Financing for Future Pandemics

A POLIS research team, led by Professor Garrett W. Brown, was awarded an ESRC grant to investigate the sustainability of future pandemic preparedness and response (PPR) financing. In collaboration with The Center for Policy Impact in Global Health (Duke University) and Open Consultants, this mixed-methods interdisciplinary research assessed PPR financing using an interdisciplinary and holistic approach across five projects.

PPR has been a key priority for international health donors since the onset of the COVID-19 pandemic with a number of new PPR-focused initiatives being launched, including the World Bank Pandemic Fund which aims to catalyse additional funding directed towards PPR strengthening. Yet, at the moment, evidence is scant and no holistic PPR financial picture exists. This lack of evidence base has made it difficult to properly assess the future sustainability, feasibility, and effectiveness of PPR financing. In response, the POLIS led research has been able to provide a more comprehensive analysis of PPR financing capacities while also revealing worrying funding implications that need to be addressed in preparation for future pandemics.

The research found that the current PPR financing architecture is fragmented and complex, and despite ongoing reform efforts, there is little evidence to suggest that current mechanisms have the scope to sufficiently meet future needs. This complexity has increased significantly over the course of the COVID-19 pandemic with a rapid increase in donor funds directed towards PPR-related activities. Yet, this came at a cost to other important health areas with funds directed away from malaria, tuberculosis, and HIV. This increase in attention to PPR has also led to a number of overlapping and competing mandates across global health initiatives.

The World Health Organization (WHO) and the World Bank requested an additional US$31.1 billion at the country level, and US$10.5 billion at the global level, to strengthen the global PPR architecture. However, despite this increased focus on PPR activities and a heightened recognition of the need for greater investment, the research found it is very unlikely that these financing targets can be met. Financing projections for the next five years under a range of scenarios from worst-case to best-case demonstrated a low likelihood of sufficient funds being raised. Given this, it is necessary to consider alternative financing mechanisms to raise additional funds needed to strengthen PPR. However, there is little evidence to suggest that commonly suggested alternatives in ‘innovative financing’ would be effective either.

Further, even if funding targets are met, there exist a series of common challenges that risk reducing the effectiveness of health financing. A scoping review conducted for this research identified eight major challenges with global health financing writ large, including evaluations of existing World Bank mechanisms. These challenges, such as a lack of country ownership over funding priorities and unequal representation, lack of transparency and accountability, and imbalanced power dynamics, will likely also manifest in the new World Bank Pandemic Fund, thus undermining its ability to work effectively.

Whilst this research paints a rather bleak picture for the future of PPR financing, it is necessary to take a realistic and informed approach to adequately and appropriately strengthen PPR architecture in a way that can help prevent and better respond to future pandemics. Through this research, a series of recommendations have been developed which aim to help actors better prepare for future pandemics. Such recommendations include the re-thinking of current PPR financing targets, reductions of the cost of PPR itself through measures such as reducing constraints on intellectual property (IP) to allow equitable global access to safe and affordable medical countermeasures, ensuring PPR funding comes from additional funding that does not detract from other health areas, explore a global tax on financial transactions, carbon, or airline flights to source additional funding, sovereign debt relief for priority reforms, and ensure funding priorities are set in collaboration with implementing countries.

The full list of recommendations and further details on the research can be found in the policy briefs (below).

This research has also been featured in a Future Development blog, with peer-review articles forthcoming. Research drafts are available upon request from Professor Garrett W. Brown g.w.brown@leeds.ac.uk