## wpiea2022068-print-pdf - 1. Support countries to develop a comprehensive toolkit: While vaccines remain a critical tool, we need to

## Source details

**Canonical URL:** [wpiea2022068-print-pdf - 1. Support countries to develop a comprehensive toolkit: While vaccines remain a critical tool, we need to](https://www.imf.org/-/media/files/publications/wp/2022/english/wpiea2022068-print-pdf.pdf)

## Other formats

- [Markdown version](/-/media/files/publications/wp/2022/english/wpiea2022068-print-pdf.pdf.md)
- [Structured JSON version](/-/media/files/publications/wp/2022/english/wpiea2022068-print-pdf.pdf.json)

---

### Comprehensive toolkit: rationale and components
- Vaccines remain a critical tool, but strategy should move beyond an approach that is overly dependent on vaccines to one that includes testing, genomic surveillance, and therapeutics.
- Strengthening health systems is likely to become more important to:
  - reduce the risk of mutations,
  - prevent the excess mortality that occurs when infections overwhelm health systems,
  - prepare for future pandemics.
- Many multi-country infectious disease outbreaks have originated and had the greatest impact in countries with weak public health systems and limited capacity to detect and suppress outbreaks.

### ACT Accelerator budget and role
- The refreshed ACT Accelerator budget of $23.4 billion (with about $15 billion in grants) outlines a financing need for vaccines, diagnostics, treatments, and health systems.
- The ACT Accelerator budget should be seen as a dynamic tool that can be updated depending on the evolution of the virus.
- Financing the strengthening of health systems is emphasized as increasingly important.

### Expand production of antivirals and ensure equitable access
- Effective oral antivirals are available that can significantly reduce the risk of hospitalization and death—if administered early.
- Paxlovid has been shown to be 89 percent effective in preventing hospitalization, albeit on a small sample.
- Global production constraints and access projections for 2022:
  - Only 120 million courses are expected to be available in 2022.
  - Of those, 30 million are expected in the first half of the year.
  - It seems likely that only a limited volume would be available to developing countries.
- Example financing need:
  - If 10 million courses were secured for developing countries, about $2 billion would be required to procure and deploy this volume (with adequate testing), which is currently not available.
- Generics are not expected until 2023.
- Substantial support will be required to expand production and create a pathway for equitable access.

### Operational requirements and global coordination
- A comprehensive toolkit is critical to enable countries to implement “test and treat” pathways that support diagnosis, prioritization and treatment with antivirals in the time frame required to maximize benefits.
- Many low-income countries will need to scale up their testing significantly.
- These actions are particularly helpful if Scenarios B or D materialize, that is, if future variants cause severe disease.
- Global coordination will be needed to ensure that these drugs are not used as monotherapies, to minimize the risk of drug resistance.

### 3. Invest in R&D and genomic surveillance: Findings and rationale
- The global scientific response developed vaccines, tests, and treatments at record speed—saving uncountable lives.
- Continued R&D investments are needed to:
  - develop a universal vaccine against coronaviruses;
  - develop improved antiviral drugs;
  - handle new SARS-CoV-2 variants, novel coronaviruses, and other threats.
- Enhanced genomic surveillance capabilities are especially needed in developing economies.
  - The rapid detection and sequencing of the Omicron variant by scientific teams in Botswana and South Africa demonstrated the value of such investments and the critical need to expand surveillance capabilities in developing economies.
- These actions are particularly important if Scenarios B or D materialize (i.e., if highly virulent future variants are encountered).
- Policy target highlighted: the goal of making safe and effective vaccines against any virus in 100 days.

