Fixing the broken pandemic financing system

By David Miliband, Elizabeth Radin and Christopher Eleftheriades

NEW YORK — Since the G-7 last met in August 2019, COVID-19 has resulted in 3.5 million deaths and economic losses projected to reach $22 trillion by 2025 — an economic shock 80 per cent greater than the one following the 2008 global financial crisis. Each of those cataclysmic events sparked bold, effective multilateralism that made the world safer and more prosperous thereafter. The G-7 now has an opportunity to demonstrate the same kind of leadership at its summit in Cornwall this week.

As the current G-7 president, the United Kingdom hopes to lead the global recovery from the COVID-19 recession in a way that strengthens the world’s resilience against future pandemics. Achieving this objective will require more money, but also further-reaching financing and reforms. Today’s leaders must address the specific failings of past pandemic financing efforts by linking long-term investments in preparedness to early-stage rapid financing mechanisms.

The devastation caused by COVID-19 has underscored what experts have said for years: Our national, regional and global systems are grossly inadequate for detecting and containing outbreaks. Investment of billions of dollars is needed to avoid trillions more in losses and untold human suffering in the future.

Proposals on how to finance pandemic preparedness abound. But unless preparedness plans and systems can be activated rapidly and at scale when an outbreak occurs, we will not have achieved the necessary level of resilience. In our work with the Independent Panel for Pandemic Preparedness and Response (IPPR), we have reviewed the recent history of pandemic financing and found that the current system was too slow to mobilise in the critical first months of the COVID-19 response.

One month after the World Health Organisation’s(WHO)January 30, 2020, statement declaring COVID-19 to be a Public Health Emergency of International Concern, the WHO Contingency Fund for Emergencies and the United Nation’s Central Emergency Response Fund had allocated a total of just $23.9 million.

Even three months later, only 5 per cent  of the UN’s (then) $6.71 billion Global Humanitarian Response Plan had received financing. Moreover, it took three months from the WHO’s declaration for the World Bank’s insurance and capital-market instruments to kick into gear. By the time its initial $196 million insurance payout was released in late April 2020, it had to be shared across 64 countries, 59 of which were already managing COVID-19 outbreaks. Although multilateral agencies eventually committed billions more to help low- and middle-income countries — often on concessional terms — it is clear that more stopgap financing was needed to facilitate responses in the very first days and weeks of the pandemic.

Moreover, when significant financing did start to flow, much of it went towards rushed and fragmented strategies. Eligible countries had not been required to define how response funds would be used prior to the emergency, owing not so much to an operational oversight as to a fundamental design flaw. The problem lay in the fragmentation between preparedness funds and “rapid-response” financing facilities, each of which had their own governance arrangements, planning frameworks, and funding criteria.

This compound failing — under-investment in preparedness, delayed financing for the response and discontinuity between the two — points to the need for an International Financing Facility for Pandemic Preparedness and Response. As outlined in the IPPR’s final recommendations, this mechanism should have the capacity both to mobilise long-term (10-15-year) contributions of approximately $5-10 billion annually to finance ongoing preparedness and to disburse up to $100 billion at short notice by front-loading future commitments in the event of a pandemic declaration. Such financing can be provided by issuing a social bond against future commitments, much like the International Finance Facility for Immunisation (IFFIm) has done for vaccines.

We are not proposing a new implementing agency. Rather than creating a “Global Fund for Pandemics” that would operate alongside the Global Fund to Fight AIDS, Tuberculosis, and Malaria, we envision an additional financing vehicle that could dedicate funds to existing institutions — like the Global Fund and GAVI, the Vaccine Alliance. The goal, ultimately, is to support global public goods related to preparedness: Surveillance systems, research and development, and rapid-response protocols (to allow for surges in the health workforce, effective public communication, and the pooled procurement of essential supplies).

To be sure, gaps in financing were not the only, or even the primary, failing that allowed a novel coronavirus outbreak to become a global catastrophe. If there is a single factor to blame, it is a lack of political leadership at the highest levels of national government and the international system. But here, too, a dedicated financing facility is part of the solution.

The facility we propose would be overseen by a Global Health Threats Council, a multilateral, multisectoral body designed to elevate pandemic preparedness and response to the highest levels of the international system. Led by chairs from the UN General Assembly and the G-20, the Council would be charged with maintaining political support for preparedness and response, monitoring progress toward global targets, and holding decision-makers accountable. With the authority to allocate significant funds from the financing facility, the Council could wield both carrots and sticks to ensure national-level preparedness and would hold a global credit card for responding to future health crises.

Central to this model is the combination of preparedness and rapid response — both of which would be governed by a unified global council, managed by an integrated facility, and financed through a single instrument. This structure ensures that as soon as an outbreak is detected, response financing can be deployed seamlessly by the same body that is responsible for planning, surveillance, and otherwise maintaining readiness. Financing both efforts through a single instrument — a long-term forward funding contract — would minimise the amount of funds sitting idle and ensure ongoing political engagement between crises.

If G-7 leaders hope to build resilience against future pandemic threats, they must first acknowledge the collective governance failures in the earliest days of the COVID-19 crisis, many of which stemmed from under-investment in preparedness. Then they must earn their title as world leaders by committing to a plan of unified governance, management, and financing of pandemic preparedness and rapid response. Otherwise, they will not have done enough to contain future outbreaks before they, too, become catastrophic pandemics.

David Miliband, a former British foreign secretary and member of the World Health Organisation Independent Panel for Pandemic Preparedness and Response, is CEO of the International Rescue Committee. Elizabeth Radin, a lecturer in epidemiology at Columbia University, is a council on Foreign Relations International Affairs fellow at the Airbel Impact Lab. Christopher Eleftheriades is lead of Innovative Finance at the International Rescue Committee. ©Project Syndicate, 2021. 

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