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25 May 2017

From #Panic and #Neglect to #Investing in #Health #Security: Financing #Pandemic #Preparedness at a National Level (WB, excerpt)

Title: From #Panic and #Neglect to #Investing in #Health #Security: Financing #Pandemic #Preparedness at a National Level.

Subject: Emerging Infectious Diseases, Pandemic Preparedness; World Bank document.

Source: World Bank, full PDF document: (LINK). Summary, edited.

Code: [ INTL ]


From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level


Conference Edition



  • Peter Sands (Chair), Harvard Kennedy School
  • Dominic Casserley, formerly Willis Towers Watson
  • Rodrigo Chaves, World Bank Group
  • Timothy G. Evans, World Bank Group
  • Sanjeev Gupta, International Monetary Fund
  • Judith Hazlewood, McKinsey & Company
  • Dean Jamison, University of Washington
  • Donald Kaberuka, African Development Bank
  • Marie-Paule Kieny/Agnes Soucat, World Health Organization
  • Outi Kuivasniemi, Ministry of Social Affairs and Health, Finland
  • Soonman Kwon, Asian Development Bank
  • Jane Pepperall, Department of Foreign Affairs and Trade, Australia
  • Alwyn Didar Singh, Federation of Indian Chambers of Commerce and Industry
  • Oyewale Tomori, Nigeria Academy of Science
  • Jeanette Vega, Fondo Nacional de Salud, Chile
  • Ron Waldman, United States Agency for International Development
  • Edward Whiting, Wellcome Trust
  • Ngaire Woods, Blavatnik School of Government


Statements, recommendations, and opinions expressed are those of the International Working Group on Financing Preparedness (IWG). The World Bank served as Secretariat for the IWG. The World Bank team was led by Mukesh Chawla, and included (in alphabetical order, by last name), Franck Berthe, Senior Livestock Specialist; Eleonora Cavagnero, Senior Economist; Erika Hartingh, Consultant; Samhita Kumar, Consultant; Adrienne McManus, Consultant; Rocio Schmunis, Operations Officer; and Gabrielle Williams, Consultant. The World Bank team was supported by Anas El Turabi, Doctoral Candidate in Health Policy, Graduate School of Arts and Sciences, Harvard University; and Philip Saynisch, Doctoral Candidate in Health Policy, Harvard Business School and Graduate School of Arts and Sciences, Harvard University. Analytical support was also provided by McKinsey & Company. The International Working Group was supported by the World Bank and Wellcome Trust.


This report has been reviewed in draft form by the following individuals chosen for their diverse perspectives and technical expertise: David Barash, GE Foundation Beth Cameron, Nuclear Threat Initiative Ashish Jha, Harvard University Rebecca Katz, Georgetown University Richard Zeckhauser, Harvard University MAY 2017 The text of this conference edition is a work in progress for a forthcoming publication.


Multiple pandemics, numerous outbreaks, thousands of lives lost and billions of dollars of national income wiped out – all since the turn of this century, in barely 17 years – and yet the world’s investments in pandemic preparedness and response remain woefully inadequate. We know by now that the world will see another pandemic in the not-too-distant future; that random mutations occur often enough in microbes that help them survive and adapt; that new pathogens will inevitably find a way to break through our defenses; and that there is the increased potential for intentional or accidental release of a synthesized agent.

Every expert commentary and every analysis in recent years tells us that the costs of inaction are immense. And yet, as the havoc caused by the last outbreak turns into a fading memory, we become complacent and relegate the case for investing in preparedness on a back burner, only to bring it to the forefront when the next outbreak occurs. The result is that the world remains scarily vulnerable.

In the wake of Ebola, a number of commissions and panels made recommendations about how the world could be better prepared to prevent, identify, contain, and respond to infectious disease outbreaks. All these reviews – including the one I chaired for the U.S. National Academy of Medicine – agreed on three key priorities: strengthening preparedness at a national level; improving coordination and capabilities at a regional and global level; and accelerating R&D in this arena.

Over the last twelve months we have seen some important steps taken, such as the creation of the Health Emergencies Program at the World Health Organization (WHO), the launch of the Coalition for Epidemic Preparedness Innovations (CEPI), and the establishment of the World Bank’s Pandemic Emergency Financing Facility (PEF). Many countries have signed up for external evaluations of their preparedness and response systems, signaling a welcome openness and willingness to collectively identify problem areas and explore solutions.

Yet this also presents a challenge. Countries that develop detailed plans to reinforce their disease surveillance, diagnostic services, infection control, emergency preparedness, etc. in the wake of these assessments will become rapidly disillusioned if there is no money available to translate these plans into reality. Any individual or government that has had direct experience of an epidemic or pandemic does not need convincing of the case for investing in pandemic preparedness.

The cruel statistic of lives lost is only the first measure of impact. To that must be added the cost to the broader economy and to society as a whole. Pandemics cause enormous economic disruption and can quickly undermine communities and governance. Responding to outbreaks once they have happened is far more expensive – in lives and money – than investing in preparedness. Yet in many countries the argument has not been won. Governments struggle to reconcile limited resources with many competing priorities. Health does not always rank as one of the top budget priorities, and within health v spending, pandemic preparedness is often overlooked in favor of more immediate and visible goals.

