Designing Trigger Mechanisms for Epidemic and Pandemic Financing and Response

Nearly every consequential choice in epidemic and pandemic response requires a trigger of some kind: a set of criteria—often, but not always, quantitative—that determines whether alerts or public health declarations are issued, financing for outbreak containment and response is released, whether personnel and medical countermeasure deployment are surged, and so on. Triggers are sometimes implicit or internally facing, nested within expert guidance and decision-support processes, but are increasingly public-facing, to help the stakeholders and citizens make sense of public health guidelines and decisions. Consequently, triggers are both increasingly utilized and increasingly visible, and are the subject of continuous innovation and debate. However, there are no established frameworks or standards guiding the development and integration of triggers into public health decision-making generally, or epidemic and pandemic financing and response specifically. This paper presents a framework for high-quality trigger design with specific application to pandemic financing and response, with the goals of improving trigger effectiveness, reliability, and communication of their attributes and intended performance to stakeholders, including the public. It also includes a brief case study on the World Bank’s Pandemic Emergency Financing Facility.