Widespread, global failures at multiple levels in the COVID-19 response led to millions of preventable deaths and reversed progress made towards the UN Sustainable Development Goals (SDGs) in many countries, according to a new Lancet COVID-19 Commission report. The Commission critically considers the global response to the first two years of the COVID-19 pandemic, citing widespread failures of prevention, transparency, rationality, basic public health practice, and operational cooperation and international solidarity that resulted in an estimated 17.7 million deaths.The report also finds that most national governments were unprepared and too slow in their response, paid too little attention to the most vulnerable groups in their societies, and were hampered by a lack of international cooperation and an epidemic of misinformation. The Commission drew evidence using new epidemiological and financial analyses to outline recommendations that will help hasten the end of the COVID-19 emergency, lessen the impact of future health threats, and achieve long-term sustainable development.The report warns that achieving these goals hinges upon a strengthened multilateralism that must centre around a reformed and bolstered World Health Organisation (WHO), as well as investments and refined planning for national pandemic preparedness and health system strengthening, with special attention to populations experiencing vulnerability.