Key messages:
1. A global Pandemic Preparedness and Response (PPR) architecture consists of five sub-systems that are interlinked and must be deployed at national, regional and global level:
- Surveillance, collaborative intelligence, and early warning
- Prioritized research and equitable access to countermeasures and essential supplies
- Public health and social measures and engaged, resilient communities
- Lifesaving, safe and scalable health interventions, and resilient health systems
- PPR strategy, coordination, and emergency operations
2. The case for investing in PPR is clear. The frequency and impact of pandemic-prone pathogens are increasing. Modest investments in PPR capacities can prevent and contain disease outbreaks, thereby drastically reducing the cost of response and the broader economic and social impacts of a pandemic or large-scale outbreak. Such investments will also help address longstanding challenges that are key drivers of mortality today, including HIV/AIDS, tuberculosis, malaria and anti-microbial resistance.
3. The total annual financing need for the future PPR system is estimated at US$ 31.1 billion, consistent with the estimate of the G20 High-Level Independent Panel. Considering current and expected domestic and international financing for PPR, it is estimated that at least an additional US$ 10.5 billion per year in international financing will be needed to fund a fit-forpurpose PPR architecture.
a. At national level, the largest PPR capacity gaps can be found in countries with the least fiscal space to address them, LICs and LMICs for which annual financing needs are estimated to be in the order of US$ 16.2 billion per year, with a gap of at least US$ 7.0 billion to be covered by international financing.
b. Meeting the annual financing gap for the global and regional components of the PPR architecture is estimated to require in the order of US$ 3.5 billion per year.
4. The COVID-19 crisis has shown the need to invest more in PPR. Further, the world currently lacks the capacity to coordinate the magnitude of funds required to fill critical gaps in PPR. Three high-level approaches, which are not mutually exclusive, provide possible solutions:
a. Selectively augment resources for existing institutions to support PPR priorities;
b. Establish a new, dedicated stream of additional international financing for PPR that can be channelled flexibly through existing institutions to strengthen PPR in a way that brings the most added value for both contributors and recipients (e.g., a pooled fund);
c. Establish a new agency to consolidate the necessary fiduciary capacity and legal, administrative, and technical expertise (limited feasibility in the short to medium term).