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Pandemic response: Time to act is now

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Photo by Dominic Chavez @World Bank 2015

The recent, devastating Ebola crisis reminded the world of a hard truth:  Pandemics are not just a threat to human health, they are a threat to societies and economies. That there will be another pandemic is not a question of “if,” but a question of “when.”  A catastrophe on the scale of the 1918 flu epidemic could conceivably wipe out all development gains of the last century.  We recognize this, but, still we are unprepared.

No country or organization has wanted to own the issue of pandemic preparedness and response. Funding has been inadequate, inflexible, unpredictable and unsustainable. Accountability has not been clear enough.  

Research shows that, if there is no productive change of approach, and money is not appropriately spent now, we could face an annual funding gap of US$35 billion by 2031.  Wise policy choices focusing on high-impact prevention and efficient treatment could halve these costs.    

The good news is that the recent Ebola crisis has spurred an appetite to act. Last week, I was invited by the World Bank Group’s Washington offices to give the opening talk at a global pandemic financing stakeholders' meeting, where the design of a new Pandemic Emergency Financing Facility was being discussed. The facility will provide financial resources to quickly deploy trained health workers, equipment, medicines and whatever else is required when a pandemic hits. 

Other initiatives under way include the UN Secretary General’s High Level Panel on Global Response to Health Crises; the World Health Organization’s (WHO) Emergency Contingency Fund and process of internal reform; the Global Health Security Agenda, the Institute of Medicine’s Global Health Risk framework; and the Bill and Melinda Gates Foundation’s several lines of support for vaccine development and diagnostic devices.  In addition, the G7’s three global priorities include pandemics, and the private sector is showing greater recognition of the issue. Pandemics are at the top of the list of ‘extreme risks’ of importance to the insurance industry, for example. 
While these initiatives are a positive sign, there remains a fragmentation of programs within and across organizations. One major issue for global readiness is WHO’s budget, which is disproportionate to its scope of responsibility.  Its budget for Infectious Disease Outbreak Response was a mere US$241 million in 2014/15.  How will this be addressed?   
In addition, there is weak implementation of the International Health Regulations (IHR) in countries, despite it being a legally binding international treaty.  Too many countries still grapple with weak local health systems and fragmentation of infectious disease surveillance systems. 
A 2015 assessment of how donor funding is spent on global versus country-specific health investments found that of a total US $22 billion in 2013, only 21% was invested in global functions for public good, such as vaccine and drug research, pandemic preparedness and response, and global governance/leadership. 
We need to revise ways of allocating and channelling money, better. Funding flows must also be adequate, relatively unrestricted and global in reach; accessible to all stakeholders within days, if not hours; and accountable, sustainable and transparent.  There must be a new approach to staffing in country offices, and one organization – the WHO – must manage coordinated activities in a pandemic.   
Effective regulatory mechanisms for animal and human systems, public health emergency operations infrastructure and functioning laboratory systems in countries are all essential. We should have national IHR focal points, training programs for human and animal health services, and a system to mobilize, train and manage volunteers as well as international and regional networks to share resources, data and personnel, as needed. Unless the global architecture and in-country frameworks are in place, funding cannot have the desired impact.
A unified monitoring system to track humanitarian aid flows is also sorely needed.  Agencies’ unwillingness, or inability, to report on actual disbursements versus commitments paints a confusing picture and should be remedied. 
It is vital that governments and international organizations enact plans for pandemic preparedness and response if we want to avoid the catastrophic global effect that has been forecast. Most importantly, we must learn to work collaboratively, exploit comparative advantage, and hold ourselves accountable.  We must design new frameworks for international financing and collaboration, like the Pandemic Emergency Financing Facility.  
We are unprepared for a major health disaster, but we have the knowledge to avert one.   The time to act is now. 
Follow the author on Twitter at: @SaniaNishtar
Follow the World Bank Health team on Twitter: @WBG_Health

Pandemic Emergency Financing Facility
World Bank and Pandemics
Pandemic Financing


Sania Nishtar

​Sania Nishtar, SI, FRCP, Ph.D

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