Future pandemic threats are imminent—some estimates indicate a 47–57 percent chance of another global pandemic as deadly as COVID-19 in the next 25 years. But threats are not even 25 years off, they are imminent. Global leaders at UNGA underscored the urgency last month, as did high level side events.
Yet just in the past weeks, the world is experiencing an unprecedented outbreak of another virus: monkeypox disease. Previously endemic to a few countries in West and Central Africa, the disease has spread to over 100 countries, cases have surpassed 65,000 and the world is struggling to get the outbreak under control. Last month, the state of New York declared a State Disaster Emergency for polio after health officials found evidence of community spread via wastewater surveillance.
New disease threats are compounded by the ongoing COVID-19 pandemic, which is still evolving and threatening lives and livelihoods. Indeed, despite claims that the pandemic is over, the numbers paint a very different picture. Thanks to the effectiveness of the vaccine and its rollout, death rates have declined significantly (though stark inequities remain). However, globally, reported new cases during the final week of August 2022 exceeded cases reported during the same week in 2021 even as fewer people report test results to authorities.
This time last year, experts warned that the window for action is narrow—voices including the Co-Chairs of the G20 High Level Independent Panel (HLIP) on Financing the Global Commons for Pandemic Preparedness and Response. But since then, not much has changed to rein in COVID-19, and we are nowhere near endemic levels—instead the globe experienced a deadly Omicron wave and nearly two million more deaths.
One bright moment in the past year of intensifying geopolitical tensions was the creation of a dedicated fund for pandemic preparedness and response, a welcome start towards defining a collective approach to combat global challenges. On June 30, nearly one year after the HLIP delivered its report to the G20 in Venice, the Board of the World Bank Group voted to approve the establishment of a new Financial Intermediary Fund (FIF) for Pandemic Preparedness and Response. Now, decisionmakers are bogged down in the details and debates over administrative matters, with less effort given to how preparedness can be measurably improved in the countries that are most vulnerable to pandemic risk. This time next year, what will the new fund have accomplished?
Sums committed are woefully inadequate
At the Second Global COVID-19 Summit in May 2022, donors began to announce their support for the Fund, with the US leading the charge. So far, 16 donors have made pledges totaling $1.4 billion, with the US and the EU making up almost two thirds of the total. Lamentably, this amounts to just a small fraction of the annual gap of $10.5 billion identified by G20 Joint Finance and Health Task Force in March of this year—which echoed the analysis of the G20 HLIP—of the actual needs. Total needs amount to a marginal 0.01 percent of global GDP—equivalent to a paltry 1.3 percent of the US Department of Defense budget. For a matter of global security that can kill millions and cost trillions of dollars, the situation is truly irrational.
At its seventh replenishment last month, the Global Fund raised a record $14.25 billion to combat three endemic, infectious diseases: AIDS, tuberculosis and malaria. This is good news, but broader preparedness and higher quality surveillance and rapid response is needed for both existing and emerging threats, alongside financing for specific diseases. Similarly, commitments were made to increase WHO core contributions at the May 2022 World Health Assembly. Again, excellent news and the path to greater technical leadership at the WHO on standard-setting and advice, but it is no substitute for on-budget spending by governments to finance public health and preparedness.
Keeping our eyes on the ball: making the money work to support government preparedness
On September 8 and 9, the Governing Board of the new pandemic fund convened for their first meeting. Amidst the administrative discussions on governing board members, civil society representation, and institutional politics, however, we need to focus on what the fund must do: provide better, additional, on-budget funding to governments and partners to make measurable progress on pandemic preparedness in low- and middle-income countries.
To get this done, the pandemic FIF must be different.
First, a small group of eligible first-wave countries should be identified. Countries should be selected using objective, publicly available data—such as the historical frequency and magnitude of pandemic risk outbreaks, the existence of a National Action Plan for Health Security, and governance quality. These are the starter countries—the pool can be expanded when more money is available.
Second, first-wave countries should be invited to co-invest with the multilateral development bank of their choice to prepare a proposal to the FIF. The so-called developing countries are growing economically and leaving low-income status over time (barring unexpected longer-term effects of current economic shocks). Basic preparedness is affordable in most countries in the world and is a public good to be financed by government, so the aim of the FIF’s external funding is to increase salience and priority for government rather than cover costs fully. And because complementary investment needs in preparedness are large and require spend on items like human resources that imply recurrent, on-budget public investments, the aim of the fund must mainly be to blend its financing with operations and reforms defined and financed by governments in cooperation with the multilateral development banks. This means prioritizing countries with a health or related lending operation in the pipeline.
Current FIF proposals suggest a global request for proposals, open to all the implementing entities. While other entities have some role, it is, by their nature, smaller than the MDB given the objective of the FIF. As a result, issuing a global request for proposals doesn’t seem to be an efficient way to move this new model of blended financing forward. It could waste a lot of peoples’ time to develop proposals that cannot be funded or could create a situation of multiple small grants with little large-scale progress to report. Other implementing entities come into play around the independent verification of preparedness progress, in support to regional entities, or in direct funding of non-government entities in fragile or conflict-affected states.
Third, money must work to drive progress. The WHO and other experts have a good sense of ways to objectively measure the results of preparedness—the accuracy and timeliness of lab and surveillance, for example, or the time between the detection of new outbreak or a new pathogen and a response. Money can be tied to progress on these measures via matching or challenge funds, and grants could be made to conduct periodic, independent measurement. Any call for proposals or cooperative effort to design grants must contain some arrangement to create clear incentives for progress and its objective measurement. FIF co-investment using MDB instruments like policy-based loans, programmatic loans, or Payment for Results would create such incentives.
While the new fund is a good start, amounts committed are far from adequate and administrative arrangements are distracting from the main purpose of the fund. As some declare COVID-19 over and competing short-term needs beckon, preparedness is again falling off the agenda, back into the cycle of panic and neglect. If a pandemic flu hits next week, an event as likely as the 100-year rainfalls that happened multiple times just this calendar year, are we prepared? The answer so far is still no.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.