Never let a crisis go to waste: prevent the next pandemic
The old adage, never let a crisis go to waste, has never been more relevant. COVID-19 is certainly a crisis of historic proportions. Its dangers to health and prosperity are illustrated by the number of deaths, which is currently heading towards 4 million, and the lost production, which is expected to reach 22 trillion dollars.
But the dangers are not limited to the current crisis. Today’s global pandemic was predictable and predicted. Eleven separate reports proposed significant changes to the global approach to health security that would have mitigated or even quelled this crisis at an earlier stage. And today, there is a real threat that, as vaccines beat the variants in the wealthier parts of the world, the crisis will be over.
It is time to challenge the inertia, short-termism and myopia that characterize pandemic preparedness and response. Sitting on three independent international panels – the Independent Panel on Pandemic Preparedness and Response, the Pan-European Commission on Health and Sustainable Development and the G20 High-Level Independent Panel on Pandemic Finance – we believe that ‘There are three essential principles to prevent another pandemic disaster.
First, pandemic preparedness and response must be understood in a new way, as a global public good. The reason is that the world has solved the wrong kind of problem when it comes to pandemic preparedness and response. International systems have treated pandemics only as health problems. Governance and responsibility have therefore been entrusted to the World Health Assembly and the World Health Organization. Funding was based on national budgets supplemented by development aid for health. This is how we govern and finance many health issues such as primary health care, nutrition, family planning, and the management of communicable and non-communicable diseases.
But there is a crucial difference between managing pandemics (alongside other truly global health threats such as antimicrobial resistance) and these other health issues. A primary care system benefits the small, localized group it is able to serve. A surveillance system that detects a new epidemic benefits everyone in the world who becomes aware of the threat. Preventing pandemics or protecting the world from cross-border infectious threats is a global public good. It is ânon-excludableâ because no country can prevent others from benefiting from it, and not rival, because a recipient country does not limit the extent to which other countries can benefit from it.
Economic theory warns that the defining attributes of global public goods lead to underinvestment due to the stowaways problem. There are substantial positive externalities that are not fully taken into account when countries make their investment decisions. In the absence of policy intervention and coordination, global public goods will be by-products. This classic market failure had a devastating effect before and during the COVID-19 crisis. Funding for pandemic preparedness has been far too low while international funds for the pandemic response have arrived far too late.
Not only do we agree that pandemic preparedness and response are global public goods, we agree that this has important implications for financing and governance.
Second, all countries should collectively fund pandemic preparedness and response as strategic global public goods, not as aid. At the national level, public goods are managed by public policy and financed by taxation, with citizens being empowered to contribute. In progressive tax regimes, richer citizens contribute proportionately more of their income to finance the provision of national public goods.
When the benefits of one country’s investments in public goods spill over to other countries, international coordination is needed. When the impact is global, as is the case with pandemic preparedness and early response, this international coordination must be global.
The same principles should apply to payments: contributions should be universal and progressive. All the countries that benefit from it, that is to say all the countries, should pay something. Countries with the largest and most open economies should pay the most, both because they are able and because they gain the most economically from pandemic prevention. One of us modeled contributions at the country level.
While preparedness and response activities can take place at the national level, the benefits are felt globally. Therefore, funding for preparedness and response activities, even in low- and lower-middle-income countries, does not meet the definition of aid as promoting “the economic development and well-being of countries.” in development as the main objective â.
The financing of pandemic prevention through budget lines other than ODA also has operational advantages. This reduces the risk of moving aid from urgent needs that benefit countries internally. It also helps insulate health security from cycles of booming and busting aid budgets that are seen as voluntary and discretionary. Finally, funding for pandemic preparedness through other headings recognizes that pandemics are not only a health issue but also an issue of security and economic stability, and an obligation for all countries. This brings us to our third point on governance.
Effective governance requires elevating pandemic threats beyond the health sector, to the highest levels of national governments and international systems. If there is one common theme across the failures of national and international systems to contain the COVID pandemic, it is the lack of high-level political leadership. For months after the January 2020 declaration of emergency, COVID-19 became a global problem. He has served on the desks of ministers of health and the WHO, but not prime ministers, finance ministers, defense ministers, the G7, the G20 or the UNSC. Even before the outbreak, warnings of gaping vulnerabilities in preparedness were met with indifference rather than leadership, responsibility and resources.
To break the cycles of panic and neglect, we need an international institution united at the level of heads of government to oversee the financing and production of these global public goods. It should be responsible for maintaining political momentum, monitoring progress towards goals, and holding nation states to account. It should be provided with reliable long-term funding for preparedness and rapid top-up funding for pandemic emergency response.
The governance proposals developed by our respective groups – with the establishment of a board or a board of directors – share common objectives and functions.
The three proposals include representation at the highest political levels as well as heads of agencies, including the IMF and the World Bank. The economic devastation caused by COVID-19 makes it clear that health security has global economic implications. All three proposals agree that the board should ensure accountability between states and relevant international agencies, including WHO and its One Health partners as well as IFIs and ACT-Accelerator partner organizations. Finally, the three proposals maintain that this institution must be able to mobilize financial resources and allocate these resources to the competent bodies according to needs and performance.
Such a body will thus focus on political leadership, peer pressure, accountability, public mobilization and support for global public goods of pandemic preparedness, including surveillance, at national, regional and global levels. Above all, it must be convened at the highest political level, with a number small enough to ensure efficiency as well as legitimacy. What matters is independence, legitimacy and efficiency, otherwise we are stuck with the old system, not a new one.
Bold proposals alone will not overcome inertia. The tyranny of completeness and the tendency to perfect the enemy of good oppose this. To survive, they will need national champions and coalitions willing to act with urgency and determination to correct the ways in which we finance and govern existential pandemic threats. The stakes could not be higher. We expect world leaders to respond positively to the timetable recently set by President Joe Biden. We have until the end of September to show we’re serious about next time.
David Miliband is Chairman and CEO of the International Rescue Committee.
Jim O’Neill is Chairman of Chatham House and a member of the Pan-European Commission on Health and Sustainable Development.
John-Arne Rottingen is Ambassador for Global Health at the Norwegian Ministry of Foreign Affairs.
The authors represent three international panels on pandemics.
The opinions expressed in this article are those of the authors.