Immunising Asean
Preventing pandemics costs money, but making sure the money is used effectively is equally challenging. By
Southeast Asia has become a hot spot for emerging and re-emerging infectious diseases, which has led to stepped-up international efforts to strengthen national and regional pandemic preparedness capacity.
Socio-economic, demographic and environmental factors are driving the emergence of more disease outbreaks in the region, according to a report by the World Bank and its partners. These include close contact between humans and animals, encroachment on areas with wildlife populations, high population density and urbanisation, high economic growth rates and climate change. The region is also prone to natural disasters — mainly floods, earthquakes and tsunamis — all of which have an impact on human health.
Recognising the threats, several Southeast Asian countries have made tremendous efforts to tackle emerging infectious diseases. However, challenges remain in terms of financing to ensure adequate, efficient and sustainable financing of pandemic preparedness.
However, the overall effort remains “suboptimal” in most countries as they spend less on health as a share of GDP and underinvest in pandemic preparedness, said the report.
“Investing in public health is often not prioritised and several countries are less than compliant with all the IHR (International Health Regulations) and OIE (World Organization for Animal Health) standard requirements,” it added.
As well, some countries have limited capacity to prevent, detect and respond adequately to disease outbreaks. Many rely heavily on out-of-pocket payments by consumers, or on external financing, to fund healthcare provision.
“Generally health financing is not pooled or managed in optimal ways and allocation tends to be inefficient and inequitable. External financing support is also often fragmented, uncoordinated, off-budget and often substitutes for domestic investment.”
Finally, the need to work across sectors and boundaries adds to the challenge in many countries in the region, it noted.
The World Bank Group (WBG) says political commitment is needed to ensure increased domestic financing for pandemic preparedness and resource sharing for vaccine and commodity stockpiles and emergency preparedness at a regional level.
It is working to improve regional collaboration and address trans-border risks of transmission of infectious diseases. It also wants to provide technical support to strengthen knowledge generation and sharing, and capacity building of national and regional institutions.
“It’s the case everywhere in the world that people do not realise the need to put money into the prevention side. I would say it’s because of the will of the general public,” said Sutayut Osornprasop, senior human development specialist for the bank’s Health Nutrition, and Population Global Practice.
“When there are epidemics or pandemics, people are scared. During such times, people will be willing to put a lot of money into addressing the situation, which we call response at the time of the spread. And because people are scared, governments are scared and they can mobilise a lot of money out of this kind of environment,” he told Asia Focus.
The World Bank is now working with five priority countries — Cambodia, Indonesia, Laos, Myanmar and Vietnam — to better assess and develop their health security financing.
Dr Sutayut explained that the programme aims to help them understand the required levels and sources of financing, compared with what they have now, and explore ways to close the gaps. Improving pandemic preparedness financing at the country level will complement work to strengthen regional cooperation against transboundary health threats.
“These countries need to assess the current situation, look at what they need and what they want to achieve,” he said. “Then we see the needs and how to mobilise the money to fill this gap. The assessment usually takes six months. It has started in Vietnam, and then we will move on to Indonesia, Cambodia, Laos and Myanmar.”
The bank works mainly with the ministries of finance, health and agriculture, as well as disaster management agencies. But it also wants to involve the private sector, given the economic impact that pandemics can have, by developing an investment case that businesses can understand.
“The private sector, mainly private hospitals, has taken part only on the response side so far. Actually, they can do more in terms of the prevention side as well,” said Dr Sutayut.
The bank’s Global Programme for Avian Influenza Control (GPAI) and Human Pandemic Preparedness and Response Project, which has provided US$1.3 billion for 72 projects in 60 countries,
has supported eight countries in Southeast Asia to strengthen their capacity for early and effective disease control.
The World Bank, the World Health Organization (WHO) and other partners have launched an innovative global funding programme called the Pandemic Emergency Financing Facility (PEF) to strengthen response efforts. It also provides incentives for investments in preparedness.
Nguyen Khanh Phuong, head of the Health Economics Department with the Health Strategy and Policy Institute of Vietnam, said her country was focusing on emerging and endemic infectious diseases, including those transmitted from animals to humans. In late 2003, avian influenza viruses emerged in the country but their outbreak was fairly quickly controlled with the number of confirmed cases declining since 2004-05.
However, significant risks remain and that requires “sustainable preparedness and prevention activities”, she said.
Challenges include coordinating efforts across multiple sectors to promote health security, and decentralising budget management to local authorities, which must be made to understand how such budgets should be managed.
“Vietnam has longstanding collaboration with partners on health security,” Ms Phuong said, citing that as a reason for the success of a recent avian influenza project in 2014.
The pilot health security financing assessment (HSFA) being undertaken with the World Bank aims to estimate the amount of financing required for health security, assess health security arrangements and fund flows, identify constraints and opportunities, as well as strengths and weaknesses in coordination and implementation.
“We hope to complete the exercise by April and share full and validated results,” she said. “The key to success is commitment from central and local governments, as well as sharing the same visions and objectives among all stakeholders. Active involvement of both technical experts and financial experts is also needed.”
mainly “The has taken private private part hospitals, sector, only on the response side [to pandemics] so far. Actually, they can do more in terms of the prevention side as well” SUTAYUT OSORNPRASOP Senior human development specialist, World Bank