In the wake of the Ebola crisis that began in West Africa in 2013, a series of
reports have recommended strengthening and scaling up investments in global
health security as an urgent priority. Expert assessments by the Harvard-London
School of Hygiene and Tropical Medicine (LSHTM) Independent Panel on the Global
Response to Ebola (November 2015), the U.S. National Academy of Medicine's (NAM)
Commission on Creating a Global Health Risk Framework for the Future (January
2016), and the UN High Level Panel on the Global Response to Health Crises
(February 2016) urge far-reaching improvements in nations' public health
capabilities and infrastructure, in international leadership for preparedness
and response, and in research and development related to infectious diseases.
Emphasizing the urgent need to invest in preparedness, the Harvard-LSHTM Panel
called upon the global community and countries to agree on a clear strategy to
ensure that governments invest domestically in building core public health and
system capacities, and to mobilize adequate external support to supplement these
efforts, especially in poorer countries. Highlighting infectious diseases as one
of the biggest risks facing humankind, the NAM Commission on Creating a Global
Health Risk Framework for the Future argued that reinforcing public health
capabilities should be a top priority and estimates that $4.5 billion must be
spent annually to prepare the world for the next global health crisis, whether
it is a resurgence of Ebola, SARS.
Or bird flu, a swiftly moving threat like Zika, or some entirely new disease. Stressing the need for all countries to meet
the full obligations of the International Health Regulations 2005 (IHR), the UN
High Level Panel noted that building a global health architecture that is better
prepared to respond to health crises will require additional financial
resources, and stresses the need to mobilize domestic and international funding,
especially for low-income countries, to support the implementation of the IHR's
Core Capacity requirements.
This Corona-Virus pandemic is much more than a health crisis; it's also an
unprecedented socio-economic crisis. Stressing every one of the countries it
touches; it has the potential to create devastating social, economic and
political effects that will leave deep and longstanding scars.
Every day, people
are losing jobs and income, with no way of knowing when normality will return.
Small island nations, heavily dependent on tourism, have empty hotels and
deserted beaches. The International Labour Organization estimates that 195
million jobs could be lost. The World Bank projects a US$110 billion decline in
remittances this year, which could mean 800 million people will not be able to
meet their basic needs.
Identifying Gaps And Estimating Funding Needs
The first International Sanitary Conference took place in Paris in 1851 in
response to a cholera epidemic that ravaged Europe for nearly 15 years. A
hundred years later, in 1951, member states of the newly-constituted WHO adopted
the International Sanitary Regulations, which were replaced by and renamed the
International Health Regulations in 1969. Narrowly focused on six serious
infectious diseases (cholera, plague, yellow fever, smallpox, relapsing fever,
and typhus), IHR (1969) depended on official country notification of disease
outbreaks and did not establish a formal internationally coordinated mechanism
to contain disease spread or ensure country commitment to standards. Further,
some countries were reluctant to report diseases for fear of trade and travel
restrictions (WHO 2009).
The resurgence of cholera, plague, and Ebola in the
1990s exposed the limitations of IHR (1969), which led to calls for their
revision in 1995, and a call to WHO in 2001 to support countries in
strengthening their capacity to detect and respond rapidly to communicable
disease threats (WHO 2009). All this while, the IHR remained largely unchanged.
Negligence persisted among countries, and the capacities of most countries to
detect and respond to disease outbreaks remained low. This inertia was shaken by
SARS, which made its first appearance in November 2002 in China's Guangdong
province (Huang 2004). The disease spread rapidly around the globe.
raised by SARS intensified the IHR revision process, and by 2005, the scope of
the regulations was broadened to cover all public health threats, including
existing, new, and emerging threats and those caused by non-infectious disease
agents. The revised IHR (2005) required countries to report all possible hazards
with the potential to be public health emergencies of international concern,
regardless of cause, and provide this information in a timely manner.
