German Ministers urge more investment in the Pandemic Fund and universal health coverage at a high-level pandemic preparedness meeting 

Even if vaccines and medicines are developed at record speed to address the next ominous global pathogen, they cannot prevent a pandemic without strong health systems to deliver them, stressed politicians and health leaders at a meeting convened by Germany’s ministries of health and economic development.

Primary health care is the “basis” of all responses to disease outbreaks and crises, stressed Dr Mike Ryan, the World Health Organization’s (WHO) head of health emergencies at the Berlin meeting on pandemic preparedness on 28 September.

“The simple availability of a countermeasure is in no way a guarantee that they will be delivered to the people who need them,” said Ryan, pointing out that there were vaccines for many of the current global disease outbreaks – from measles to diphtheria.

Karl Lauterbach, Germany’s Federal Minister of Health, said that the annual cost of rolling out universal health coverage (UHC) was estimated to be $350 billion.

“Now everyone will think: ‘$350 billion, that’s enormous. Who’s going to pay for that?’ But on the other hand, we spend more than $7000 billion dollars for subsidies for fossil energy, which is only contributing toward climate change,” said Lauterbach.

“Wouldn’t it be a much better world if we cut a lot of our fossil energy subsidies and spend some of that money on universal health coverage? It would be definitely a more equitable world it would be a more just world and it would clearly also be safer,” he added.

Meanwhile, WHO Chief Scientist Jeremy Farrar, warned that “the pandemic will fade from memory, and if governments don’t find utility and value in what they’re investing in every Monday, every Tuesday, every September and October, then they won’t continue to invest in it. 

“So invest in the basic science, invest in people, invest in institutions, and make sure we build trust in institutions and make sure that they are part of our culture rather than something done in ivory towers by people in white coats,” Farrar urged the meeting, which was convened partly to take stock of what is needed to address future pandemics.

Need for pandemic treaty to set mandatory rules

Lauterbach said that we may soon be  “living in the era of pandemics”, as warned by Farrar. This is being driven by biodiversity loss, which makes it increasingly possible for the “10,000 viruses harboured in animals” to infect people, and the “exponential increase in migration”, he explained.

To address the growing threats, the pandemic agreement currently being negotiated at the WHO needs to “have clearly defined responsibilities that are also mandatory” to maximise the “golden gap” between outbreaks and a pandemic, he urged.

He also expressed support for a “pathogen access benefit-sharing system”, one of the potential sticking points of the pandemic accord. African countries, in particular, want to be compensated for sharing information about pathogens while the pharmaceutical sector says this will slow the response to international outbreaks.

“Across the globe, people have come to realise that no one is safe until everybody is safe. But this is not only true for pandemic times. Health is literally a global public good that must be accessible to all people worldwide,” said Svenja Schulze, German Federal Minister for Economic Cooperation and Development, who co-hosted the meeting.

For Schulze, the pandemic treaty would provide “an international framework for communication and action, which creates trust and sets the rules”. 

“This will lay the ground for a swift exchange of data and a fair distribution of vaccines and medicines, and I hope that the agreement will be concluded as soon as next year because pandemic prevention will either work globally or not at all,” she said.

Pointing to outbreaks of dengue fever in parts of Europe as the world warmed up, Schulze, said that “as a result of climate change and globalisation, diseases are spreading to world regions that were previously unaffected”.

However, Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), urged pandemic treaty negotiators to protect innovation and factor in pharma’s offer (in its Berlin Declaration) to make a percentage of pandemic goods to low-income countries in real-time.

“Few people talk about the risk of failing,” added Cueni. “When you look at the vaccine situation pre-pandemic, three of the world’s largest vaccine manufacturers flopped…. We were lucky to have a pretty much unknown biotech company in Germany and another one in the US coming up with the mRNA vaccine, and the collaboration between Oxford University and AstraZeneca and also the Johnson and Johnson vaccine. 

“Eighty-five percent of the vaccines used by COVAX for the low-income countries in 2021 came from four innovative companies, which means when I look at the pandemic treaty negotiations, we really need to make sure that what worked – the innovation ecosystem,  which went back more than 20 years – is not compromised.”

Pointing out that low and middle-income countries were unable to get vaccines because the Indian government prevented the Serum Institute of India (SII) from exporting its generic vaccines, Cueni added that a joint partnership including the private sector needs to “focus on how can we improve diversity of vaccine manufacturing geographically”.

Germany ups emergency support, appeals for more Pandemic Fund resources 

Germany agreed last week to contribute a further €40 million to WHO’s work in health emergencies and also signed a long-term agreement to support the new Berlin-based WHO Hub for Pandemic and Epidemic Intelligence. With the new contribution, Germany has provided €53.5 million this year to support WHO’s response to more than 50 active health emergencies.

Meanwhile, Schulze said that the health sector could not build stronger health systems alone: “Development banks need to do their bit and that is why I have joined with other shareholders to initiate a reform of the World Bank. It must step up investments in global public goods, including in the health sector. Other development banks should do the same.”

She also appealed for stronger cooperation with the private sector, pointing out that Germany “is providing more than €550 million under the framework of a European national initiative to support efforts to develop [vaccine] production capacities in Africa, especially in Ghana, Rwanda, Senegal and South Africa”.

Schulze also appealed for other countries to support the Pandemic Fund, currently hosted by the World Bank. Germany is one of the biggest contributors to the fund.

Pandemic Action Network (PAN) co-founder Carolyn Reynolds described the Pandemic Fund as “one of the bright spots that have come out of the past three years in terms of global action”, but added that  $2 billion has been committed so far while $10.5 billion is needed a year to address gaps in pandemic preparedness.

“We can get there but it’s all about political results and leadership,” said Reynolds.

WHO’s Ryan pointed out that, before the pandemic, “106 countries had national action plans for public health security”. 

“They had gone through joint external evaluation they had done after action reviews, they had carried out exercises and simulations to test their system. They had identified the weaknesses in their system. Can you hazard a guess about how many of those plans got funding from the international community of the 106? Three,” said Ryan.

“Therein lies the seeds of the pandemic impact. Countries knew what was wrong. They knew what was missing. But we simply did not have the governance and financial architecture to change the dial. And we didn’t have the capacity to deliver the systems that were needed to make good on the needs of those plans.”

WHO officials welcome UN pandemic declaration

While Reynolds was disappointed by the lack of ​​”political resolve and call to action” at the recent United Nations (UN) High-Level Meeting on Pandemic Prevention, Preparedness and Response, Farrar and Ryan expressed support for the Political Declaration adopted by the meeting.

“Political declarations do matter,” said Farrar. “Try and achieve something global health without political support. You can’t. Does political support translate into action? No, not necessarily. And that’s why pushing the political class is so important.”

It’s the first time in the history of the United Nations that all member states came together and said anything about this, so I’ll take it,” said Ryan.

“World leaders came together. They’ve agreed to recognise the impact of the pandemic. They agreed to say: ‘We can never let this happen again.’ They’ve identified a number of areas in which we need to make progress. 

“Now, the ball is back with us. We’ve got the negotiations on the [pandemic] treaty, we’ve got the revision of the International Health Regulations. We’ve got the Pandemic Fund. We’ve got various initiatives through the G7,” said Ryan.

“I do think that next May [at the World Health Assembly], the countries of the world will come together, I hope, and there will be a solemn agreement between states that says in vernacular terms to the people of the world: ‘Never again’.”