The international community’s response to famine prevention is in urgent need of reform as nearly one million people face famine conditions. Six countries are at highest risk of famine: Somalia, Ethiopia, Afghanistan, Yemen, northeast Nigeria, and South Sudan. They host nearly 100 million people facing food insecurity – close to one-third of the global caseload. This represents a tripling in food insecurity compared to the ‘four famines’ risk in 2017. By late 2022, these states already hosted nearly one million people who were projected to slip into famine conditions and millions more on the brink, putting them at risk of starvation. Getting the global response right in these states could tip the scale away from catastrophe.