The investment case for bolstering global systems for pandemic preparedness and response is clear. Yet, COVID-19 exposed gaping holes in our collective ability to respond to pandemic threats. And even after more than 6.9 million deaths from COVID-19 and trillions in economic losses, financing and policy arrangements for preparedness remain insufficient. Policymakers still need to reckon with the lessons learned during recent outbreaks to ensure stronger systems going forward.
CGD recently released the season finale of the new podcast series Pandemic Proof. Over the past 10 episodes, co-hosts Amanda Glassman and Javier Guzman talked with experts from around the world about the weaknesses in the global architecture for pandemic preparedness and response. Each episode dove into a different aspect of preparedness and policy actions needed to improve global systems going forward.
In this blog, we draw out three themes that emerged throughout the season and consider the future of pandemic preparedness and response—and Pandemic Proof. We’ve heard from our guests that stronger global preparedness capacity requires…
More coordination within and between countries
COVID-19 caught the world unprepared and led to disparate, nationalistic approaches to curb the outbreak, secure medical countermeasures, and balance trade-offs between health precautions and economic impacts. Going forward, better coordination within and between countries will be critical to translate lessons learned into stronger preparedness and response capacity at the national, regional, and global levels.
At the national level, Taiwan saw the return on its earlier investments in stronger preparedness measures during early stages of the COVID-19 pandemic. Yi-Chun Lo, Deputy Director-General of Taiwan’s Centers for Disease Control, reflected on Taiwan’s policy actions and legislative changes in the wake of the 2003 SARS epidemic, including bolstering capacity for quick and early disease intelligence and establishing a strong and centralized epidemic command center. These initiatives enabled Taiwan to mount a rapid intersectoral response to COVID-19, with only 10 deaths during the first year of the pandemic. However, since Taiwan reversed its “Zero COVID” policy last year, mortality rates have climbed, underscoring the work ahead to improve Taiwan’s capability to respond beyond the initial acute phase.
Regional initiatives are key to driving collective action and enabling a more efficient response to pandemic threats. Jarbas Barbosa da Silva, who was inaugurated as the new Director of the Pan American Health Organization (PAHO) earlier this year, discussed the role PAHO can play in expanding regional manufacturing capacity in Latin America and the Caribbean and ensuring access to medical countermeasures among vulnerable populations, such as indigenous groups, during future health emergencies.
Regional coordination is also critical to combat another pandemic threat—antimicrobial resistance. Malin Grape, Sweden’s Ambassador of Antimicrobial Resistance, outlined how Sweden is leveraging its current presidency of the European Union to bring together stakeholders across the region and induce cooperation on key issues like the availability of antimicrobials in European markets and incentives to develop new drugs. At the same time, Sweden is piloting a novel purchasing system for antimicrobials, which could generate lessons for application around the world.
Inequities in the global response to COVID-19 led to delays in accessing vaccines and treatments in lower-income countries. And although progress has been made to address gaps in global coordination and preparedness, the world has not translated all lessons from COVID-19 into stronger capacity. Boghuma Titanji, Assistant Professor of Medicine at Emory University, characterized the mpox (formerly called monkeypox) outbreak that flared up last year as a stress test that the world failed. Medical countermeasures were again concentrated in higher-income countries, pointing to an urgent need to reform global systems to ensure better coordination and a more equitable response in the future.
More and better distributed financing
Swift and equitable responses to outbreaks of pandemic potential require adequate, available financing. Since July 2022, when Pandemic Proof launched, significant strides have been made to bolster finance for pandemic preparedness at the international level.
The establishment of a new Pandemic Fund at the World Bank is an important step. Victor Dzau, President of the National Academy of Medicine, set the scene for this emerging financing mechanism, which will provide additional financing for pandemic prevention, preparedness, and response capabilities in low- and middle-income countries. Commitments to the Pandemic Fund so far ($1.6 billion) have far undershot the estimated annual international need ($10.5 billion)—an estimate Dzau called “conservative” to begin with. Expressions of interest in the Pandemic Fund’s first round of funding amounted to nearly 20 times the funding available, showing a clear need for additional financing.
