A new model for funding global health takes shape

In an era of shrinking aid budgets and growing global health demands, the Pandemic Fund is testing a new model of funding, one focused on filling gaps, and increasingly reliant on domestic commitment. The fund, launched two-and-a-half years ago in response to the COVID-19 pandemic, was created to invest in pandemic prevention, preparedness, and response in low- and middle-income countries. According to its executive head, Priya Basu, the Pandemic Fund is the first and only multilateral financing mechanism focused exclusively on helping these countries get better prepared to contain outbreaks and prevent pandemics from happening. During a Devex event on the sidelines of the 78th World Health Assembly on Thursday, Basu emphasized its “horizontal approach” to health systems strengthening rather than a top-down approach and a “light-touch administrative structure.” “Low- and middle-income countries, particularly lower-middle- and upper-middle-income countries, have brought a tremendous amount of their own financing,” said Basu, though she noted that a large proportion of that leverage — about $4 of every $7 — came from multilateral development banks. “We would like to grow more because, as we move forward, we really do need to think about sustainability. Aid can help, but our investments are not going to be sustainable if the countries don't come forward with their own resources and commitment.” The fund has been swift to allocate available resources. In its first two funding rounds, it awarded $885 million, which Basu said leveraged over $6 billion from both external and domestic sources. Countries applying for grants are expected to demonstrate strong ownership, coordinate with international organizations, and bring their own financial contributions to the table if they can. The fund’s approach encourages proposals that reflect broad government engagement, including from finance, agriculture, and environment ministries. The fund’s ability was demonstrated during the mpox outbreak in Africa. Within five weeks of the World Health Organization and the Africa Centres for Disease Control and Prevention declaring mpox a public health emergency, the Pandemic Fund board allocated $129 million to 10 affected countries. Basu highlighted early results, such as the training of 30,000 community health workers and support to laboratories in Rwanda and other countries. “Rwanda actually is a great example, because soon after mpox, they were hit by Marburg, and the investments that we made for mpox helped them deal with Marburg as well and quickly contain it,” Basu said, referring to the rare but highly lethal virus which belongs to the same family as the Ebola virus. The fund currently works with 13 implementing entities, including multilateral development banks, three United Nations agencies, and organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and the Coalition for Epidemic Preparedness Innovations, or CEPI. With these partners facing financial strain, the fund's model may be tested further. Organizations such as the Global Fund and Gavi are also adjusting their strategies to maximize impact amid challenges in accessing resources and funding. During the side event, Françoise Vanni, director of external relations and communications at the Global Fund, said countries are increasingly willing to lead and accelerate their health investments. “We want to build on that,” said Vanni. “It's been very much at the core of the Global Fund model since we were created more than 20 years ago, to work with countries to support their efforts, to support their leadership.” Vanni said that the Global Fund tries to enable countries to engage local communities and make decisions tailored to the local context. But she cautioned that making this transition is very difficult. “How do we address the current crisis without putting people at risk, while at the same time engaging on these long-term, medium-term pathways toward transition and sustainability and fully funded and owned health systems.” “We need to be very careful when we approach transitions,” she added. “If we go too fast, we will risk the gains achieved so far, and we will have more people die. It’s as simple as that.” David Kinder, the director of development finance at Gavi, echoed the need for country-centered approaches. “We have to all look at doing things differently and using finance differently, ensuring every dollar that is received by organizations is used most effectively,” he said, adding that Gavi’s strategy going forward is to deepen partnerships with multinational development banks. Gavi recently came to an agreement with the Asian Infrastructure Investment Bank to make up to $1 billion available for health projects linked to immunization. Both Gavi and the Global Fund are looking to harness private sector investment as well. Vanni said that Takeda, a global pharmaceutical company that focuses on research, development, manufacturing, and marketing of pharmaceutical drugs, made a new commitment to the Global Fund for its eighth replenishment. This new approach to pandemic preparedness aligns with broader global efforts. WHO member states at WHA just adopted the Pandemic Agreement, which is a legally binding international treaty to ensure global cooperation during future pandemics. Looking forward, all three experts said that they expect the model for international health funding to evolve. The Pandemic Fund’s third round of funding is open until June 6, Basu said.