### A balanced and integrated global response: barriers to meeting global targets
- Four main reasons for limited progress toward global targets for COVID-19 tools:
  1. Lack of financing:
     - The global response has raised only about $18.7 billion in grant form for the ACT Accelerator.
     - The IMF Pandemic Proposal identified a grant need of $35 billion, leaving a gap of about $15 billion.
  2. In-country delivery barriers:
     - COVAX offers free vaccines to 91 Advance Market Commitment (AMC) countries as a contribution toward the 70 percent goal.
     - Over half of countries have deferred or refused delivery of free vaccines despite low vaccine coverage; typical reasons were absorptive capacity or lack of demand.
     - COVAX allocation Round 14 offered 420 million doses to AMC countries, but only 100 million doses were accepted—signifying serious in-country delivery barriers.
     - Overcoming these barriers requires more reliable long-term supply forecasts and flexible financing to support in-country efforts to get shots in arms and strengthen health systems.
     - Similar delivery barriers impede equitable access to tests and treatments, though for tests and treatments the primary binding constraint remains financing.
  3. Unpredictable supplies and inefficiencies in regulatory processes:
     - Episodic and unpredictable supply of vaccines discouraged countries from planning mass vaccination programs.
     - Regulatory authorities have struggled to provide timely and clear guidance on the use of tools for a swift response.
  4. Unbalanced response:
     - Tests, therapeutics, and supportive care (including medical oxygen) are vastly under-resourced across many regions.
     - Funding for diagnostics through the ACT Accelerator has been only a fraction of what would be required.

### Pandemic long-term impacts and policy priorities
- Hidden scars and social impacts:
  - About 65–75 million additional people are estimated to be in extreme poverty in 2021 compared with pre-pandemic projections.
  - Employment and labor-market participation remain below pre-pandemic levels, with emerging market and developing economies hit harder on average.
  - Nearly one in four people in the world are school age, and school closures were twice as long in developing economies as in advanced economies.
  - Knock-on impacts include delayed diagnoses and extended waiting lists in rich countries, and reversals in progress on other infectious diseases in poorer countries, leading to hundreds of thousands of additional deaths.
- Policy implication: as the global emergency ends, ensure equitable access to the comprehensive COVID-19 toolkit while balancing competing national health priorities and preventing long-term scarring through greater country engagement, ownership, and support to customize toolkits to national priorities.
- Need for greater macro-fiscal attention and increased efficiency of health spending in countries with limited policy space.

### Unified approach to reduce global risks (Policy Implication 4)
- Four refreshed principles for global response and preparedness:
  - Donor financing should be recognized as addressing a systemic international risk, not just development aid; allocate additional funding for pandemics and health system strengthening beyond official development assistance.
  - Acting early is far more valuable than delayed action; accessing resources even one week earlier can save lives.
  - Emphasize complementarities between disease-specific investments and multi-pathogen systems/platforms (invest in systems, platforms, and capacities on a multi-pathogen basis).
  - Strengthen global collaboration and systems for faster response by action in five areas:
    1. stronger multilateral institutions with high-level political support to coordinate global response to health shocks;
    2. rapid and adequate financing windows for global public goods activated at pandemic onset;
    3. diversified regional manufacturing capacity for vaccines, tests, and drugs with arrangements to share technology and know-how;
    4. increased investment in disease surveillance at global, regional and national levels, resilience and sustainability of national public health systems, and in R&D to enable more rapid delivery of medical countermeasures;
    5. improved regulatory frameworks to allow speedy delivery of existing and novel tools worldwide.
- Also emphasized: better understanding of environmental drivers of SARS-CoV-2 and other pathogens (One Health program).

