Published on Investing in Health

The first line of defense against outbreaks is to finance pandemic preparedness at a national level

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A portrait of an Ebola survivor, Dr. Gassama Ibrahima at the Matam Medical Center in
Conakry, Guinea on March 16, 2015. Photo © Dominic Chavez/World Bank

The case for investing in pandemic preparedness is –or at least, should be -  completely compelling. Few things could kill as many people as an influenza pandemic. Few threats can cause as much economic disruption as the contagion of fear triggered by a rapidly escalating epidemic. Reinforcing capabilities such as disease surveillance, diagnostic laboratories and infection control would be more effective and cost far less than spending money to contain outbreaks when they occur. Yet, so far, the global community has demonstrably not invested enough in preparedness. As a result, too many lives have been lost and too many livelihoods damaged, and the world remains scarily vulnerable.  

In the wake of Ebola, a number of commissions and panels made recommendations about how the world could be better prepared to prevent, identify, contain and respond to infectious disease outbreaks. All these reviews – including the one I chaired  for the US National Academy of Medicine – agreed on three key priorities: strengthening preparedness at a national level; improving coordination and capabilities at a regional and global level; and accelerating R&D in this arena.  Over the last twelve months progress has been made in implementing many of these recommendations, but big gaps and weaknesses remain. As a recent paper in the British Medical Journal put it, there has been “ample analysis, inadequate action”.
The first line of defense against infectious disease outbreaks is preparedness at a national level, so reinforcing these capabilities is a top priority. Finding sustainable financing is a challenge. It’s always easier to find the money to respond to an outbreak than to secure investment to stop one happening. There’s always another health priority that offers more immediately visible results than investing in disease prevention and control.
To address this challenge an International Working Group on Financing Pandemic Preparedness was created in November 2016. This Group, which I chair, comprises experts and leaders from multilateral organizations, academia, philanthropic institutions and businesses (see box 1 for a list of members). The secretariat is provided by the World Bank and is led by Mukesh Chawla.
Box 1

The objective of the International Working Group is to propose ways in which national governments and development partners can ensure adequate and sustainable financing for actions to strengthen pandemic preparedness and thus enable effective compliance with the International Health Regulations. We‘re looking at the financing of critical capacities such as disease surveillance systems, laboratory networks and emergency operations centers, as well as “One Health” initiatives like those described in Franck Berthe’s recent blog. Our primary focus is infectious disease outbreaks. But because so much of what needs to be done also makes sense to counter the threat of anti-microbial resistant outbreaks, we’ve expanded our scope to cover actions that serve both purposes.

For many countries, the starting point will be the results of a Joint External Evaluation. This recently introduced process of rigorous peer review is a huge step forward. It provides a systematic and objective assessment of a country capabilities across 19 domains, plus a prioritised list of gaps to be addressed. We want the outcomes of these evaluations to be translated into adequately funded action plans that countries can implement. It’s crucial that the financing is sustained: investing in preparedness is not a one-off, but an ongoing requirement.

The scope of our investigation includes domestic resource mobilization, development assistance and private sector engagement. For many countries, financing preparedness through the domestic public sector budget is the best way to ensure sustained funding and seamless integration with the rest of the health system. This requires ensuring sufficient priority is attached to investing in pandemic preparedness in budget allocations. In some countries, there may also be scope to increase the fiscal envelope through improvements in tax design and collection or even hypothecated taxes.

For the poorest and most fragile countries, there is clearly a role for international development assistance in reinforcing pandemic preparedness.  Here, the challenge is to ensure such contributions are effectively coordinated and prioritized, and that we transition to a sustainable funding arrangement, rather than something that withers when donor priorities change.

The private sector can potentially play a significant role: as an advocate for better preparedness, as a provider of capabilities and as a source of finance. But for private sector to play their part, they need a better understanding of what’s at stake – what they stand to lose from a serious disease outbreak, and the potential return on investment on actions taken to prevent such events.

The International Working Group on Financing Pandemic Preparedness will deliver its final report in May for consideration by the UNSG’s Global Health Task force, the G20 and the World Health Assembly. We’re open to ideas. So if you have thoughts or suggestions  on how best to secure sustainable financing for pandemic preparedness at a national level, we would be delighted to hear them. Leave a comment or email us at



Peter Sands

Senior Fellow at the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School

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