Pandemic Lessons

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Pandemic Lessons

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• Authors: RUCHIR AGARWAL
• Published: December 2, 2021

Economists' blind spot on pandemics

• COVID-19 exposed that pandemics pose significant macroeconomic costs and were not given due attention by economists and financial institutions.
• Evidence cited by Peter Sands:
  • He identified "15 countries that had suffered infectious disease outbreaks" and reviewed country reports.
  • Outbreaks were "mentioned in 63 percent of the IMF reports published afterwards, not a single report published before an outbreak highlighted the risk."
  • Reports reviewed covered "two years prior and two years after those outbreaks."
• Causes of the blind spot:
  • Difficulty estimating "low-probability, high-impact events."
  • Specialists in health and economics "can’t speak each other’s language," creating a chasm of understanding.
  • Institutions like the IMF "didn't feel comfortable with issues related to epidemiology" and therefore did not look at those risks.

IMF's comparative advantage and recommended approach

• The IMF can assess a country's vulnerability to outbreaks and its economic impact much as it assesses other macrocritical challenges (for example, "liquidity shocks").
• The IMF should:
  • Draw on epidemiological expertise from others for the health side.
  • Use its core skills to examine "how an outbreak could affect the economy."
• Sands' view on institutional learning:
  • "If large institutions like the Fund haven’t worked out that infectious diseases can have massive macroeconomic and financial effects because of COVID-19, I don’t know what will convince them."
  • The pandemic is "even bigger than the global financial crisis" in macroeconomic and financial impact.

Global Fund response, priorities, and scale-up

• The Global Fund rapidly deployed resources in response to COVID-19:
  • "We responded to the COVID-19 crisis very quickly, making money available in March 2020."
  • "Since then, we’ve deployed about $4 billion."
  • The Global Fund has been "the primary provider of support to low- and middle-income countries for non-vaccine health elements, such as testing, PPE [personal protective equipment], and oxygen."
• Near-term priorities and strategy:
  • "To beat the pandemic, it is necessary to go bigger and faster."
  • Avoid a "lopsided response"; vaccines are "our most potent weapon, but vaccines alone will not defeat COVID."
  • Adopt a "more comprehensive response that encompasses a wider range of elements."
  • Emphasize speed: "The logic of fighting infectious diseases is to hit them fast because there’s a nonlinear impact both on beating them and if you let them run rampant."

Impact of COVID-19 on other major diseases

• COVID-19's effect on HIV, TB, and malaria:
  • COVID-19 is characterized as "the worst thing that ever happened to the fight against HIV, TB, and malaria."
  • The Global Fund's 2020 results report showed that "for the first time in our 20-year history, there were reverses in key results across all three diseases."
  • Context: "The Global Fund was set up to fight the last big pandemic, HIV/AIDS, which killed nearly 40 million people."
  • In most low- and low-middle-income countries, "HIV, TB, and malaria kill more people than COVID."
• Policy implication: responses must address both "the direct impact of COVID and its knock-on impact on these other diseases."

Innovation, urgency, and end-to-end perspectives

• Innovation timelines and expectations:
  • COVID-19 "broke previous assumptions about how long it takes to develop responses such as rapid diagnostic tests and vaccines."
  • The approval of the malaria vaccine RTS,S "took years," and the Global Fund contributed funds to its development.
  • There is discussion in the TB field about "the possibility of a vaccine in four to five years."
  • Sands questions why a one-year vaccine development (for a novel virus) should not reset expectations: "If we can develop a vaccine in just a year for a virus we’d never seen before, why are we excited about waiting four to five years for a vaccine for a disease we’ve had for hundreds of years?"
• Operational lessons:
  • Value an "end-to-end perspective," aligning those "involved in the deployment of new medical tools" with those "developing and launching them."
  • Translate pandemic-era speed into responses for other diseases: "As a banker, I heard people say, 'time is money.' In the global health world, time is life."
  • Protect people "from a whole slew of pathogens" to avoid saving someone from COVID-19 only for them "to die of TB."

F&D Magazine interview with Peter Sands, December 2021.

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