Financing pandemic preparedness: from analysis to recommendations

In my blog in February I described the rationale behind the creation of the International Working Group on Financing Preparedness (“IWG”), which is focused on how to ensure sustainable funding for the first line of defence against pandemics – prevention, identification and containment of infectious disease outbreaks at a national level. The IWG had its second face-to –face meeting earlier this month in London at Wellcome Trust. The goal of this meeting was to review the analytical work that had taken place over the last couple of months and debate a draft set of recommendations. Since that meeting we have been refining these recommendations with a view to presenting them in draft form to the UN Secretary General’s Global Health Crisis taskforce on May 1 and launching the full report at the World Health Assembly on May 25.

Our report will start by reiterating the case for investing in pandemic preparedness, both to save lives and to minimize the economic risks. As Bill Gates asserted at the Munich Security Conference, pandemics rank alongside climate change and nuclear war as one the three biggest threats facing the world. World Bank President Jim Kim has also recently made the case for sustained funding of preparedness and response, arguing that we must break out of the cycle of “panic, neglect, panic, neglect”.
 
The recommendations themselves will revolve around four key themes: 1) identifying gaps and estimating funding needs; 2) developing a structured approach to reinforcing preparedness; 3) identifying sources of funding and mobilising the appropriate financial resources; and 4) reinforcing the incentives for national governments to invest in preparedness.
 
The starting point must be a systematic assessment of gaps in preparedness and a structured approach to estimating the costs of rectifying these weaknesses. The Joint External Evaluation (JEE) provides the basis for such an assessment by providing an objective peer assessment of capabilities across 19 different domains. Since its launch in February 2016, 37 countries have completed JEEs with another 32 scheduled for the next 18 months. The World Organization for Animal Health (OIE) has a well-established equivalent tool called the PVS Pathway. So far 131 countries have completed the PVS assessment (although some of these need updating). Given that most infectious diseases are zoonotic in origin, it is important that countries conduct both assessments, so as to be able to devise a truly “One Health” approach to health security.
 
There are two challenges with these vital assessments. The first is to ensure that every country conducts a JEE and a PVS, since given the global nature of these threats, our defenses are only as strong as the weakest link. The second is to ensure that such assessments don’t sit on the shelf, but are costed, turned into plans and implemented. If the JEE and PVS are the diagnostic tools, we also need effective remedial therapy.
 
Developing a structured approach to reinforcing preparedness is the next key priority. This is more difficult than many might suppose, because building preparedness is a multi-stakeholder exercise requiring coordination across many parts of government as well as the private sector and civil society. Moreover, reinforcing health security shouldn’t be pursued as yet another silo initiative, but integrated into national health plans as part of the journey towards universal health coverage. Thus far only a few countries have managed to translate their JEE assessments into fully costed plans, so this step risks being a critical bottleneck.
 
Even a good plan will fail without adequate funding, so the next requirement is to identify sources of funding and ensure the allocation of appropriate financial resources to support and sustain implementation. For most countries, domestic fiscal resources will be the primary source of funding, so the emphasis will be on winning the domestic budget prioritization debate. We need to make sure the case for investing in health security is made as compelling at the level of individual countries as it is at a global level. For the poorest countries, development assistance clearly has a role to play, particularly in funding capital investments and a step-change in capabilities. Innovative financing mechanisms, including earmarked taxes and direct contributions from the private sector, may have a role to play in some circumstances.
 
The IWG has focused considerable attention on how to reinforce the incentives for national governments to prioritize investments in health security. Ensuring health risks are factored into macroeconomic assessments of economic growth and risks would change the way policymakers view such threats. Once businesses start taking account of the risk of infectious disease outbreaks in their investment decisions, or sovereign bond prices reflect  a country’s state of preparedness, then such risks would be much more visible to finance ministers. So too would insurance premiums that reflected different levels of preparedness.
 
The IWG’s objective is to come up with a relatively small number of concrete recommendations across these four areas, so as to build on the momentum generated by the JEE process. Securing adequate and sustainable finance is vital to escaping the “panic, neglect” cycle. Look for our report on May 25.