Running red lights: Risk recognition versus follow-up implementation in the case of Germany's pandemic preparation.

The discrepancy between formal arrangements to ensure health security, as assessed in the Global Health Security Index, and COVID-19 outcomes points to a broader problem where formal risk recognition is de-coupled from potentially resource-intensive follow-up policy implementation. Germany is an extreme example of this. Pre-COVID-19, Germany's Federal Office of Civilian Protection conducted two pandemic preparation exercises based on scenarios which closely mirrored the current COVID-19 pandemic: (a) a multi-jurisdictional, multi-agency crisis management exercise assuming a global influenza pandemic and (b) a joint federal and expert-agency based risk-analysis assuming the outbreak of a modified severe acute respiratory symptom virus. While informing legal and institutional reforms, key recommendations on storing personal protective equipment (PPE) and disinfectants for front-line staff were subsequently ignored. PPE shortages initially put staff at risk, led to export restrictions on PPE, and later on hampered the country's ability to address a second wave of the pandemic. This short paper calls for a fuller exploration of factors which hinder ''implementation post-cognition.''.