Opinion: Why set up new pandemic finance mechanisms when 2 already exist?

In December 2021, as an apparent panic reaction to the spread of omicron, member states of the World Health Assembly reached a consensus decision to establish an Intergovernmental Negotiating Body to draft an international agreement to strengthen pandemic prevention, preparedness, and response, or PPPR. After several drafts and a dynamic process of nearly two years, on Oct. 30, the INB released its Proposal for Negotiating Text of the Pandemic Agreement that is now under consideration. Among its many provisions, this version of the text proposes that the Conference of Parties — the yet-to-be-created supreme decision-making body of the agreement — establish two new global health financing mechanisms for PPPR. These mechanisms, a capacity development fund and an endowment, are both primarily aimed at assisting low- and middle-income countries meet agreement obligations and build their PPPR infrastructure. This proposal, however, fails to take into account two key global health financing mechanisms: the newly created Pandemic Fund and the well-established Global Fund to Fight AIDS, Tuberculosis and Malaria. Avoid duplication With a focus on LMICs, the Pandemic Fund was launched in November 2022 with the very purpose of providing critical investments to bolster national, regional, and global PPPR capacities. It is fully operational and has already completed its first round of allocation of $338 million for countries and regions and is predicted to launch a new funding round at the end of this year. “A very critical aspect of preventing another global public health catastrophe such as COVID-19 is to ensure that reliable and sustainable financing is available for LMICs.” --— The Global Fund, which has been fighting pandemic-size diseases since 2002, is also already providing financing to bolster the capacity of countries and regions. It has recently committed approximately $1.5 billion annually to strengthening formal and community health systems and has further allocated for the 2023-2025 period around $2.2 billion to LMICs for health system strengthening, considered a fundamental pillar for PPPR. Because the Pandemic Fund and the Global Fund are already in place to support LMICs with financing for PPPR, creating two additional funds with a similar purpose is likely to harm the global health ecosystem by duplicating efforts, scattering focus, and diluting an already strained pool of donor resources. It is also likely to foster wasteful and counterproductive competition while unnecessarily increasing overall transactional costs and administrative expenses needed to achieve the same or similar objectives. This is a lose-lose situation for all. In a landscape where many countries wrestle with pandemic recovery and widespread economic hardship that is predicted to negatively impact national health spending worldwide, the focus should be on amplifying the capacity of existing financial mechanisms to get money expediently and efficiently to countries and regions. It should also be geared toward negotiating much-needed co-investments and working with countries to ensure that resources flow to where they are needed most — and not to the creation of a new administrative machinery. The Pandemic Fund as a financial mechanism for PPPR A very critical aspect of preventing another global public health catastrophe such as COVID-19 is to ensure that reliable and sustainable financing is available for LMICs and their respective regions to develop their PPPR architecture. Such financing is needed to, among other things, train personnel, strengthen surveillance and early warning systems, improve national and/or regional laboratory infrastructure, and develop response capacities. Without adequate resources, countries will not be able to effectively detect, alert, and respond to infectious disease outbreaks at their source nor respond to larger outbreaks that spread beyond their origin. A sustainable solution could be for the Pandemic Fund to become the Pandemic Agreement’s financial mechanism for PPPR. But to accomplish this, its leadership must proactively advocate and champion this function. In this scenario, a narrow funding mechanism within the Pandemic Fund should be dedicated to supporting the activities of the Conference of Parties and its secretariat. Further, the INB should also recognize the role that is already being played by the Global Fund, and work with this entity to harness its experience in negotiating with countries the co-investments that are needed under national plans for PPPR. Formalizing the positions of the Pandemic Fund and the Global Fund as part of the financing architecture of the Pandemic Agreement offers a viable option for constructing a more coordinated, sustainable, and reliable global health financing system. This will also require that the Pandemic Fund and The Global Fund go to greater lengths to cooperate more closely and efficiently to avoid duplication and ensure complete synergy in their efforts.