Lawrence H. Summers, a professor at and past president of Harvard University, was treasury secretary from 1999 to 2001 and an economic adviser to President Barack Obama from 2009 through 2010. Robert Hecht, a professor at Yale University School of Public Health and a former senior manager at the World Bank and UNAIDS, is president of Pharos Global Health Advisors. Shan Soe-Lin is a lecturer at Yale University Jackson School of Global Affairs and managing director of Pharos.
In response to the covid-19 pandemic, world leaders in November launched a new global Pandemic Fund housed at the World Bank to break the historic pattern of “panic and neglect” regarding global disease outbreaks.
The fund was crafted with good intentions and has enormous potential. But that’s far from sufficient to guarantee success.
Already, the fund is at risk of insufficient resources and a lack of focus that could hamper its mission. This is a shame. With China abruptly abandoning its zero-covid policy, thereby unleashing a huge spike in new infections, and other pathogens such as monkeypox, polio and Ebola reemerging in East Africa, the importance of pandemic preparedness has never been more urgent.
Regrettably, only $1.6 billion has been committed to the Pandemic Fund to date by more than 20 governments and philanthropies, including just $250 million from the United States. This is woefully inadequate. A recent blue-ribbon panel (on which one of us served) estimates that strengthening global capacity for pandemic preparedness requires $20 billion to $50 billion per year.
We hope that the $1.6 billon is a down payment and that much larger contributions will flow from the United States and other wealthy nations. It is also essential that these contributions are true increases in spending and do not cannibalize other global health funding. They should also come from national security budgets, not highly constrained health budgets.
Such spending would be easily justified. Experts predict a 50/50 likelihood that we will see another pandemic as deadly as covid-19 or greater over the next two decades. Given that covid-19 has cost the global economy $12.5 trillion (and climbing), $20 billion a year or more on pandemic preparedness would be a sound investment, even if it lowers the chances of more losses by just 10 percent.
This is why it is imperative the Pandemic Fund produces promising results in its early months. If it stumbles, it could jeopardize efforts to enhance global pandemic preparedness for years to come.
We urge the fund's newly constituted board to take three critical actions:
First, target its limited money wisely. The first grants, expected to amount to just $300 million, should focus on a single area of greatest need — namely helping countries that are the most likely sources of outbreaks to build up their disease detection systems. The new “7-1-7” target — detecting and identifying a new pathogen within seven days, notifying the World Health Organization in one day and mounting a full response within another seven days — should be the goal.
No single country alone can create such a surveillance network. A global mechanism is best placed to plug the financing gaps so that countries can train and deploy additional front-line surveillance workers, conduct tests rapidly and alert the world to outbreaks. This was done poorly for Ebola and covid-19 and greatly magnified the loss of life.
Poor countries with limited capacity in the health sector will be reluctant to reallocate scarce resources from people dying today to help protect against future pandemics. This is why we need additional outside funding. Smart spending by the global community in pandemic surveillance will help these countries to fight current scourges while simultaneously giving them stronger motivation to invest in future unknown threats.
The new Pandemic Fund should also focus on a single priority geographic area and not spread its resources too thinly. This would be more effective than ad hoc projects in different parts of the world, which the fund is unfortunately contemplating.
For example, the fund could assist six nations of the Congo River Basin (Cameroon, Central African Republic, Democratic Republic of Congo, Republic of Congo, Equatorial Guinea and Gabon). Examples of successful multicountry efforts show that when there is political commitment from national leaders, this is possible.
Second, the fund should harness the strengths of existing multilateral institutions, giving each an equal chance to act as a financial intermediary. Right now, the playing field appears tilted toward the World Bank and World Health Organization. The role and voice of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Gavi, the Vaccine Alliance, long-existing funds already dedicated to control of ongoing endemics, should be expanded, since investing Pandemic Fund resources through them would serve both present and future needs.
More broadly, the new fund should seek to be an enabler rather than a coordinator of pandemic fighting activities. So far, the signs have not been encouraging. The Pandemic Fund has chosen to set up its own rules for applications, proposal review and negotiations in parallel with existing institutions, making coordination more complicated and costly for health agencies in Africa and elsewhere.
Finally, since the multilateral organizations already have elaborate processes for technical review of prevention projects, the new Pandemic Fund should minimize additional checks. We are concerned that its technical advisory panel will be slow, cumbersome and duplicative. Such a panel should limit itself to setting priorities for future funding rounds and evaluating grant performance.
Achieving the fund’s promise will require world leaders to act boldly and make hard choices. Given the stakes involved, it would be tragic if the Pandemic Fund is remembered as simply a summit communique item.