Five factors to ensure pandemic fund’s success

It is an understatement to say the world was unprepared to face the COVID-19 pandemic. But the big question dominating global discourse is: Have we learnt from our past mistakes? In response to urgent calls for a new approach, the G20 under the leadership of the Indonesian presidency, proposed the creation of a “Financial Intermediary Fund” (FIF) for pandemic prevention, preparedness and response (PPR). The launch date is tentatively set for this fall. And Oxfam and others have weighed in, highlighting key concerns and recommendations on its design.

What is clear is that countries require greater support to prepare for pandemics in the future. But whether the FIF as currently proposed can deliver on this remains to be seen. Much will depend on whether it gets its design right and below are five things needed to get it right.

To begin with, truly inclusive governance is needed with voice and vote for recipient countries and strong civil society representation. A key priority over the last few months has therefore been to get the governance arrangement right. Civil society has strongly and consistently pushed for a more inclusive structure, and the sum of these efforts culminated in a much-improved governance structure being adopted during the inaugural board meeting last week. The board now has 21 voting seats — nine for recipient countries, nine for sovereign donors, one for philanthropic donors, and two for civil society. This moves us closer to addressing some of the inequalities in the global health arena which were largely responsible for the failures of the COVID-19 pandemic response. We look forward to stronger engagement and participation of civil society and its diverse constituencies from the Global South, Global North, and affected workforces and communities — which will improve allocation effectiveness, raise accountability levels, and will add to the FIF’s legitimacy.

This and other examples show that improving the health workforce, strengthening primary healthcare and reducing financial barriers to accessing health services remain fundamental to the Financial Intermediary Fund hitting its mark.

Second, there is a need to prioritize support for public health systems including primary healthcare and expanding the health workforce. An integral part of the FIF’s design will be to determine how and what to prioritize for funding.

It is disconcerting that strengthening national public health systems does not feature strongly in the priority list of pandemic PPR gaps to be addressed. Ideally, funds should be directed first towards improving impoverished health systems, which underlie PPR failures in many low- and middle-income countries. An example from Nigeria shows that improving their PPR system requires supporting local councils to provide water, sanitation and hygiene facilities, as well as recruiting and posting trained health workers at every level.

This and other examples show that improving the health workforce, strengthening primary healthcare and reducing financial barriers to accessing health services remain fundamental to the Financial Intermediary Fund hitting its mark.

Third, it is necessary to build strong guardrails for the engagement of private actors. Given the emphasis around sourcing funds from non-ODA (official development assistance) sources, the discussion will inevitably turn to the role of private finance. Clear and strict guardrails need to be established for receiving funds from private entities (including philanthropic individuals and organizations) and engaging or funding any private actors.

Notably, commercial actors should be excluded from all decision-making processes and not be funded through the Financial Intermediary Fund. There could be limited instances where private actor expertise may be considered. In such cases, all engagements should serve the public good and be ring-fenced by conditions that ensure equitable, affordable, and timely access of any resulting innovations or lifesaving products that could benefit all.

Fourth, it is important to ensure sustainable financing of the Financial Intermediary Fund through country-level ownership and the right incentives. There is broad agreement that the funds should be additional, complementing existing structures, and not displacing funds for other key health priorities.

But little is known about how this will be achieved, raising concerns that aid could be diverted from other health priorities. One aim of the Financial Intermediary Fund is therefore to incentivize domestic investments in prevention, preparedness, and response mechanisms. However, sufficient buy-in and ownership of the Financial Intermediary Fund would be required from low- and middle-income countries to do this effectively. All in all, far greater attention should be paid to how PPR funds can be sustainably mobilized across levels.

And fifth, it is also necessary that the World Health Organization provide leadership and coordination for the fund as it evolves and matures. While it seems that the WHO’s role has been decided for the moment, it is important to codify the global health body’s role given its centrality in global health security. This could be done by working out a road map on how the leadership and coordination of the fund will evolve over time.

There is a great deal more to consider. But if we don’t get these five elements right, it will be hard to imagine a financial intermediary fund that will be “fit for the purpose” — inclusive, legitimate, and sustainable. It’s time to put people and public good before politics, so we can say with conviction that we are doing all we can to prepare for the next global health crisis.