to address some of the systemic inequalities faced by the Global South in accessing vaccines and help them improve their healthcare services.

The WHO has faced criticism over its COVID response, accused of failing to declare the initial an international emergency.

A report by The Lancet medical journal said the WHO had acted "too cautiously and (was) too slow" on , be it on face masks or travel bans.

The return of Donald Trump has further clouded the outlook, with the newly-sworn-in president signing an executive order to withdraw his nation, the WHO's top funder, from the U.N. agency.

The order accuses the WHO of and being unduly influenced by other nations, which the WHO denies.

Last December, WHO chief Tedros Adhanom Ghebreyesus said he was confident of securing a pandemic deal by May 2025 but some nations fear such an accord could

The pandemic treaty talks resume on Feb. 17.

Which countries suffered worst from COVID-19?

UNITED STATES – It registered the with 1.2 million people dying from the virus, according to the Centers for Disease Control and Prevention.

In 2021, then-President Joe Biden established the American Pandemic Preparedness Plan to and bolster their links with local communities.

A year later, Congress established the Office of Pandemic Preparedness and Response Policy to advise the president.

Trump, who had threatened to during the presidential campaign, recently appointed Gerald Parker, a former health official, to run it.

BRAZIL - More than 700,000 people died between 2020-2023 as a result of COVID, the highest death toll in South America. 

Then-president Jair Bolsonaro was criticised for downplaying the risk, and promoting unproven treatments.

Last year, a major Brazilian vaccine manufacturer, , joined the Coalition for Epidemic Preparedness Innovations' (CEPI) - a network of vaccine manufacturers in the Global South.

The group wants faster, fairer responses to future threats.

CEPI has adopted the , aiming to develop safe and effective vaccines within 100 days of any pandemic threat being reported.

INDIA - India was particularly by a second wave of COVID in 2021 with hospitals scrabbling for beds and oxygen. The country logged more than half a million COVID deaths.

Some experts said India's initial response was faster than its neighbours', but that vaccine rollout was then slow and its healthcare systems were underfunded, meaning millions were struck in the

In early 2024, India established a National Pandemic Preparedness Plan for Respiratory Viruses. 

The Serum Institute of India, the world's largest vaccine manufacturer, last year.

RUSSIA - According to Russian data, more than 400,000 people , although some estimates suggest the figure is

There is little on Moscow's handling of COVID.

In 2022, Russia unveiled a project known as the to strengthen public health and "fend off infections". Under the project, scientists and epidemiologists work on pandemic prevention and vaccine development.

MEXICO - COVID accounted for about in Mexico between 2020 and 2022, according to the John Hopkins Coronavirus Research Center.

The government was for refusing to close its borders when the Omicron variant surfaced in 2021, accused of prioritising over domestic health.

Restrictions were only imposed after Mexico came under U.S. pressure due to the rising number of migrants crossing Mexico as they headed north for the U.S. border.

Last October, Mexico, Canada and the United States unveiled the North American Preparedness for Animal and Human Pandemics Initiative, updating an old plan drawn up for influenza.

Under the pact, the three countries will collaborate on policy and health efforts in the event of a pandemic.

Mexico for 2025 by 12%, raising concerns that pandemic preparations would suffer.

Which other countries were hard hit?

Peru, Bulgaria, Hungary and Bosnia and Herzegovina suffered some of the worst COVID death rates, averaging some 3,000 – 7,000 deaths per million people.

Eastern European and Balkan countries made up a majority of the countries with the , which experts put down to in public health after the collapse of communism.

In 2024, North Macedonia adopted an action plan to deal with disease threats, leading the way in the Western Balkans.

Bulgaria, which had the highest death rate in Europe, is after experts found rural areas fared worse under COVID than its big cites. 

(Reporting by Noah Anthony Enahoro; Editing by Lyndsay Griffiths.)