Preparing for the next pandemic: What will it take?

In the wake of COVID-19, there have been calls for the world to be better prepared for the next pandemic.  These calls are driven by a sense that the outbreak could have been foreseen and prevented, or that the spread could have been more effectively contained causing less social and economic disruption and averting deaths.

Such calls have been made in the past and have resulted in meaningful action. Yet, the world tends to move on quickly, with new crises taking center stage, resulting in the now familiar cycle of “panic and neglect”. This is a concern: although the timing and nature of the next pandemic spark is unknowable, it is certain to happen.

Perhaps things will be different this time. COVID-19 has brought into sharp focus the limitations of past efforts and the need for a more ambitious and sustained approach to preparedness.  It is encouraging to see widespread calls for more financing, a reform of global governance for health-related crises, and fresh thinking around global public goods.

But let’s first take a look at what pandemic preparedness is and what types of investments it requires.

Pandemic preparedness starts at the country level

Preparedness starts at country level and comprises many elements.  First and foremost, it requires strong and resilient health systems, in particular primary care, to facilitate detection of disease outbreaks, provide essential care, and support deployment of vaccines and other medical countermeasures. Second, it requires surveillance systems and laboratory capacity to detect both human and zoonotic disease outbreaks. Third, mechanisms are needed for coordination across sectors for prevention and preparedness. Fourth, preparedness requires legal frameworks and regulatory instruments to support both outbreak prevention and the deployment of countermeasures. Fifth, there is a need for well-functioning supply-chains as well as adequate stockpiles of essential goods and equipment.

These and other elements of preparedness are established and reflected in the approach to the Joint External Evaluation Tool that emerged from the 2005 International Health Regulations.

As pathogens do not respect borders, there are also important cross-country dimensions of preparedness, with regional, and sub-regional institutions playing key roles in areas such as regulatory harmonization, standards for reporting and information sharing on disease outbreaks, sharing of key public health assets such as high complexity laboratories, and pooled procurement.

Many countries, especially low- and middle-income countries, have long-standing weaknesses in these preparedness domains, which translate into weaknesses at the regional level as well.  Even countries with stronger preparedness were profoundly challenged by the COVID-19 pandemic, highlighting vulnerabilities associated with the breakdown of global supply chains, and the role that a lack of trust, cohesion, and mechanisms for intra-government coordination have played in undermining response.

The World Bank’s support to preparedness

The World Bank, though IDA and IBRD, has a strong track record in providing the long-term, predictable, sustained financing that countries need to prepare for pandemics, often requiring multi-sectoral interventions. For example, using a One Health approach, that recognizes the linkages between human and animal health, and the environment, the Regional Disease Surveillance Systems Enhancement (REDISSE) program, developed in the wake of the Ebola crisis, has helped strengthen national and regional capacity for disease surveillance and epidemic preparedness across 16 countries in West and Central Africa. We have also supported the Africa CDC through IDA financing. As we help countries to address the current pandemic with our $157 billion COVID support package, the largest in our history, we continue to help build capacity to prepare for future pandemics.  What’s more, both IDA and IBRD leverage significant resources in the capital markets: IDA now provides more than $3 in concessional finance for every dollar of donor contribution; for IBRD, one dollar of additional capital can enable additional $10 in financing to clients. 

Looking ahead, the World Bank’s suite of financing mechanisms and instruments, global footprint, strong in-country presence, multisectoral expertise, and broad reach to policymakers positions us well to expand support for country and regional preparedness. Preparedness will be an important focus of IDA20, and it is set to feature more prominently in our country engagements.

The need for global action

The COVID-19 pandemic has also highlighted the need for action at the global level and a large share of proposed increases in international finance for preparedness is focused on addressing perceived gaps in the global domain.

Financing needs at the global level are diverse and complex. One key priority is to step up the financing of R&D on therapeutics and vaccines. This area is receiving significant public, private, and philanthropic financing, including in support of the Coalition for Epidemic Preparedness Innovations (CEPI), which is set up as a World Bank-supported FIF and seeks to positively disrupt financing models for vaccines against epidemic diseases.  

Equally important is the financing for medical countermeasures to ensure timely and equitable access for all countries. On the demand side, this will require building on our collective experience with pooled procurement mechanisms like COVAX and the African Vaccine Acquisition Trust (AVAT). On the supply side, there is a need to boost distributed manufacturing capacity to ensure equitable access to low-cost vaccines. Not every country needs its own vaccine manufacturing capacity, but we need to ensure that there is sufficient production capacity in developing countries that can be quickly scaled up.  Pharmaceutical companies are unlikely to invest without some degree of demand and price certainty, which is where advanced market commitments backed by donor financing can help.

How do we move forward?

The ambitious preparedness agenda has generated calls for scaling up financing. The G20 HLIP estimated that US$34 billion of public financing per year is needed over the next five years, with nearly half coming from donors. More recently, the US government has called for a US$10 billion global health fund to prepare for future pandemics and announced a US$250 million contribution to jumpstart the effort. It has been proposed that the fund be established at the World Bank.

Additional financing for preparedness could help expand the support that the World Bank and others provide to countries and regional institutions and help address gaps at the global level.

A key next step is to unpack the needs assessment and costing exercise prepared by the G20 HLIP and deepen the analysis of gaps. Financing is key for better preparedness, but strong preparedness also requires sustained political will.  This would seem to require a set of globally agreed norms and standards on pandemic preparedness—building on the Joint External Evaluation Tool–-and regular monitoring and assessment of performance against those standards. Perhaps it is time to consider a new “global compact on pandemic preparedness”, similar to the one for climate, to ensure shared commitment and collective accountability around pandemic preparedness.