To address this challenge, an International Working Group on Financing Preparedness was created in November 2016. This Group, which I chair, comprises experts and leaders from multilateral organizations, academia, philanthropic institutions, governments and businesses. The objective of the International Working Group is to propose ways in which national governments and development partners can ensure adequate and sustainable financing for actions to strengthen pandemic preparedness and thus enable effective compliance with the International Health Regulations (IHR) as well as World Organisation for Animal Health (OIE) standards.

Our primary focus is on the prevention, identification, and containment of infectious disease outbreaks, so we have concentrated on the financing of critical capacities such as disease surveillance systems, laboratory networks, and emergency operations centers, as well as “One Health” initiatives designed to protect people from pathogens in the animal population. We also recognize the crucial importance of supporting health systems strengthening as a key investment in preparedness. For many countries, the starting point in assessing what needs to be financed will be the results of a Joint External Evaluation (JEE) or outcome of a Performance of Veterinary Services (PVS) pathway analysis. The recently introduced JEE process is a huge step forward. It provides a systematic and objective assessment of a country’s capabilities across core domains, plus a prioritized list of gaps to be addressed.

But of course, a good diagnostic is only the first step. We want the outcomes of these evaluations to be translated into adequately funded action plans that countries can implement. And it is crucial that the financing is sustained: investing in preparedness is not a one-off, but an ongoing requirement. The scope of our investigation includes domestic resource mobilization, development assistance, and private sector engagement. For many countries, financing preparedness through the domestic public sector budget is the best way to ensure sustained funding and seamless integration with the rest of the health system. Yet this requires ensuring sufficient priority is attached to investing in pandemic preparedness in budget allocations. In some cases, it may also require enhancing fiscal mobilization or attracting direct financing from the private sector.

For many countries, especially the poorest and most fragile, there is clearly a role for international development assistance in reinforcing pandemic preparedness. Here, the challenge is to ensure such contributions are effectively coordinated and prioritized, and that we transition to a sustainable funding arrangement, rather than something that withers when donor priorities change. Ensuring sustained commitment to financing preparedness will be difficult, since the mark of success is that nothing happens, and there will always be multiple competing priorities.

In this context, we need to harness the powerful incentives that business and the financial markets can provide. We want investors and business leaders to be taking account of health risks as they decide where to invest and trade. This will reward those countries that have vi translated their JEE and PVS assessments into implemented action plans, and expose those countries which have failed to act. Through developing indices that measure intrinsic risk, state of preparedness, and economic vulnerability, we can make the threat of infectious disease outbreaks much more visible and concrete. This in turn will incentivize governments and the private sector to mitigate these risks. Investing in health security through financing preparedness is a highly cost-effective way to protect lives and safeguard livelihoods and communities. Whether measured in human lives saved or economic disruption avoided, the return on investments in pandemic preparedness is extraordinarily high.

Moreover, many of the capabilities and much of the infrastructure required for pandemic preparedness also support efforts to fight endemic diseases and counter the threat of antimicrobial resistance. Taken together, the recommendations of the International Working Group set out in this report represent a pathway towards achieving the goal of universal health security, whilst strengthening health systems and helping ensure delivery of the Sustainable Development Goals.

Peter Sands, Chair International Working Group on Financing Preparedness

Executive Summary

Deadly infectious pandemics will mark humanity’s future, as they have shaped its past. Neither individual governments nor the global community can entirely prevent the emergence of infectious threats. But we can be much better prepared. This report by the International Working Group on Financing Preparedness (IWG) proposes ways in which national governments and development partners can finance investments in country and regional preparedness and response capacities for pandemics and other health emergencies. Preparedness for pandemics refers to health and non-health interventions, capabilities, and capacities at community, country, regional, and global levels. Their purpose is to prevent, detect, contain and respond to the spread of disease and other hazards, mitigating social disruptions and limiting risks to international travel and trade. The Case for Preparedness Pandemics cause vast human suffering and devastating economic costs.

Experts differ in their estimates of the economic cost of pandemics and the closely related threat of drug-resistant infections. However, all the figures advanced are alarmingly high. Even the most conservative estimates suggest that a pandemic could destroy over 1.0 percent of global GDP, comparable to other global threats such as climate change. Even much smaller outbreaks can cause significant loss of life and immense economic disruption. Investments improving preparedness therefore offer an extraordinarily high potential return. Yet we invest relatively little in mitigating the risks of infectious disease crises relative to what we spend against other risks to human lives and livelihoods, such as climate change, war or financial crises.

In countries where there is a reasonably comprehensive and well-functioning underlying health system, which would include a number of low-income and many middle-income countries, financing improved preparedness might cost less than $1 per person per year, not a huge sum compared to the scale of the risks to human lives and livelihoods. More advanced economies can and do choose to spend much more per person. Achieving improved preparedness in countries with fundamental gaps in health coverage and capacities, particularly in primary care, will cost more, since preparedness is built on these foundations.



Keywords: World Bank; Worldwide; Updates; Pandemic Preparedness.