## TOWARD BETTER PANDEMIC PREPAREDNESS

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**Canonical URL:** [TOWARD BETTER PANDEMIC PREPAREDNESS](https://www.imf.org/-/media/files/publications/fandd/article/2021/december/patel.pdf)

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### Metrics upended
- Preexisting preparedness rankings failed to predict COVID-19 outcomes:
  - Global Health Security Index (2019) ranked the United States best prepared and the United Kingdom next best prepared; two years later:
    - United States recorded more than 700,000 deaths from COVID-19.
    - United Kingdom recorded seven times more deaths than the 20,000 that its government chief scientific adviser suggested in March 2020 would be a “good outcome.”
  - World Health Organization (WHO) 2018 self-assessment of IHR implementation found:
    - 86 percent of countries in Europe at the highest levels of pandemic preparedness on paper.
    - 15 percent of countries in Africa at comparable levels.
  - Actual outcomes up to September 28, 2021:
    - Europe experienced 1,294 deaths per million.
    - Africa reported fewer than 205 deaths per million.
- Explanations for the disconnect:
  - Prior experience with viral outbreaks improved operational responses in some countries (examples):
    - Liberia: reforms after the 2014–16 Ebola outbreak standardized and improved community-based health care.
    - Sierra Leone: adapted targeted quarantine measures used for Ebola to isolate COVID-19 cases.
    - Senegal: Institut Pasteur de Dakar was one of only two laboratories in Africa able to test for SARS-CoV-2 in February 2020; by April 2020, 43 African countries had capacity to effectively diagnose COVID-19, with free tests yielding results within 24 hours or less.
  - Failures in seemingly strong systems often reflected shortages across “staff, stuff, space, and systems”:
    - United Kingdom built seven Nightingale Hospitals at a cost of $736 million that largely went unused because of insufficient trained staff.
  - Community- and local-government-based approaches helped curb transmission without severe lockdowns:
    - Thailand: four decades of recruiting a large network of volunteers mobilized for logistics and remote coverage.
    - Vietnam: engaged existing local governance for community-based coordination of quarantines and self-isolation.
    - Japan: rapid training of public health nurses enabled thorough contact tracing and early cluster identification.

### Investing in prevention and preparedness
- Economic case and financing needs:
  - By 2025, COVID-19 will have a global economic burden of $16–$35 trillion (estimates from McKinsey & Company and an independent G20 panel).
  - G20 High Level Independent Panel opportunities and financing figures presented:
    - Minimum annual international financing: $15 billion.
    - Estimated cost of COVID-19: $16 trillion (minimum estimate cited).
    - Minimum five-year international financing with sustained investments over subsequent years: $75 billion.
    - Equivalency noted: $75 billion = $10 billion (contextual pairing in chart).
- Health investments deliver twice over:
  - In acute public health emergencies (including antimicrobial resistance).
  - In building healthier and more equitable societies, yielding continuous everyday value and faster economic recovery (example: Finland’s approach).
- Science and government support:
  - Rapid development of multiple safe and effective COVID-19 vaccines was enabled by decades of investment in scientific research and timely government support to accelerate development and distribution.
- Vaccine equity and manufacturing:
  - The COVAX Facility has underdelivered and lacks financial power to bring down prices, forcing reliance on donations.
  - Accusations of vaccine hoarding by wealthy countries; example cited: Canada ordering doses equal to 10 times its population.
  - Recommendation to build and scale up vaccine manufacturing hubs in low-income regions to end the acute phase sooner and provide infrastructure for other diseases.
- International Health Regulations (IHR) and WHO capacity:
  - Pandemic exposed deficiencies in IHR compliance; many countries complied only in part due to incomplete awareness or deliberate flouting.
  - The IHR remains central to global health architecture but needs adjustments:
    - Adopt a more nuanced alerting mechanism.
    - Empower the WHO to continually review and improve member states’ compliance.
  - Financing the WHO:
    - An increase in funding of $1 billion a year in assessed contributions for the WHO would be a start.

### Lessons and policy implications
- Preparedness must be treated as investment, not cost:
  - Even modest reductions in pandemic costs through better preparedness yield substantial absolute returns given the $16–$35 trillion potential burden.
- Local capacity, prior outbreak experience, and sustained public health workforce development are critical complements to hospital infrastructure.
- Policy priorities to improve future pandemic outcomes:
  - Strengthen local community health systems and rapid training programs for public health staff.
  - Invest in diagnostic capacity and decentralized testing capabilities.
  - Scale up regional vaccine manufacturing capacity in low-income regions.
  - Reform and strengthen incentives and accountability for IHR compliance.
  - Increase predictable, sustained international financing for pandemic preparedness (figures cited above).
  - Provide the WHO with the financial support, authority, and trust needed to ensure better compliance and continuous improvement.

*Jay Patel and Devi Sridhar. Finance & Development, December 2021.*

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_Source: https://www.imf.org/-/media/files/publications/fandd/article/2021/december/patel.pdf_