Background
The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing.
Methods/Results
The article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed.
Conclusion
It remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges.
Key questions
What is already known?
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There are serious concerns about the emerging global pandemic preparedness and response (PPR) agenda and its ability to meet existing financing challenges.
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There remain significant questions about the design and functioning of the new Pandemic Fund and its ability to fulfil its remit to address PPR policy and financing shortfalls.
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The need to address these challenges / questions gain relevance considering failures associated with the COVID-19 pandemic.
What are the new findings?
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We identify eight challenges related to international financing instruments and development aid for health within the existing literature on global health governance and financing.
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When measured against the Pandemic Fund, these challenges have been unclearly addressed or unaddressed within the current design and practices of the Fund.
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There is a need to rethink current PPR financing and its relationship to global health financing writ large, in order to address and respond to known PPR and global governance and financing challenges.
What do the new findings imply?
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If new global PPR initiatives such as the Pandemic Fund are to be successful, then they must address the recognised challenges highlighted in this article. Without a more integrated and holistic approach to PPR financing and global health financing generally, any new health financing instrument will struggle to bring about significant improvements in PPR or global health outcomes more broadly.