### Financing: identified needs and proposals
- ACT Accelerator consolidated financing framework (released February 2022) identified:
  - an urgent grant financing need of $16.8 billion to meet global COVID-19 targets between October 2021 and September 2022;
  - an additional $6.8 billion as part of a larger investment to support countries’ local delivery of COVID-19 tools.
- As of mid-March 2022, the grant financing gap stood at about $15 billion.
- Future pandemic preparedness financing estimates:
  - WB-WHO report estimates total annual financing need for a future PPR system to be $31 billion.
  - Considering current and expected financing, the report estimates additional international financing required to fund a fit-for-purpose PPR architecture at about $10 billion.
- IMF authors’ suggestion:
  - make an additional $15 billion in grant financing available in 2022 (primarily geared toward fighting COVID-19 in line with the ACT Accelerator financing framework);
  - provide $10 billion annually going forward to support PPR activities (in line with the WB-WHO and HLIP reports).
  - Rationale: these funds should be grants because ending the pandemic in a timely manner is a global public good and to avoid saddling developing economies with large debt burdens.
- Other financing notes:
  - World Bank’s COVID health operations have provided about $15 billion in financing for COVID-19 tools, of which about $6.5 billion is in IDA financing, of which a third is on grant terms.
  - Existing institutions and channels—CEPI, Global Fund, Gavi, WHO—will continue to play important roles amid complexity and fragmentation in global health.
  - Strengthening procurement capabilities, streamlining regulatory approvals, and improving coordination are essential at national, regional, and global levels.
- IMF’s role:
  - support countries to open up fiscal space and potentially act as a third-resort line of finance.
  - 2021 IMF Executive Board approved an SDR allocation of $650 billion.
  - IMF is exploring options to channel SDRs through a Resilience and Sustainability Trust (RST) to provide affordable long-term financing for structural challenges including pandemic preparedness.

### Closing thoughts and imperatives
- Major pandemics have historically caused severe harm; frequency of epidemics and pandemics is expected to rise.
- A dangerous legacy is weakened capacity in developing countries to invest in health combined with lower appetite for grant support.
- Large welfare gains exist from avoiding pandemics—estimated to be about 10 percent of a single year’s consumption—warranting greater policy attention.
- Final policy priority: end the acute phase of this pandemic everywhere and adopt a global strategy to manage long-term risks of COVID-19 and future infectious disease threats.

*Source: IMF Working Paper “A Global Strategy to Manage the Long-Term Risks of COVID-19,” Working Paper No. WP/2022/068 (excerpt).*

### 1. Support countries to develop a comprehensive toolkit: While vaccines remain a critical tool, we need to

### wpiea2022068-print-pdf - 1. Support countries to develop a comprehensive toolkit: While vaccines remain a critical tool, we need to

### Comprehensive toolkit: rationale and components
- Vaccines remain a critical tool, but strategy should move beyond an approach that is overly dependent on vaccines to one that includes testing, genomic surveillance, and therapeutics.
- Strengthening health systems is likely to become more important to:
  - reduce the risk of mutations,
  - prevent the excess mortality that occurs when infections overwhelm health systems,
  - prepare for future pandemics.
- Many multi-country infectious disease outbreaks have originated and had the greatest impact in countries with weak public health systems and limited capacity to detect and suppress outbreaks.

### ACT Accelerator budget and role
- The refreshed ACT Accelerator budget of $23.4 billion (with about $15 billion in grants) outlines a financing need for vaccines, diagnostics, treatments, and health systems.
- The ACT Accelerator budget should be seen as a dynamic tool that can be updated depending on the evolution of the virus.
- Financing the strengthening of health systems is emphasized as increasingly important.

### Expand production of antivirals and ensure equitable access
- Effective oral antivirals are available that can significantly reduce the risk of hospitalization and death—if administered early.
- Paxlovid has been shown to be 89 percent effective in preventing hospitalization, albeit on a small sample.
- Global production constraints and access projections for 2022:
  - Only 120 million courses are expected to be available in 2022.
  - Of those, 30 million are expected in the first half of the year.
  - It seems likely that only a limited volume would be available to developing countries.
- Example financing need:
  - If 10 million courses were secured for developing countries, about $2 billion would be required to procure and deploy this volume (with adequate testing), which is currently not available.
- Generics are not expected until 2023.
- Substantial support will be required to expand production and create a pathway for equitable access.

