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The Next Pandemic Doesn’t Have to Hit So Hard

Investing in global health security can provide critical insurance against disaster.

A nurse administers a Pfizer booster vaccine.
A nurse administers a Pfizer booster vaccine.
A nurse (left) administers a Pfizer booster vaccine for COVID-19 in Jakarta, Indonesia, on March 29. Adek Berry/AFP via Getty Images

Global health emergencies are no longer a once-in-a-generation threat, and the world must act now so that the tragic impacts of COVID-19 do not reoccur. This pandemic exposed a gap in the ability to coordinate globally to detect and address emerging—and later full-blown—health threats. The impact of this weakness has been first and foremost in lives lost, but it has also produced economic shocks that have led to greater poverty and hardship. Around the world, COVID-19 has resulted in well over 6.2 million deaths directly to the virus, more lives lost indirectly, and a financial cost of $13.8 trillion.

And the losses of the next pandemic could be far, far worse.

The world’s top priority should be to end the COVID-19 pandemic, and we must press forward to overcome the hurdles to vaccinating at least 70 percent of the population in all countries. But leaders also need to learn the lessons of this pandemic and advance plans to reform global health security architecture. With increasing pandemic threats, climate change, and conflict, COVID-19 will not be our last major global health emergency.

Global health emergencies are no longer a once-in-a-generation threat, and the world must act now so that the tragic impacts of COVID-19 do not reoccur. This pandemic exposed a gap in the ability to coordinate globally to detect and address emerging—and later full-blown—health threats. The impact of this weakness has been first and foremost in lives lost, but it has also produced economic shocks that have led to greater poverty and hardship. Around the world, COVID-19 has resulted in well over 6.2 million deaths directly to the virus, more lives lost indirectly, and a financial cost of $13.8 trillion.

And the losses of the next pandemic could be far, far worse.

The world’s top priority should be to end the COVID-19 pandemic, and we must press forward to overcome the hurdles to vaccinating at least 70 percent of the population in all countries. But leaders also need to learn the lessons of this pandemic and advance plans to reform global health security architecture. With increasing pandemic threats, climate change, and conflict, COVID-19 will not be our last major global health emergency.

Strengthening global health security is an investment in the future and will be a focus at the G-20 Finance Ministers and Central Bank Governors meeting this week. The proposal for a Financial Intermediary Fund for pandemic prevention, preparedness and response (PPR) , which is under discussion by the G-20, is key to addressing critical investment gaps in global health architecture. The fund would be hosted by the World Bank, with a central role for the World Health Organization (WHO). The fund is one part of the solution and would be designed to complement other essential structural improvements being made to the global health system in the wake of COVID-19, such as strengthening surveillance and early warning mechanisms; prioritizing research and equitable access to tests, treatments, vaccines, and other lifesaving tools; and girding countries’ health systems for future outbreaks.

All three of us agree the world cannot miss this window to apply the sobering lessons learned from COVID-19 before it is too late. But with the harshest impacts of COVID-19 fading and many countries experiencing declines in deaths and severe cases, policymakers and the public alike are already starting to move on to other, admittedly pressing, priorities.

This is understandable. The war in Ukraine and other humanitarian crises around the world demand attention, as do domestic economic, social, and political issues. But there’s a continuing pattern around such crises. Countries follow a cycle of panic and neglect with infectious disease outbreaks, ramping up efforts during the crisis and then forgetting about it when the threat subsides.

This makes it all the more urgent to address the profound gaps in global health security architecture exposed by COVID-19 rather than returning to habits of neglect. The global response has been hampered by inadequate or splintered resources, fragmented governance, capacity gaps in critical systems, and a misalignment of priorities.

For example, the distribution of basic global public goods for COVID-19—such as tests, treatments, and vaccines—has been lopsided. Based on the latest publicly available data from the WHO Coronavirus Dashboard, nearly 2 billion people in low- and lower-middle-income countries—one quarter of the world’s population—have yet to receive even a single shot. This won’t just lead to more deaths and stresses on health systems; these profound and unnecessary inequalities are prolonging the pandemic, threatening the globe’s economic recovery, and increasing the risk of new and dangerous variants emerging. It is also undermining trust and our ability to act as a global community that cares for one another.

This is compounded by the fact that in low- and lower-middle-income countries, essential health services, including immunization programs for other deadly diseases, have been thrown badly off track. With stronger collaboration, sufficient funding, and a fine-tuned understanding of obstacles at the country level, nations working in partnership can bring the acute phase of the current pandemic to an end by dramatically stepping up global vaccination efforts, with priority given to health workers, older populations, and other groups at risk for serious illness.

At the request of the G-20, the WHO and World Bank have analyzed global health security architecture as well as financing needs and gaps for pandemic prevention, preparedness, and response. We estimate the gaps in pandemic preparedness at $10 billion per year in additional investments beyond what countries and international partners are already doing to strengthen health emergency systems. This is a small price to pay to help protect the world from a future pandemic.

Modest additional, coordinated investments in global health security capacities at the national, regional, and global levels can address critical gaps in the collective ability to prevent, detect, and control disease outbreaks, thereby drastically reducing the cost of response and the broader economic and social impacts of a pandemic or large-scale outbreak. There is never a magic bullet when it comes to public health, but we are able to see what worked and what didn’t and learn from our successes as well as our mistakes.

A look at comparative mortality data offers a starting point: Many countries in East Asia, with long experience in managing disease outbreaks, had far, far lower death rates than in the West. Even in Europe, for instance, Germany, with a strong public health system, had a far lower mortality rate than most of its neighbors. We need to understand and build on what works. At the same time, we’ve also had clear demonstrations of how underlying systemic gaps and deep inequalities left many countries, including wealthy ones, vulnerable. And that puts everybody at risk.

The money must be spent in the right places and at the right time—which means before the crisis occurs, not after. Just as communities come together to invest in fire departments, traffic enforcement, and food safety regulations, the world can invest in stronger pandemic preparedness and global health security.

A pandemic preparedness fund such as the Financial Intermediary Fund will reduce risks from epidemics and pandemics in the most vulnerable parts of the world, save lives, and prevent reversals in development gains while keeping everyone safer and economies more stable.

In addition to a fund, a joint finance and health ministers’ body, building on the G-20’s Joint Finance and Health Task Force, can also enhance the coordination of pandemic preparedness and response financing within a stronger global health security architecture. Countries have already begun the process of developing a global agreement or other international instruments to clarify the governance and accountability plans for pandemic preparedness and response.

The nations of the G-20—which have the most resources and account for 80 percent of the global economy—must act together and with the strongest possible political will and tenacity. Philanthropic and private sector support as well is a critical part of this. Future pandemic prevention only works if the architecture for global health security is agile and inclusive, has broad engagement across countries, and the governance needed to promote a coherent and coordinated global response.

Let’s stop the cycle of panic and neglect. Plugging the most critical gaps in global health security is an investment in all our futures.

Janet Yellen is the U.S. treasury secretary.

Tedros Adhanom Ghebreyesus is director-general of the World Health Organization. Twitter: @DrTedros

Sri Mulyani Indrawati is the minister of finance of Indonesia.

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