3. Pandemic Preparedness
In an increasingly interconnected and interdependent world, human security means that global health is necessarily the responsibility of all countries, requiring long term, predictable, flexible and sustained financing based on global solidarity.[45]) We believe this should be rooted in principles of Human Security, that include: (a) the right of all people to live in freedom and dignity, free from poverty and despair; (b) the pursuit of people-centred, context-specific and prevention-oriented responses that strengthen protection and empowerment of all people and communities; (c) acknowledging the interlinkages between peace, development and human rights; and (d) strengthening national solutions which are compatible with local realities.[46]
The protection of health underpins all aspects of a functioning, prosperous society. COVID-19 has made clear that pandemic preparedness and response are not choices between protecting people and protecting the economy: one reputable estimate projects the cumulative global fiscal deficit as a result of the pandemic at US$25-30 trillion, equivalent to 30% of global GDP.[47] Existing emergency funding mechanisms are inadequate for a pandemic response, which include established models of development assistance that depend on a small number of countries, foundations, and development banks.[48] Although the WHO Contingency Fund for Emergencies and the Pandemic Emergency Financing Facility can be deployed quickly, only a relatively small amount of funds is available through these mechanisms and they can be depleted quickly. This has meant that international financial institutions needed to play a critical role at the beginning of the pandemic. The World Bank was able to rapidly mobilize US$14 billion for emergency COVID-19 response in the first three months, as the IMF disbursed US$87.8 billion to date through its US$250 billion Catastrophe Containment and Relief Trust.[49],[50] There are nonetheless no dedicated mechanisms to allow the rapid deployment of a large amount of funds at the beginning of a pandemic. A lack of sustainable financing threatens WHO’s capacity to play a central role in global health emergencies but also to deliver on its broader mandate.
Among the most difficult challenges beyond the current COVID-19 pandemic is how quickly and effectively nations will be able to develop strategies and mobilize resources should this situation arise in the near or distant future. It is also important to recognize that global preparedness is not simply the sum of national preparedness: a pandemic is a global event demanding global action.[51] That includes stronger mechanisms for collective action that enable countries, businesses, and societies to coordinate and collaborate towards a common goal. While multilateral systems like the UN and G20 have reiterated strong commitments to preparedness, they have struggled to implement a collective response, which has been further hampered by global political tensions undermining multilateral institutions and exacerbating WHO’s financial fragility.
A strong multilateral system is foundational of global pandemic preparedness, across public, private and non-profit sectors working together bilaterally, regionally and internationally. Collective action is needed to ensure a common strategy, coordinated and effective clinical and public health action, and equitable access to countermeasures. Interconnected supply chains and international travel mean that all countries depend on the economic, social, and physical health of all others. The Global Preparedness Monitoring Board (GPMB) is an independent monitoring and accountability body, convened by the WHO and the World Bank to ensure preparedness for global health crises. In its first annual report in September 2019 three months before COVID-19 was discovered, the GPMB outlined the urgent need for strong multilateral systems to undertake the following set of core functions for pandemic preparedness and response:[52]
- Developing global and regional mechanisms for tracking potential pathogens;
- Strengthening early notification and comprehensive information sharing;
- Intermediate grading of health emergencies;
- Development evidence-based recommendations on the role of domestic and international travel and trade recommendations;
- Collaborative mechanisms for R&D, regulatory capacity building and harmonization and allocation of countermeasures; and
- Mechanisms for assessing International Health Regulation compliance and core capacity implementation, including a universal, periodic, objective and external review mechanism.
The COVID-19 pandemic has also demonstrated that efforts are also needed to ensure stockpiles, including global supply chains for essential goods are strengthened, developed, sustained, and financed.[53] Here, simulations and exercises that test and demonstrate the capacity and agility of health emergency preparedness systems, and their functioning within societies can be developed using predictive mechanisms for assessing multisectoral preparedness.
Lastly, COVID-19 has highlighted a fundamental issue with how we define and measure preparedness. Our understanding of preparedness is based on a narrow set of public health capacities that do not fully capture the range of national and international capacities necessary to ensure preparedness, including R&D, measures to mitigate the socio-economic impacts of epidemics and ensure continuity of essential services, international cooperation, and preparedness of international organizations.[54] In addition, current measures focus more on the presence of an institutional policy rather than a demonstrated capacity to operationalize those capacities, and the critical importance of science-informed political leadership.