### Operational requirements and global coordination
- A comprehensive toolkit is critical to enable countries to implement “test and treat” pathways that support diagnosis, prioritization and treatment with antivirals in the time frame required to maximize benefits.
- Many low-income countries will need to scale up their testing significantly.
- These actions are particularly helpful if Scenarios B or D materialize, that is, if future variants cause severe disease.
- Global coordination will be needed to ensure that these drugs are not used as monotherapies, to minimize the risk of drug resistance.

*IMF WORKING PAPERS A Global Strategy to Manage the Long-Term Risks of COVID-19*

### 3. Invest  in  R&D  and  genomic  surveillance: The  COVID-19  pandemic  has  been  one  of  the  greatest

### 3. Invest in R&D and genomic surveillance: The COVID-19 pandemic has been one of the greatest

### R&D and Genomic Surveillance: Findings and Rationale
- The global scientific response developed vaccines, tests, and treatments at record speed—saving uncountable lives.
- Continued R&D investments are needed to:
  - develop a universal vaccine against coronaviruses;
  - develop improved antiviral drugs;
  - handle new SARS-CoV-2 variants, novel coronaviruses, and other threats.
- Enhanced genomic surveillance capabilities are especially needed in developing economies.
  - The rapid detection and sequencing of the Omicron variant by scientific teams in Botswana and South Africa demonstrated the value of such investments and the critical need to expand surveillance capabilities in developing economies.
- These actions are particularly important if Scenarios B or D materialize (i.e., if highly virulent future variants are encountered).
- Policy target highlighted: the goal of making safe and effective vaccines against any virus in 100 days.

### A Balanced and Integrated Global Response: Barriers to Meeting Global Targets
- Four main reasons for limited progress toward global targets for COVID-19 tools:
  - Lack of financing:
    - The global response has raised only about $18.7 billion in grant form for the ACT Accelerator.
    - The IMF Pandemic Proposal identified a grant need of $35 billion, leaving a gap of about $15 billion.
  - In-country delivery barriers:
    - COVAX offers free vaccines to 91 Advance Market Commitment (AMC) countries as a contribution toward the 70 percent goal.
    - Over half of countries have deferred or refused delivery of free vaccines despite low vaccine coverage; typical reasons were absorptive capacity or lack of demand.
    - COVAX allocation Round 14 offered 420 million doses to AMC countries, but only 100 million doses were accepted—signifying serious in-country delivery barriers.
    - Overcoming these barriers requires more reliable long-term supply forecasts and flexible financing to support in-country efforts to get shots in arms and strengthen health systems.
    - Similar delivery barriers impede equitable access to tests and treatments, though for tests and treatments the primary binding constraint remains financing.
  - Unpredictable supplies and inefficiencies in regulatory processes:
    - Episodic and unpredictable supply of vaccines discouraged countries from planning mass vaccination programs.
    - Regulatory authorities have struggled to provide timely and clear guidance on the use of tools for a swift response.
  - Unbalanced response:
    - Tests, therapeutics, and supportive care (including medical oxygen) are vastly under-resourced across many regions.
    - Funding for diagnostics through the ACT Accelerator has been only a fraction of what would be required.

### Pandemic Long-Term Impacts and Policy Priorities
- Hidden scars and social impacts:
  - About 65–75 million additional people are estimated to be in extreme poverty in 2021 compared with pre-pandemic projections.
  - Employment and labor-market participation remain below pre-pandemic levels, with emerging market and developing economies hit harder on average.
  - Nearly one in four people in the world are school age, and school closures were twice as long in developing economies as in advanced economies.
  - Knock-on impacts include delayed diagnoses and extended waiting lists in rich countries, and reversals in progress on other infectious diseases in poorer countries, leading to hundreds of thousands of additional deaths.
- Policy implication: as the global emergency ends, ensure equitable access to the comprehensive COVID-19 toolkit while balancing competing national health priorities and preventing long-term scarring through greater country engagement, ownership, and support to customize toolkits to national priorities.
- Need for greater macro-fiscal attention and increased efficiency of health spending in countries with limited policy space.

