With Madagascar’s health system under strain from the COVID-19 pandemic and schools shuttered for the foreseeable future, the health, education, and overall wellbeing of the Malagasy people are increasingly at risk. As the pandemic hits more and more countries, the World Bank Group and other organizations are stepping up to provide immediate support in order to quickly get resources to the front lines of fighting this disease. Photo: World Bank / Henitsoa Rafalia
The COVID-19 pandemic put into stark relief what the global health community has known all along: We are only as strong as the world’s weakest health systems. Now, a new fund for pandemic prevention, preparedness, and response could change the global health landscape for the better.
We asked our global health experts Cecilia Mundaca Shah and Dana McLaughlin for a 101 on the Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response — what it is, what it aims to accomplish, and why the world should pay attention.
The World Bank Executive Board approved the establishment of a new FIF for Pandemic Prevention, Preparedness and Response on June 30. What does this mean for global health, and why do we need a fund like this?
The COVID-19 pandemic showed us that countries around the world — high-, middle-, and low-income countries alike — were woefully unprepared to handle a global health threat of this magnitude. This poor worldwide response was an expected consequence of decades of underinvestment in such capacities, and therefore highlighted a clear, urgent need to be better prepared when a new threat emerges by mobilizing resources to build capacities before rather than after a pandemic happens.
A health care worker wearing personal protective equipment at a mobile COVID-19 testing station. Photo: JHDT Productions / Adobe Stock.
This new fund, which is currently known as the Financial Intermediary Fund (FIF) for Pandemic Prevention, Preparedness and Response (PPR), or “the FIF” for short, could dramatically improve our capacity to prevent, detect, and contain disease outbreaks by investing in these capacities before the next pandemic occurs. One key advantage is that FIFs are flexible financial instruments coordinated by the World Bank (acting as a trustee), which leverage public and private funding to help the international community respond to climate change, food insecurity, and other major challenges. The World Bank hosts 27 FIFs, with the Global Fund to Fight AIDS, Tuberculosis, and Malaria being the largest.
How did the idea of a dedicated fund for PPR take shape?
This new FIF was proposed by a panel mandated by the G20 under Italy’s presidency, which pointed to the large gaps in financing preparedness and the benefits and urgency of having a dedicated funding instrument in place to build capacities for pandemic preparedness and response.
This FIF is helping stakeholders think about PPR as a global public good, aiming to target the most critical gaps in countries that do not have the resources to implement information systems, train front-line workers, or access the medical tools and technology to prevent, detect, and respond to a pandemic. And while the FIF focuses on pandemic financing more specifically, these investments can also strengthen the response to other health emergencies and overall health needs; positively impact the global economy, livelihoods, and people’s safety and well-being; as well as advance the Sustainable Development Goals.
What’s the benefit of having this new centralized pandemic fund? How does this fund differ from other sources of funding for health priorities?
As noted earlier, PPR has been underinvested in for a long, long time. In October 2019, the Global Health Security Index Report found that “no country is fully prepared for epidemics or pandemics.” In fact, most countries don’t have line items in their budgets for pandemic preparedness.
"No country is fully prepared for epidemics or pandemics."
2019 Global Health Security Index Report
Too often in the global health landscape, there are highly earmarked sources of funding for specific disease programs or interventions and fewer funding streams that provide countries with the resources they need to invest in health systems in order to fortify them against future pandemics and/or other health threats. For example, there may be funding allocated to work on specific diseases like malaria, HIV, or tuberculosis, but not necessarily to build capacities that will respond to the broader health needs. While this change is happening, we need to be more purposeful if we want to achieve the level of preparedness that’s needed.
Now with this mechanism, PPR funds can be coordinated through a central platform and governed by an independent body that will decide on the funding focus areas. The intention is for this mechanism to bring additional money designated specifically for pandemic preparedness and response and different from the traditional official development assistance (ODA), which has been declining and is capped in several countries. The investments through this mechanism should also incentivize countries to invest in their own pandemic preparedness efforts.
Our collective experience with COVID-19 has made it painfully clear that no one country can go it alone when an outbreak of pandemic potential strikes. But there are already many partners and programs working in the global health sector beyond governments. How will this fund complement existing efforts?
The resources mobilized for this FIF should add to, and not substitute for, other global health investments. It is meant to complement existing resources and fund gaps that are not addressed by other funding sources. Part of the goal is to allow better coordination between partners already supporting and building preparedness capacities and as shown during the COVID pandemic can be essential to pandemic response. Challenges such as pandemics will require the collaboration of international, regional, and local actors to really achieve the goal of strengthening prevention and response systems.
Delegates are requested to apply additional precautionary measures to protect themselves and others against COVID-19 during the 43rd session of the Human Rights Council in June 2020. Photo: Human Rights Council
The new FIF should, in fact, be seen as a key opportunity. We’ve never had such political momentum to have consensus from G20 countries and beyond to fund pandemic preparedness, and it has taken a devastating pandemic to get us there. We finally have the opportunity to design and implement an instrument that can make the world better prepared for the next pandemic because it is not a matter of if but when it will happen.
Why should we care regardless of the country we live in, and why now?
The real question is: How many more lives, disruption, and economic loss are we willing to face before we do something? Why do we let this keep happening? With COVID-19, it’s taken millions of lives for us to get to this point and decide that we really need to prioritize investments so that countries can be better prepared to tackle a wide range of diseases and health threats. With new sources of funding for pandemic preparedness, we can prevent the next pandemic.
Now that the Executive Board of the World Bank has approved the decision for the World Bank to host the new FIF, over the next few months, the founding donors and partners will develop a strategy, establish a governance structure, and determine funding priorities. A new governing board, whose composition is yet to be determined, will be the central decision-making body of the FIF. According to a fact sheet released by the World Bank, the governing board will be advised by a technical advisory panel.
The core focus of the new FIF for PPR is to ensure all countries, particularly low-income countries, have the health systems, resources, and infrastructure required to prevent, detect, and respond to future pandemics. This means strengthening the health care workforce, expanding manufacturing capacity for medical commodities, and reinforcing health surveillance systems.
This is a golden opportunity to channel the lessons we’ve learned from the ongoing COVID-19 pandemic and from other pandemics and invest in building and strengthening these capacities. Such investments will benefit everybody. If we take forward one lesson from the COVID-19 pandemic, it must be that if any country is unprepared to face a pandemic, then we are all at risk.