Realising the 100 Days Mission

Accelerating defence and health capabilities for medical countermeasures readiness

Close up of ampules on a conveyor belt being filled and capped.

Photo by wacomka/Adobe Stock

What is the issue?

Biological threats, whether emerging naturally, accidentally released, or deliberately engineered, pose asymmetric risks to health and security, underscoring the urgent need for coordinated interagency responses. The 100 Days Mission (100DM), a global agenda lead by the Coalition for Epidemic Preparedness Innovations (CEPI) and adopted by G7, G20, and NATO, aims to deliver vaccines, therapeutics, and diagnostics within 100 days of a novel biological incident. CEPI is one cog in the machinery of operationalising this ambition and bridging gaps between health and security capabilities is essential for realising this ambition.

How did we help?

Our aim was to identify where collaboration between the health and defence sectors would add the greatest practical value to the 100DM. Desk research, interviews and a scenario-based tabletop exercise (TTX) to map existing public health and defence sector capabilities that can support the 100DM, identify critical enablers and interdependencies between health and defence functions, and clarify roles to pinpoint where joint capabilities can accelerate response timelines.

What did we find?

Our mapping analysis highlighted domains where capabilities are needed and sectors with a role to play. We turned this into an investment and prioritisation building TTX, which identified a focused set of priority joint capabilities targets (Figure 1) that could offer the greatest value if developed prior to an emergency by the defence and/or civilian health sectors.

Our findings showed a strong interest in financing for vaccine R&D, at-risk scale-up and manufacturing, as well as for broader medical counter measures (MCMs). Safe and secure preemergency investments in vaccine-design tools and capabilities, a library of prototype vaccines for priority viral families and delivery innovations for candidate deployment in low-resource civilian and military settings were among the capabilities most highly prioritised by both sectors during our TTX.

In particular, highly prioritised capability areas across the health and defence sectors had three characteristics:

Clear relevance to existing defence roles and incentives
Practical operational value during an outbreak
Feasibility for advancement through preemergency investment, standing arrangements or integration measures, rather than requiring wholesale legal or institutional transformation before appropriate actions could be implemented.

Figure 1. Joint capabilities across the 100DM: Stakeholder priority areas by readiness phase

1. Detection	2. Development	3. Deployment Readiness
Early-warning innovation and joint rapid diagnostic development and deployment	Financing and standing capability for vaccine and broader MCM R&D, testing, scale up and manufacturing
End-to-end biosecurity and biosafety for samples, research, and response	High-containment protocols and joint pathogen characterisation	MCM allocation principles, public trust and countering misinformation and disinformation
Pre-agreed civil–military logistics and mutual support protocols	Therapeutics co-development	Regulatory reliance for emergency authorisation

What can be done?

To translate these priorities into practical preparedness gains, stakeholders should focus on the following actions:

Defence and health funders should jointly plan investments in vaccine readiness and the broader 100DM.
Defence and health funders should build and sustain pre-agreed standing financing arrangements, in advance of an emergency, for vaccine research and development, scale-up, testing and manufacturing.
Civilian health and defence agencies should establish standing arrangements for rapid diagnostics and laboratory surge before the next emergency.
Governments and preparedness actors should define practical use cases for early-warning innovation before investing at scale.
Health, defence and emergency management authorities should codify civil–military logistics and mutual support protocols before the next emergency.
Regulators, health authorities and defence planners should invest in supporting international mechanisms, emergency authorisation and regulatory coordination for MCM development and deployment before the next public health emergency.
Biosafety and biosecurity are critical investment areas before and during a biological emergency.
Health, defence, and government leaders should treat public trust, countering misinformation and disinformation, and criteria for vaccine deployment as preparedness requirements.
Under-prioritised 100DM capabilities (e.g. tests, therapeutics, PPE) need explicit institutional investments and sponsorship before the next emergency.
Governments—including defence and health agencies and organizations—should treat the 100DM as a standing preparedness requirement rather than an emergency ambition.