### Unified Approach to Reduce Global Risks (Policy Implication 4)
- Four refreshed principles for global response and preparedness:
  - Donor financing should be recognized as addressing a systemic international risk, not just development aid; allocate additional funding for pandemics and health system strengthening beyond official development assistance.
  - Acting early is far more valuable than delayed action; accessing resources even one week earlier can save lives.
  - Emphasize complementarities between disease-specific investments and multi-pathogen systems/platforms (invest in systems, platforms, and capacities on a multi-pathogen basis).
  - Strengthen global collaboration and systems for faster response by action in five areas:
    1. stronger multilateral institutions with high-level political support to coordinate global response to health shocks;
    2. rapid and adequate financing windows for global public goods activated at pandemic onset;
    3. diversified regional manufacturing capacity for vaccines, tests, and drugs with arrangements to share technology and know-how;
    4. increased investment in disease surveillance at global, regional and national levels, resilience and sustainability of national public health systems, and in R&D to enable more rapid delivery of medical countermeasures;
    5. improved regulatory frameworks to allow speedy delivery of existing and novel tools worldwide.
- Also emphasized: better understanding of environmental drivers of SARS-CoV-2 and other pathogens (One Health program).

### Financing: Identified Needs and Proposals
- ACT Accelerator consolidated financing framework (released February 2022) identified:
  - an urgent grant financing need of $16.8 billion to meet global COVID-19 targets between October 2021 and September 2022;
  - an additional $6.8 billion as part of a larger investment to support countries’ local delivery of COVID-19 tools.
- As of mid-March 2022, the grant financing gap stood at about $15 billion.
- Future pandemic preparedness financing estimates:
  - WB-WHO report estimates total annual financing need for a future PPR system to be $31 billion.
  - Considering current and expected financing, the report estimates additional international financing required to fund a fit-for-purpose PPR architecture at about $10 billion.
- IMF authors’ suggestion:
  - make an additional $15 billion in grant financing available in 2022 (primarily geared toward fighting COVID-19 in line with the ACT Accelerator financing framework);
  - provide $10 billion annually going forward to support PPR activities (in line with the WB-WHO and HLIP reports).
  - Rationale: these funds should be grants because ending the pandemic in a timely manner is a global public good and to avoid saddling developing economies with large debt burdens.
- Other financing notes:
  - World Bank’s COVID health operations have provided about $15 billion in financing for COVID-19 tools, of which about $6.5 billion is in IDA financing, of which a third is on grant terms.
  - Existing institutions and channels—CEPI, Global Fund, Gavi, WHO—will continue to play important roles amid complexity and fragmentation in global health.
  - Strengthening procurement capabilities, streamlining regulatory approvals, and improving coordination are essential at national, regional, and global levels.
- IMF’s role:
  - support countries to open up fiscal space and potentially act as a third-resort line of finance.
  - 2021 IMF Executive Board approved an SDR allocation of $650 billion.
  - IMF is exploring options to channel SDRs through a Resilience and Sustainability Trust (RST) to provide affordable long-term financing for structural challenges including pandemic preparedness.

### Closing Thoughts and Imperatives
- Major pandemics have historically caused severe harm; frequency of epidemics and pandemics is expected to rise.
- A dangerous legacy is weakened capacity in developing countries to invest in health combined with lower appetite for grant support.
- Large welfare gains exist from avoiding pandemics—estimated to be about 10 percent of a single year’s consumption—warranting greater policy attention.
- Final policy priority: end the acute phase of this pandemic everywhere and adopt a global strategy to manage long-term risks of COVID-19 and future infectious disease threats.

*Source: IMF Working Paper “A Global Strategy to Manage the Long-Term Risks of COVID-19,” Working Paper No. WP/2022/068 (excerpt).*

---


_Source: https://www.imf.org/-/media/files/publications/wp/2022/english/wpiea2022068-print-pdf.pdf_