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A new report released today by the World Bank shows that the world is not quite prepared to face the next pandemic. As for many other issues, money, or rather the lack of it, is at the heart of the problem, according to the report, which provides 12 recommendations to tackle the issue at the country level.

In the plush environment of the Intercontinental Hotel near the United Nations in Geneva, the World Bank Group launched the report “From Panic and Neglect to Investing in Health Security,” on the side of the 70^th World Health Assembly.

The report was prepared by the World Bank International Working Group on Financing Preparedness (IWG).

“We know by now that the world will see another pandemic in the not too distant future that random mutations occur often enough in microbes that help them survive and adapt; that new pathogens will inevitably find a way to break through our defenses; and that there is the increased potential for intentional or accidental release of a synthesized agent,” says the report.

Twelve Recommendations as a Package

Peter Sands of the Harvard Kennedy School, and chair of the Working Group presented the report this morning. He said although considerable progress has been made, the world remains unprepared to face the next pandemic.

The report provides 12 recommendations, which he said “should translate into things happening on the ground.” One of the main questions is how to change incentives for policymakers to commit funds, he said.

According to the report, “Many countries chronically underinvest in critical public health functions like disease surveillance, diagnostic laboratories, and emergency operations centers, which enable the early identification and containment of outbreaks.”

“Severe pandemic could result in millions of deaths and cost trillions of dollars, and even smaller outbreaks can cost thousands of lives and cause immense economic damage. The most conservative estimates suggest that pandemics destroy 0.1 to 1.0 percent of global GDP,” according to a World Bank press release.

Sands underlined recommendation 5 as being “absolutely crucial.” Recommendation 5 states “Each national government should develop an investment case, articulating the political and economic arguments for integrating the coasted plan into national budget cycles and committing resources to reinforce and sustain preparedness, plus a change management strategy to engage and coordinate relevant stakeholders.”

Recommendation 2 foresees that by the end of 2019, joint external evaluations should have been conducted in all countries to assess their capacity to comply with the requirements of the International Health Regulations 2005 (IHR).

Recommendation 6 asks that countries examine ways of generating incremental domestic resources to finance preparedness, through schemes such as improving overall tax design and collection, or by introducing earmarked taxes.

Recommendation 8 calls for countries to incorporate the private sector into their strategy for reinforcing preparedness, “through a combination of awareness-building, direct involvement in preparedness and response planning, and regulation.”

The recommendation (8) further says that when private sector contributes “directly or indirectly to the risks of disease outbreak and spread by the nature of their business,” countries should introduce regulations requiring companies to invest in risk mitigation and preparedness.

Finance Ministers Hard to Convince

Recep Akdağ, Turkey’s Minister of Health, remarked on the H1N1 flu (so-called swine flu) had pandemic consequences in Turkey, and said the most difficult issue at that time was communication, and how to contain the spread of erroneous news. The first H1N1 case was identified in July 2009 in Turkey, just one month after the start of the pandemic in Mexico, he said.

He underlined the importance for health systems strengthening, in particular in today’s interconnected world. The first H1N1 case was imported in Turkey through a passenger flying to Istanbul, he explained.

He remarked on the difficulties to get budget space for preparedness. “Finance ministers have strong feelings for human tragedy,” he said, “but generally think how their budget will change.” If there is a way to show that the lack of preparedness will badly influence the budget, they can be persuaded to allocate more funds to preparedness, he said.

“We are only as strong as our weakest link,” he said, adding there is no substitute for preparedness.

Peter Salama, executive director of the WHO Emergencies Programme, commented on the need to find ways to “give teeth” to the International Health Regulations. He also remarked on the lack of funds in the WHO Contingency Fund for Emergencies (CFE), which he said should be ideally funded to the vicinity of US$100 million.

According to a WHO background document [pdf], the CFE, established in 2015, “fills a critical gap from the beginning of an emergency until resources from other financing mechanisms begin to flow,” and is expected to allow WHO to deploy experts on the ground immediately.

World Bank: Blind Spot in Health

Tim Evans, senior director, Health Nutrition and Population Global Practice at the World Bank Group, said the World Bank is “looking very seriously at how our investments can be much more effective.”

In health, there is a “blind spot,” he said, explaining that the World Bank made “important investments in public health functions but this was not done systematically under the umbrella of the universal health coverage.”

He said there is a general undervaluation of risk in the context of pandemic preparedness, and there is a need to value that risk more systematically, with a discipline of that valuation which is translated into an expectation for action and accountability.

More attention has to be given to the responsibilities in terms of capacity within core government sectors, and the different dimensions of industry. “I will reject a blanket assessment [that says] let’s just get the private sector involved,” he said. “It is way, way too heterogeneous.”

Areas such as travel, trade, communications, logistics, and supply chains are involved in preparedness and the plurality of actors in those areas need to be brought together in “a new type of discipline to understand how to manage these risks that no individual institutional entity can manage effectively on its own.”

Tie-In to WHO Work

Intellectual Property Watch asked a World Bank representative later whether efforts by the WHO Pandemic Influenza Preparedness (PIP) Framework to help countries, and in particular developing countries and least-developed countries, could be noticed by the Working Group on the ground. No answer was provided by press time.

The PIP Framework includes a benefit-sharing mechanism by which pharmaceutical companies using biological materials from the WHO’s Global Influenza Surveillance and Response System (GISRS) have to provide a yearly financial contribution. According to the WHO website, “The contributions are used to strengthen pandemic preparedness and response capacities, mostly in developing countries where they are weak.”