Never Let a Crisis Go to Waste: Preventing the Next Pandemic | Opinion

The old saying, never let a crisis go to waste, has never been so relevant. COVID-19 is certainly a crisis of historic proportions. Its dangers to health and prosperity are graphically demonstrated by the number of deaths, currently heading to 4 million, and the lost output, projected to reach $22 trillion.

But the dangers are not limited to the present crisis. Today's global pandemic was predictable and predicted. Eleven separate reports proposed important changes to the global approach to health security that would have mitigated or even snuffed out this crisis at an earlier stage. And today there is real threat that as vaccines beat variants in the richer parts of the world, the crisis does go to waste.

It is time to challenge the inertia, short-termism and myopia that dogs pandemic preparedness and response. Sitting on three independent international panels—the Independent Panel on Pandemic Preparedness and Response, the Pan-European Commission on Health and Sustainable Development and the G20 High Level Independent Panel on Pandemic Financing—we believe there are three principles that are key to preventing another catastrophic pandemic.

First, pandemic preparedness and response must be understood in a new way—as a global public good. The reason is that the world has been solving the wrong type of problem when it comes to pandemic preparedness and response. International systems have treated pandemics solely as health issues. Governance and accountability have therefore sat with the World Health Assembly and the World Health Organization. Financing has relied on domestic budgets supplemented by development assistance for health. This is how we govern and finance many health issues such as primary health care, nutrition, family planning and the management of both communicable and non-communicable diseases.

But there is a critical difference between the management of pandemics (alongside other truly global health threats such as antimicrobial resistance) and these other health issues. A primary care system benefits the finite and localized group that it has the capacity to serve. A surveillance system that detects a new outbreak benefits the entire global population that learns of the threat. Preventing pandemics or protecting the world from cross border infectious threats is a global public good. It is "non excludable," as no country can prevent others from benefiting, and non-rival, as one country benefiting does not limit the extent to which other countries can benefit.

Economic theory warns that the defining attributes of global public goods lead to underinvestment due to the free-rider problem. There are substantial positive externalities that are not fully taken into account when countries make their investment decisions. In the absence of policy intervention and coordination, global public goods will be underproduced. This classic market failure has played out to devastating effect before and during the COVID-19 crisis. Financing for pandemic preparedness has been far too little while international funds for pandemic response came far too late.

Not only do we agree that pandemic preparedness and response are global public goods, we agree this has important implications for financing and governance.

Second, all countries should collectively finance pandemic preparedness and response as global public goods with strategic value, not as aid. At a national level, public goods are managed through public policy and financed through taxation, with citizens mandated to contribute. Under progressive tax regimes, richer citizens contribute proportionately greater shares of their income to finance the provision of domestic public goods.

When the benefits of one country's investments in public goods spill over into other countries, international coordination is needed. When these spillovers are global—as is the case with pandemic preparedness and early response—this international coordination must be global.

The same principles should hold to payments—contributions should be universal and progressive. All countries that benefit, which is to say all countries, should pay something. Countries with the largest and most open economies should pay the most—both because they are able and because they gain the most in economic terms from pandemic prevention. One of us modeled contributions at a country level.

A nurse prepares to inoculate a man
A nurse prepares to inoculate a man with a dose of the Covaxin vaccine against the COVID-19 coronavirus. MANJUNATH KIRAN/AFP via Getty Images

While preparedness and response activities may take place at a national level, the benefits are experienced globally. Therefore, financing for preparedness and response activities, even within low- and lower-middle-income countries, does not meet the definition of aid as promoting "the economic development and welfare of developing countries as its main objective."

Financing pandemic prevention through non-ODA budget lines has operational advantages as well. It decreases the risk of displacing aid from urgent needs that benefit countries internally. It also helps to insulate health security from the boom-and-bust cycles of aid budgets which are treated as voluntary and discretionary. Lastly, financing pandemic preparedness through other line items recognizes that pandemics are not solely a health issue but also an issue of security and economic stability, and an obligation for all countries. This leads to our third point on governance.

Effective governance requires elevating pandemic threats beyond the health sector, to the highest levels of national government and international systems. If there is a common theme across the national and international system failures to contain the COVID pandemic, it is a lack of high-level political leadership. For months after the January 2020 emergency declaration, COVID-19 languished as a global issue. It sat on the desks of health ministers and the WHO but not prime ministers, finance ministers, defense ministers, the G7, G20 or UNSC. Even prior to the outbreak, warnings of gaping vulnerabilities in preparedness were met with indifference rather than leadership, accountability and resources.

To break the cycles of panic and neglect, we need an international institution convened at the head of government level to oversee the financing and production of these global public goods. It should be tasked with maintaining political momentum, monitoring progress to targets and holding nation states accountable. It should be armed with reliable long-term financing for preparedness and rapid surge financing for response in the event of a pandemic emergency.

The proposals for governance developed by our respective groups—with establishment of a council or a board—share common aims and functions.

All three proposals include representation at the highest political levels as well as heads of agencies including the IMF and the World Bank. The economic devastation wrought by COVID-19 makes clear that health security has global economic implications. All three proposals agree the board must ensure accountability among states and relevant international agencies, including WHO and its One Health partners as well the IFIs and the ACT-Accelerator partnership organizations. Lastly, all three proposals argue that this institution must be able to mobilize financial resources and to allocate those resources to relevant bodies based on need and performance.

Such a body will thereby focus on political leadership, peer pressure, accountability, public mobilization and on supporting global public goods of pandemic preparation including surveillance, at national, regional and global levels. Critically, it must be convened at the highest political level, with numbers small enough to ensure effectiveness as well as legitimacy. What counts is independence, legitimacy and effectiveness—otherwise we are stuck with the old system, not a new one.

Bold proposals will not overcome inertia on their own. The tyranny of comprehensiveness and the tendency to make perfect the enemy of the good stand in the way. To survive, they will need national champions and coalitions of the willing to act with urgency and decisiveness to fix the ways we finance and govern existential pandemic threats. The stakes could not be higher. We look to world leaders to respond positively to the timetable recently set by President Joe Biden—we have till the end of September to show we are serious about making next time different.

David Miliband is president and CEO of the International Rescue Committee.

Jim O'Neill is chair of Chatham House and a member of the Pan-European Commission on Health and Sustainable Development.

John-Arne Rottingen is the ambassador for Global Health at the Norwegian Ministry of Foreign Affairs.

The authors represent three international panels on pandemics.

The views expressed in this article are the writers' own.

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