Every country needs to act immediately to prepare, respond, and recover. United
Nations Secretary-General António Guterres has launched a US$2 billion global
humanitarian response plan in the most vulnerable. Developing countries could
lose at least US$220 billion in income, and the United Nations Conference on
Trade and Development has called for US$2.5 trillion to support them. Drawing on
with the past experience with other outbreaks such as Ebola, HIV, SARS, TB and
malaria WHO will help countries to urgently and effectively respond to COVID-19
as part of its mission to eradicate poverty, reduce inequalities and build
resilience to crises and shocks.
Preparing A Financing Proposal, A Compelling Investment Case And A Change Management Strategy
Once a country has developed a costed and prioritized plan, the next steps are
to work out how to finance this plan and then how to implement it effectively.
This requires three key components:
first, a realistic financing proposal to
ensure inclusion in domestic budgets and, where relevant, win the support of
development partners; second, a compelling investment case that ensures
sustained economic and political support for improving preparedness; and
finally, a change management strategy that facilitates the committed engagement
of relevant stakeholders.
Points to look out during the Pandemic
- Ensuring economic stability and growth of the country
- Contributing to universal health coverage
- Improving security and protecting social stability
- Managing externalities to regional and global community.
Identifying Sources Of Finance And Means Of Mobilizing/Allocating Funds To Preparedness
There are vast differences across countries in how much of their public
resources they spend on health, a metric that is a good proxy for the extent to
which health is prioritized by governments.12 World Bank data suggests that in
2014 the share of health in aggregate government expenditure in 190 countries
ranged from 2.4 percent in Timor-Leste to 27.9 percent in Andorra, with a mean
of 11.8 percent.
Unsurprisingly, higher income countries devote a larger share
of government expenditure to health (17.8 percent in the high-income OECD
countries) than do lower-income countries (9.8 percent in the low-income IDA
countries). Estimates of financing required for preparedness vary dramatically;
depending on whether underlying health system capacities need to be strengthened
first or whether only a limited set of specific preparedness capacities must be
The post-JEE costing exercises in Tanzania and Pakistan suggest that
just $0.5 to $1 per capital per year may suffice. An analysis of self-assessed
requirements under IHR in several other countries, such as Bangladesh, Nepal and
Indonesia, also result in similar modest estimates.Ways to get the
funds for Pandemic Preparedness:
- Domestic vs. International Funding
- Improved Tax Collection
- Priorities for Donor Investments in Preparedness
- Strengthening Regional Preparedness( Each state should be kept ready for
- Engaging the Private Sector in Financing Preparedness
We know that it is only a matter of time before the next pandemic hits us. We
also know that there is a good chance that it will be severe. It may mean death
on a slow fuse, spreading insidiously through populations, unrecognized for
years, like Corona pandemic today or HIV in the 1980s. Or it may strike people
down with stark violence and lightning speed, plunging national economies
abruptly into chaos, like Ebola in West Africa in 2014–15. Whatever its mode of
attack, the next large-scale, lethal pandemic is at most only decades away.
Even if we escape the terrifying prospect of a lethal pandemic of global scope,
the possibility that any of the outbreaks or epidemics that are occurring all
the time might become such a pandemic can still cost many lives and cause huge
disruption to economies and societies. The economic impact of infectious disease
outbreaks is caused by the contagion of fear. And in our 24-hour media, highly
interdependent world, fear spreads extraordinarily rapidly.
Of course, the money has to be there, too. Otherwise, unfortunately, none of the
assessments and plans will matter. Between achieving real health security and
aspiration rhetoric, the difference is dollars. This is the challenge before the
WHO and world that sought to be addressed.
We are well aware that others have called for better funding of preparedness
before with limited success. Yet we hope that three differences can make more
success: first, the recommendations are specific and time bound: second, they
are practical and supported by tools; and third, the recommendations include
mechanisms to change policy makers' incentives.
Award Winning Article is Written By: Puneet Jangid
- GLS Law College, Ahmedabad
Authentication No: SP02455910650-1-920