Although the COVID-19 response saw remarkable institutional innovations focused on controlling the pandemic once it had begun – notably the Access to COVID-19 Tools Accelerator (ACT-A) with its vaccine arm COVAX – the pandemic still frustratingly demonstrated once more the enormous costs of failing to invest adequately in prevention and control measures and other global health activities to protect the world.
The sad reality is that despite an overwhelming humanitarian and financial case for fully funding ongoing international measures against COVID-19 as well as longer-term measures to prepare for and prevent future pandemics, the international community has so far failed to mobilize the level and breadth of political commitment needed.
A good illustration of the challenge was the Coalition for Epidemic Preparedness Innovations (CEPI) replenishment summit in March. Although it was a good outcome – considering competing demands on international financing – that funders committed $1.5 billion to underwrite CEPI’s plan for fostering development of new vaccines within 100 days of a future pandemic being identified, and ensuring a fair and equitable global distribution, it was still well short of the $3.5bn requested.
Since then, international efforts have seen further development of the International Monetary Fund (IMF) Resilience and Sustainability Trust (RST) at the spring meetings of the World Bank and IMF, the global COVID-19 Summit, the announcement of the World Bank-hosted Financial Intermediary Fund for Pandemic Preparedness and Response, and Pfizer’s new initiative to supply patented drugs, including vaccines, at cost price in low-income countries.
But the combined impact of these efforts still falls well short of what is needed, especially in respect of their long-term sustainability and the extent to which they assure global equity. Meanwhile, the Ukraine invasion has placed large additional financial demands on Western governments, and aid budgets may have to respond to an emerging global food crisis. Finding funds to support international health interventions is inevitably harder now.
Weakened global governance
At their latest meeting in May, G7 finance ministers clearly acknowledged the need for additional funding to fight the pandemic and to close financing gaps in pandemic preparedness and response. But they appeared to push responsibility forward to the G20 Summit at the end of October, noting that ‘more efforts by all members of the international community, including the G20, are required’.
This is certainly in line with the G20’s declared role as the ‘premier global economic forum’ and reflects the reality that G20 members outside the G7 will also share substantially in the benefits of supressing COVID-19, and reducing the risk of future pandemics, as well as having considerable economic and financial capabilities of their own. But in the present circumstances it also significantly raises the risk the financing gap will not be closed in 2022.
Russia’s attack on Ukraine has seriously damaged the G20 as a global coordination and decision-making body as Western countries balk at working in a group where a leading member is undermining the entire international governance system. But other major economies are not prepared to expel or suspend Russia from G20.
China’s continuing struggle with COVID-19 and its determination to maintain a ‘zero COVID’ strategy, at least until the autumn, means the domestic response remains the top priority for the Chinese authorities, potentially further complicating the job of developing a decisive G20 response on global health financing.
It is not yet clear how the shortfall in global governance will be addressed – a lot will depend on how quickly and in what way the war in Ukraine is brought to an end. In the unlikely event that a generally acceptable resolution happens relatively quickly, the G20 may still be able to play an effective and leading role – however if it drags on, another grouping may need to be found.
But to capitalize on the opportunities which do become available, it is becoming increasingly clear that the approach to official funding of international health priorities, and particularly those that serve to protect the entire world population, needs a fundamental rethink.
This rethink needs to take account of the context in which the ultimate decision-makers – such as finance ministries and political leaders – make decisions and prioritize the available finance between vitally important but competing priorities. Long-standing international funding efforts in areas such as HIV/AIDS and antimicrobial resistance (AMR) provide valuable insights.
Components for a solution
Ongoing research at Chatham House has highlighted three factors which should lie at the heart of this rethink.
First, the overall ‘ask’ for international funding of global health priorities has become too elastic – it needs to be more specific in terms of scope and timescale, with clear prioritization and justification.
There also needs to be a clearer articulation of which global health priorities should be funded domestically and what should be funded through collective international initiatives, whether in the form of vertical funds or other structures.
Second, the complexity of, and lack of faith in, the international architecture for funding global health priorities is a major source of hesitancy among funders.
Wholesale reform, even if desirable, is unlikely to be politically and administratively realistic, and attempting it could be counter-productive in the near term.
But agreement on the direction of travel and a plan for sustained incremental improvement in institutions and procedures would at least rebuild confidence. In this respect, the following areas deserve particular attention:
- The role of OECD Development Assistance Committee rules – both the design of the rules themselves and the way they are interpreted by members states.
- The role of the international finance institutions (IFIs) at both the country level and in support of collective international priorities, including issues such as the risk appetite of the IFIs and use of capital.
- The role of periodic replenishments for initiatives such as CEPI – how they interact with national funding decision-making systems and with each other.
Third, civil society has at times played an enormously powerful role in mobilizing political support for the international funding for global health priorities. But crucially this depends on the availability of high quality, politically-independent information on the nature and impact of specific global health threats, as well as the most effective response.
A new approach is urgently needed to ensure the public is provided with such information, and it should draw on models in other global threat areas, such as the The Intergovernmental Panel on Climate Change (IPCC) for climate change science.
Addressing these issues will not on its own ensure the international community finds a solution to sustainable funding of global health priorities – that is ultimately dependent on political leadership. But doing so will make the most of whatever political leadership the international community can muster.
Creon Butler, Research Director, Trade, Investment and New Governance Models, and Director, Global Economy and Finance Programme and Emma Ross, Senior Research Fellow, Global Health Programme.