COVID-19 proved a surprise for most of the world despite a trend of increasingly frequent pathogen outbreaks in the last 40 years. Scientists warn the trend will continue. But pandemic crises typically suffer from a ‘panic-and-neglect’ cycle, in which global measures to prevent and prepare for future pandemics remain chronically deficient. Will COVID-19 be any different?
It should be because the scale and severity of this pandemic are of a different order of magnitude to any outbreak in the past 40 years. There is some momentum for more multilateralism in global health security: the topic is on the agenda of key international forums, but without any sign yet of strong commitments to reform and financial support. The risk of not breaking the panic-and-neglect cycle is real. The European Union could be instrumental in brokering a global deal.
A number of reports containing extensive diagnosis of the COVID-19 crisis and proposals for future measures have been issued in the last six months. These include the May 2021 report by the Independent Panel for Pandemic Preparedness and Response (IPPPR), convened by the World Health Organisation/World Bank; a report by a High Level Independent Panel (HILP) to the G20 at the request of the Italian Presidency of the G20; and a report by WHO Europe’s Pan-European Commission on Health and Sustainable Development. All conclude that global health security governance is fragmented and non-transparent, and pandemic prevention and preparedness is grossly underfunded. All make recommendations on global governance and financing:
Still it will not be easy for the international community to agree on a way forward. A choice will have to be made between reliance on a United Nations-based system or a more flexible ad-hoc set up, like the G20, as proposed by WHO Europe’s Pan-European Commission and the HLIP. The IPPPR promotes a UN based system, perceived as offering more legitimacy through the principle of ‘one country, one vote’. It can secure political commitment at the highest level of heads of state and government. It can deliver a new Treaty with strong obligations and mandatory financial contributions. But as shown for climate change, such a system is slow and not always effective in raising funds in practice.
Proposals in favour of a body under the auspices of the G20 build on the good track record of the Financial Stability Board (FSB) as an informal body that has successfully shaped and enforced international financial regulation, paving the way out of the financial crisis. The G20 is perceived as more agile and solution-driven. It covers the most important donors in global health. It relies strongly on the club of finance ministers, who handle national budgets and can leverage national and international resources, including from the private sector. On the downside, The G20 has an issue of representativeness, though membership could be extended into a G20+ format. In addition, G20 structures do not always have the resources and leadership to deliver and do not have accountability processes to manage funds. The way forward might be a two-layer structure in which the G20-related body would report to the Global Health Threat Council. A cumbersome governance set-up likely to lead to paralysis and dilute responsibilities should be avoided.
The second issue is pandemic preparedness and response financing. The various expert reports indicate funding gaps of $5 billion to $15 billion annually. These estimates are substantially higher than any figure previously estimated by the global health community, and would represent a significant additional effort for the international community compared to current levels of spending. This partly reflects a push for more pooling of resources at international level, in line with a global public goods rationale. It also takes on board the COVID-19 experience, with the need to support the global supply of vaccines, therapeutics and diagnostics with substantial funding.
It is essential that the international community give due consideration to these needs. The debate will not only be on the amounts. Decisions also need to be taken on how to channel financing to the constellation of government and non-government bodies in the field of global health security. A new fund could be established (as proposed by the WHO/World Bank IPPPR), or there could be a fund of funds, a Financial Intermediary Fund (FIF), hosted by the World Bank (as proposed by the G20 HLIP). Deciding on the centre of gravity of the global health security financial support system will also be part of the early international discussions. A central role could be played by the international financial institutions (IFIs), which have strong leveraging power and long experience of programme financing. Alternatively, the lead could be given to one global health security organisation, for instance the WHO or the Global Fund. The global health community trust them for their expertise on and experience of health systems, policies related to infectious diseases and health crises. They are good at creating a community to deal with prevention and preparedness, involving non-government participants.
These discussions have started, for example at the G7 summit in June 2021 and the UN General Assembly in September. Talks will continue at the G20 meeting in October and the World Health Assembly in November. In September, the US already came up with a strategy for prevention and preparedness to pandemics and convened a Global COVID-19 Summit to promote common global goals. As part of this, the US has come out in favour of a Financial Intermediary Fund, joined by the European Commission.
Growing support for this idea is very good news though more work is needed to persuade the G20. It will not be an easy task because the different constituencies within national governments – finance, health and development – have very different views on governance and funding. There is no unified view yet on these matters among EU countries. But failing in this would increase the risk of the COVID-19 crisis giving way to another ‘panic-and-neglect’ cycle.
The US seems to be ready to step up, with announced seed funding of $850 million for the new funding facility. Traditionally the US has been a global health security leader with funding for global health security of $57.6 billion committed between 2014 and 2020. The second funder is the United Kingdom with $12.5 billion. The EU comes third with $9.7 billion from EU central funding and $12.6 billion collectively from the 27 member states. The EU needs commitments from all member states to reach a critical mass of funding. With increasing geopolitical tensions, the US contribution will not be enough to secure a global response. The EU has the means to act as an effective broker in this new multilateral set up and should develop a common view on the governance proposals for pandemic prevention and preparedness. The EU’s international legitimacy will benefit from broad-based financial efforts and a European Health Union well anchored in the global landscape.
Bucher, A. (2021) ‘Pandemic prevention: avoiding another cycle of “panic and neglect”’, Bruegel Blog, 7 October