—by Ngozi Okonjo-Iweala, Tharman Shanmugaratnam and Lawrence H. Summers
We are nowhere near the end of the pandemic. Yet covid-19 is a prelude to more and possibly worse pandemics to come.
Scientists have repeatedly warned that in the years to come outbreaks will be more frequent, spread more quickly and take more lives. Together with the world’s dwindling biodiversity and climate crisis, to which they are inextricably linked, infectious-disease threats represent the primary international challenge of our times.
We cannot avoid outbreaks altogether. But we can sharply reduce the risk of them blowing up into pandemics. What is striking has been our inability to act and invest collectively to do so. We are flying blind into the next pandemic. It could come anytime, from a deadly influenza strain or another pathogen that jumps from animals to humans. It could even strike while the world still struggles with covid-19.
Bringing COVID-19 under control is the most urgent task. But we also need a more basic reset. The current system of global health security will not prevent the world from blundering into another pandemic with catastrophic human and economic costs. It is too fragmented, dependent on bilateral aid and underfunded.
We need a new way of thinking about international cooperation. Financing pandemic prevention is fundamentally not about aid to other nations but collective investments in global public goods that benefit all nations, rich and poor.
We must invest significantly more to close the major gaps in global public goods, often in the national and regional capacities that are critical to detecting and thwarting outbreaks. A massively scaled-up network of early warning systems is needed, as well as efforts to prevent zoonotic spillovers at their source.
Most countries also lack the core capacities to control infectious-disease outbreaks, which are both for their own benefit and the global good. Coupled with a broader strengthening of public health systems, many developing nations should spend at least an additional 1 percent of gross domestic product over the next five years. International institutions will have to step up grant support for lower-income countries.
Crucially, we must have the capacity to radically speed up supplies of vaccines and other essentials, and avoid the staggeringly unequal access that the current pandemic has revealed. It requires a vastly larger, globally distributed development, manufacturing and supply ecosystem in normal times, with the ability to pivot in a pandemic. We must establish a tight network of global health organizations and national and regional agencies such as the United States’ Biomedical Advanced Research and Development Authority (BARDA), Europe’s Health Emergency Preparedness and Response Authority (HERA) and the African Vaccine Alliance, along with close collaboration with the private sector.
The Group of 20 panel we co-chaired assessed that the world needs, at absolute minimum, an additional international investment of $15 billion per year in these global public goods, or a doubling of current levels. But covid-19 demonstrates that the costs of a pandemic are several hundred times more than these preventive investments.
To succeed we must find creative ways to strengthen multilateralism.
First, we must put the finances of the World Health Organization on more secure multilateral footing. There is no solution for pandemic security that does not involve a reformed and strengthened WHO.
Second, we must repurpose the Bretton Woods institutions. The World Bank and International Monetary Fund were created more than 75 years ago, to help countries deal with their own challenges. Their mandates must be updated for an era where the largest challenges facing countries, including the developing world, lie in the threats to the global commons. They must work closely with the regional development banks and other international players, including the global health organizations, to incentivize lower-income countries and regions to invest in global public goods.
The shareholders of these key institutions play a key role. They must make timely replenishments of capital and grant resources, so that the greater emphasis on global public goods is not at the expense of poverty reduction and other key development goals. They must also enable the World Bank and IMF to put out much more money, much faster and with less elaborate conditions in a pandemic, just as their treasuries and central banks became major lenders and investors of first resort in their own countries.
Third, we need a global funding mechanism to mobilize the much larger and sustained investments needed for pandemic prevention and preparedness. A new multilateral fund to mobilize at least $10 billion each year would provide a critical overlay on today’s siloed and underfunded system of global health security.
The new fund will enable both scale and agility in plugging the gaps in global public goods. It should also aim to catalyze domestic investments by governments, and private and philanthropic funding. However, it should be designed to support existing institutions and networks that have boots on the ground, rather than become an operating institution in its own right and add to further fragmentation of the system.
At $10 billion per year, countries’ contributions, made on a fair and equitable basis, will amount to less than 0.02 percent of their GDPs. This is entirely affordable.
Fourth, we must also bridge today’s gaps in financial governance to ensure both proactive and impactful use of funds for global health security. This is most effectively achieved by establishing a board comprising health and finance ministers from an inclusive “G-20 plus” group of countries, with adequate representation from developing regions, and the leaders of the WHO, IMF, World Bank Group, and World Trade Organization.
The window for action is narrow. As experience shows, the opportunity to make bold change will fade once we are past the worst of the pandemic in the richest countries.
We must also act urgently to repair the distrust of the global system in large regions that have been left ill-equipped in the pandemic, which will make it very difficult to address climate change and the other problems of a dangerous world.
We urge leaders to commit to these reforms at the U.N. General Assembly this month, and for the G-20 Summit to launch the new global funding and governance mechanisms at the end of October.
Our greatest risk is that nations paralyzed by the domestic trauma of the current pandemic will fail once again to cooperate and invest collectively, disregarding even their own interests. It would be politically and ethically indefensible, and financially reckless, to wait for the next pandemic to overwhelm us.
The writers are co-chairs of the G-20 High Level Independent Panel on financing the global commons for pandemic preparedness and response.