If nothing else, the massive price tag associated with insufficient preparedness should incentivize such investments. The costs of a pandemic far exceed those of investing before an outbreak begins, as Rachel Glennerster, Associate Professor of Economics at the University of Chicago, laid out: the expected global losses from pandemics amount to over $800 billion annually, but according to her model, spending $60 billion up front and $5 billion annually on production capacity for vaccines and supply chain inputs would help us to mitigate those losses.
In addition to the total amount of financing, who holds the purse strings matters to ensure equity. Amadou Alpha Sall, CEO of Institut Pasteur of Dakar in Senegal, highlighted the need for increased supply of medical countermeasures to mitigate diseases with disproportionate impact in Africa—including sickle cell, cholera, and Ebola—and called for Africa to have more control over the financing for preparedness on the continent. And the lack of timely, sufficient funds for COVAX—the vaccine pillar of the Access to COVID-19 Tools Accelerator (ACT-A)—led to delays in accessing COVID-19 vaccines in lower-income countries, as Ayoade Alakija, WHO’s Special Envoy for the ACT-A and co-chair of the African Union’s African Vaccine Delivery Alliance, pointed out. Strengthening the global architecture for pandemic preparedness requires that funds enable equitable, as well as quick, responses.
More robust data and data systems
Data helps drive decisions about whether to increase caution or relax guidelines; continue with current policies or pivot to alternate approaches; and/or invest in one priority or another. During the COVID-19 pandemic, policymakers and the public scrambled for data to inform decision-making. Many initiatives made headway to fill data gaps in the midst of COVID-19, but systems must still be strengthened to support better understanding of, and more effective responses to, health emergencies going forward.
During the COVID-19 pandemic, reporters stepped up to the frontlines to disseminate information on disease transmission, infection rates, and the development of medical countermeasures. John Burn-Murdoch, Chief Data Reporter at the Financial Times, reflected on the demand for information and data visualizations to track the outbreak. Natasha Loder, Health Editor at The Economist, acknowledged the media’s agility to react during the “fog of war,” which enabled a quicker response while also contributing to a rise in misinformation and disinformation.
Functional public health surveillance systems rely on continuous and systematic collection, analysis, and interpretation of health-related data. However, data gaps and deficiencies plagued COVID-19 responses in higher-income as well as lower-income settings, as Oliver Morgan, Director of the Health Emergency and Risk Assessment Department at the WHO Health Emergencies Programme, and Theo Vos, Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation, highlighted.
As data indicates changes in outbreaks, policies should, in turn, evolve. We’re in a very different stage of the pandemic now than we were three years ago—or in July 2022, when Pandemic Proof began. And policies must reflect current realities. Ashish Jha, COVID-19 response coordinator in President Biden’s White House, attributed the upcoming end of the US public health emergency for COVID-19 to higher levels of vaccination than before and less need for the “flexibilities” permitted during emergencies.
What comes next?
Within and beyond these three focus areas, there are many ways to bolster global preparedness capacity. Priority setting will be especially important given tight budgets and multiple, competing crises.
To this end, Pandemic Proof guests were asked the same question: If you could prioritize one change in the global architecture for pandemic preparedness and response, what would it be? Proposals ranged from global mechanisms to facilitate equitable, timely sharing of medical countermeasures to a global network of pathogen sampling among cross-border travelers and representative governance arrangements that amplify voices from lower-income countries.
There is a lot on the horizon to move some of these policy proposals to action. The Pandemic Fund will select projects for its first round of funding this summer (and we at CGD are monitoring its next steps). The UN General Assembly passed a resolution for a High-Level Meeting on pandemic prevention, preparedness, and response, set to take place in September 2023. World Health Organization member countries are negotiating a global pandemic accord to protect against future pandemic emergencies.
And this means there’s still much more to talk about on Pandemic Proof! We want to hear from you—the listeners—on whom we should speak to and what topics we should cover in the next season. Feel free to email us (firstname.lastname@example.org) or reach out to us on Twitter (@CGDev) to share suggestions. And in the meantime, check out more of CGD’s work on financing for outbreak preparedness and response and global health security.
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.