Global health governance confronts two long-term problems. One of them is a growing fragmentation and misalignment of agendas and initiatives. The other is a problem of power, encompassing accountability, transparency, and meaningful voice. Inevitably the two problems are linked, and nowhere more so than when it comes to the financing of global health agendas. Each of these problems have intensified since the pandemic, as identified by numerous commissions and initiatives including the International Panel on Pandemic Preparedness and Response and the more recent Future of Global Health Initiatives process.
But where do the various recommendations that have emerged from these processes take us? The answer may be nowhere if the formal governmental and multilateral processes seeking a common approach to pandemic preparedness and response continue to underestimate the significance of an adequately and equitably financed post-COVID regime. This would be a victory for entrenched inequalities. But the challenge concerns not just the volume of the financing needed for effective PPR. It also concerns the quality of that financing and how it is governed.