Global Health at the G7: Finance the Whole Package in a Time of Crisis

Next week, G7 leaders convene at Schloss Elmau for the G7 Leaders’ Summit. Amid multiple global crises—war in Ukraine, recession risks, intensifying climate change, rising hunger and poverty, ongoing and emerging pandemic threats—all eyes are on the Summit to deliver what high-income countries do best: more visibility and financing to address the world’s biggest problems. But equally, big solutions are often stymied by the multiple asks and competing initiatives on the table, each supported by an array of interests pushing to see “their” issues reflected in final declarations.

Despite this competitive landscape, there is an opportunity to develop a comprehensive and articulate G7 response on global health including pandemic preparedness and response. While some note the multiple asks circulating from ACT-A, the Global Fund, WHO, the new pandemic financial intermediary fund, and others, the reality is that there are relatively few multilateral global health entities of scale at more than $10 million per year, and each has a distinct mission and comparative advantage.

In a new brief, we look at the organizations’ financing requests holistically and propose a high-level outline for a package of reforms and replenishments in global health financing. Based on the organizations’ requests, a modest 33 percent increase above pre-COVID-19 G7 global health spending could address the backlog in vaccination and virus surveillance, recoup losses in other infectious disease threats like polio and HIV, and drive the basic investments in and progress on collective global health security that all agree are urgent and necessary.

The G7’s track record on financing pandemic preparedness and response

This year’s priorities are reminiscent of last year’s priorities. Last year’s “leading the global recovery from coronavirus while strengthening resilience against future pandemics” is this year’s “enhanced preparedness for healthy lives.”

On the one hand, these repeated priorities demonstrate a consistent push toward common goals. On the other, making the same commitments year after year without action and adequate investment is detrimental at a time when the world needs leaders to follow through.

Past G7 meetings have launched initiatives but have not put needed actions and—most importantly—sufficient financing behind the words. During the 2021 UK presidency, the pandemic preparedness partnership (PPP) developed a 100 Days Mission to respond to health emergencies with diagnostics, therapeutics, and vaccines within 100 days. However, these actions—deemed essential—were not even close to fully funded. Last year, the G7 also committed to ending the pandemic in 2022, but, as Dr. Tedros Adhanom Ghebreyesus reminded representatives from WHO member countries at the World Health Assembly in May, COVID-19 is “most certainly not over.”

This year, under the German presidency of the G7, we’ve seen a renewed effort to take those pledges forward as the pandemic lingers and global gaps in the COVID-19 response widen. In fulfilment of goal three of the G7 presidency, “healthy lives,” Germany laid out plans to expand the G7’s role in the commitment to pandemic prevention and control as well as improve the international health architecture.

Back in January, German Federal Minister of Health Dr. Karl Lauterbach presented the G7 Health Track priorities: to end the pandemic, tackle antimicrobial resistance (AMR), and address the nexus between climate change and health. And in May, the G7 issued a Pact for Pandemic Readiness for two outcomes: collaborative surveillance and predictable rapid response to ensure swift, decisive, and coordinated response to global health threats.

At this year’s G7 Summit, we don’t need another Carbis Bay Declaration, or multiple, small-scale initiatives, but rather a more comprehensive plan to move the global health security architecture and field forward.

A package of reforms

As multiple global funding requests and replenishments are made, we suggest that external funders take a comprehensive view of the major global health initiatives and argue for reform and replenishment together across the system, recognizing the huge scope of needs as the COVID-19 pandemic persists while long COVID threats mount.

We envision a package of near-term actions for global health including pandemic preparedness and response with three components:

1. Reform and adequately finance WHO, by increasing assessed contributions to 50 percent of the base budget, as agreed at the World Health Assembly in May 2022, and strengthening technical capacities and governance, especially in the context of health emergencies.
2. Replenish and re-envision existing global health entities—including the Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, The Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations; the Global Financing Facility; and the Global Polio Eradication Initiative—to recoup losses in the highly cost-effective fight against three still-endemic infectious diseases as well as the ongoing COVID-19 response.
3. Establish a fund for pandemic preparedness, housed at the World Bank. Together, G7 countries, including Germany, have committed just $1 billion of the $10 billion ask to set up the fund. We outline actions to make the fund effective here.

Table. Proposed global health security package – estimated additional funding per year

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Note: Sources for the figures in the above table can be found in the brief.

Taken together, we estimate that a 33 percent increase on top of existing global health aid spend—which was estimated at about $40 billion in 2019—is needed, an amount that represents a miniscule fraction of the economic devastation suffered during the COVID-19 pandemic and future potential losses. And, this $13 billion incremental ask adds up to about the same amount of additional global health aid allocated in 2020 to the COVID-19 health response. Evidently this amount of financing is feasible in a fiscal year in most high-income countries and philanthropies.

We recognize that much more must be done to assess and reimagine the global health architecture and the organizations involved than can be set out in a short framing document. Further, actions require consultation and ideation with the G20 and the rest of the world. But a G7 political and financial commitment that brings together multiple threads of requests and organizations in a way that envisions a multilateral global health system and triggers needed reforms and financing would meet the moment of pandemic and crisis.