MANILA — The high-level body that warned the world of the threat of a pandemic in 2019 — and how the world was unprepared for it — has come out with new recommendations that call for a new international framework for health emergency preparedness and response.
The Global Preparedness Monitoring Board, co-chaired by Norway’s former Prime Minister Gro Harlem Brundtland and former Secretary General of the International Federation of Red Cross and Red Crescent Societies Elhadj As Sy, recommended that the heads of the United Nations, World Health Organization, and international financing institutions convene a U.N. Summit on Global Health Security in a new report published on Sept. 14.
The aim for the summit is to agree on an international framework that not only incorporates but also expands on the International Health Regulations to include mechanisms on sustainable financing, research and development, social protection, equitable access, and accountability. The IHR is a legally binding instrument agreed to by WHO member states to monitor and control the international spread of diseases.
The recommendation stems from the board’s review of the COVID-19 response, in which it found the U.N. has struggled to fulfill its leadership and coordination role amid the pandemic. Political tensions have prevented it from playing a strong leadership role in the response, the U.N. Security Council struggled to agree on resolutions, and U.N. agencies have taken a “siloed approach” to address the different aspects of the pandemic.
The board also pointed out questions raised over WHO’s declaration of COVID-19 as a pandemic, as well as on the timing and criteria used to determine a public health emergency of international concern. It reiterated calls made by other health experts on the need to develop intermediate levels of emergency alert under the IHR.
“With all due respect, I think building back better is not good enough. We cannot go back to what brought us here.”— Jagan Chapagain, secretary general, IFRC
There is also the question of governance of the global health emergency architecture. The board finds that governance for global health preparedness as “too complex” and “underdeveloped.”
“While the IHR provide the core governance framework for preparedness, they do not cover all relevant areas and stakeholders. Other mechanisms to facilitate the engagement and contribution of different sectors and stakeholders in health emergency preparedness are relatively ad hoc and less well developed,” according to the report.
“We have in the report a picture of the present governance [architecture], and I think anyone looking at that picture sort of scratched their head and said, ‘how come they get to do anything at all?’” said Professor Ilona Kickbusch, chair of the International Advisory Board at the Global Health Centre, Graduate Institute of International and Development Studies in Geneva, during the virtual launch of the report. Kickbusch is also a member of the board.
“That's why we've called for this Global Health Security Summit, because we do need to find a new structure, we need to find a new international agreement, and we, in a sense, need to put new order into this because, … there are still bits and pieces missing,” she said, noting for example, agreements on intellectual property or agreements on global supply chains.
‘Pandemic proof’ future
One of the lessons from COVID-19 is the need to widen understanding of preparedness, and make the social and economic sectors also “pandemic proof,” according to the report.
But what does that mean in practice?
For Jagan Chapagain, secretary general at IFRC, it’s about investing in communities and building community resilience, and investing in social protection.
“One thing I want to highlight here is, with all due respect, I think building back better is not good enough. We cannot go back to what brought us here,” he said at the virtual event.
Decades after Alma Ata — the declaration adopted by the international community in 1978 recognizing the importance of primary health care to achieving health for all — basic health infrastructure remains lacking for millions of people living in Africa and parts of Asia.
“So we really have to build very differently in the future pandemic proofing we're thinking. We have to be much more inclusive in the future,” he said.
Mamta Murthi, vice president for human development at the World Bank, meanwhile, underscored the need to put in place safety nets for people that can be scaled up as needed, and for governments, businesses, and educational institutions to have contingency plans so they can still function amid a pandemic.
Changes in preparedness financing
In April, the World Bank announced plans to establish a $500 million multidonor trust fund to incentivize low-income countries to increase investments in health preparedness and support their COVID-19 response.
But the report notes this is “far from sufficient in scope or scale to incentivize the necessary national investments and support global preparedness.” In fact, the board concludes that traditional development assistance in general “is inadequate for preparedness and response” as it depends on a small number of donor governments, foundations, and development banks.
The report also notes that existing emergency funding mechanisms are “inadequate” for a pandemic response, as illustrated during COVID-19.
Both WHO’s Contingency Fund for Emergencies and the World Bank’s Pandemic Emergency Financing Facility, or PEF, contain only “a relatively small amount of funds” and can be depleted quickly. Conditions attached to the PEF’s insurance window also limit its usefulness during a pandemic.
The World Bank in April said it no longer plans to renew the PEF insurance window after the current pandemic bonds and swaps matured in July 2020.
Board recommendations for sustained investment in prevention and preparedness include G-20 leaders ensuring adequate financing is made available “now” to mitigate the current and future impacts of the pandemic. Heads of governments should also sustain domestic financing for health emergency preparedness and response beyond COVID-19.
The board also called on the U.N. and international financing institutions to develop a mechanism for sustainable global health security financing not reliant on development assistance, and for international financial institutions to make room for R&D investments in their financing, including for health emergencies.