The world lacks the funds, political will and appropriate global platforms to tackle the next pandemic – and the World Health Organization (WHO) should possibly be split into two entities, with one focusing solely on health emergencies.

This is according to a new report by former New Zealand Prime Minister Helen Clark and former Liberian president Ellen Johnson Sirleaf, former co-chairs of the Independent Panel for Pandemic Preparedness and Response.

“If there were a new pandemic threat today, such as if H5N1 began to spread from person to person at scale, the world would likely be overwhelmed again. We just aren’t equipped enough to stop outbreaks before they spread further,” according to Clark speaking at an event to release the report hosted by Club de Madrid.

The report, No time to gamble: Leaders must unite to prevent pandemics, takes stock of progress made to implement recommendations made by the Independent Panel to the World Health Assembly in May 2021, following its eight-month review of the global response to COVID-19. 

“We were clear in 2021 at the height of COVID-19, that leaders needed to act urgently to make transformative changes to the international system so that there would be a new approach to funding, new ways of managing equitable access to products like vaccines, therapeutics and tests, and a new Framework Convention at WHO to complement the rules for outbreaks and pandemics,” said Clark 

“Instead of taking action to prepare for the next major outbreak, leaders have turned away from pandemic preparedness. This is a gamble with our futures,” write Clark and Sirleaf in the report. 

Clark decried the lack of funds to pandemic-proof the world, how “high-income countries are holding on too tightly to traditional charity-based approaches to equity”, and that there was still no pandemic agreement after two-and-a-half years of negotiations.

“A new agreement must be successfully concluded. But the world can’t wait for its adoption or for the ratification required from 60 countries – an effort that could take three or more years,” the report notes.

“There must be action now – to close the gaps that put eight billion people at risk of a new pandemic. The recent jump of the avian H5N1 virus to more mammals – including new human cases transmitted from cattle in the United States – portends an influenza pandemic the world is nowhere near ready to manage.”

However, Clark said there had been some “encouraging developments” such as the amendments to the International Health Regulations.

Sirleaf was not present as she was attending the funeral of her son, Charles.

Controversial proposal to split WHO

The report notes that 40% of the WHO’s operational spending goes on emergencies, including on the delivery of supplies, and this is “far outstripping” spending on important issues such as universal health coverage, non-communicable diseases and the social determinants of health. 

However, the WHO’s “focus should be on high-quality normative and technical work, not just during emergencies but also for preparedness purposes,” according to the report. 

“We pose an open question, and I stress it is an open question: Should WHO is split into two organisations, one that is focused on emergency operations, as that work has to be done, and one that’s focused on operational and technical excellence in health?” asked Clark.

She repeated the Independent Panel’s call for “a truly independent monitoring mechanism” to assess countries’ pandemic preparedness – such as a “Global Preparedness Monitoring Board which is completely independent of WHO” or “a new independent monitoring group”, perhaps along the lines of the Intergovernmental Panel on Climate Change (IPCC).

Inadequate financing

Around $10–15 billion is needed annually to fill the gaps in pandemic preparedness, particularly in low and middle-income countries.

“This does not include investments in One Health, which would require an added $10.3–11.5 billion annually to raise public veterinary standards, improve farm biosecurity and decrease deforestation in high-risk countries,” according to the report.

The Pandemic Fund, set up under the World Bank to assist, has raised almost $2 billion.

The report proposes that the fund be converted into a “preparedness and surge mechanism based on a global public investment model” rather than an ODA [overseas development aid] mechanism.

“All governments [should] contribute based on a formula according to their ability to pay, supporting both preparedness efforts and immediate response needs including to pay for the countermeasures countries will need to stop outbreaks and mitigate the impact of pandemics,” according to the report. It adds that countries should also have a say in the fund’s administration.

However, Mauricio Cardenas, former finance minister of Colombia, warned that public finances are “under a lot of stress in different countries, mainly because of the high levels of debt and very high interest rates”.

“Public finances play a very important role, because domestic resource mobilisation is crucial and should be the foundation of preparedness and response, but that’s not enough. We need international finance, but we don’t need charity,” he stressed.

Expanding access to medical countermeasures 

Indonesian Health Minister Budi Gunadi Sadikin called for different rules for the Pandemic Fund during a pandemic, which he compared to wartime, including “speedy decision-making and expedited fund disbursement”.

Sadikin, who addressed the launch, also called for all emergency medical countermeasures produced during pandemics to become “public”.

There needs to be an “upfront agreement” in the pandemic agreement that for-profit companies answering to shareholders will be reasonably compensated by a large public institution or country , for their products such as vaccines and therapeutics, added Sadikin.

The report describes medical countermeasures as a “global common good”, noting that inequities in access to these during COVID-19 “have left a lasting painful moral stain, and the resulting mistrust has affected negotiation of a pandemic agreement”.

Dr Petro Terblanche, CEO of Afrigen Biologics which hosts the WHO mRNA hub in South Africa, said that the world’s knowledge base around pandemic response had “tripled” in the past three years.

“Yet if we have a pandemic today, the Global North will move at speed and will be better prepared than three years ago because of the knowledge that we’ve been able to possess,” said Terblanche. But the position of the Global South would depend on “where these critical medical countermeasures are produced”.

The mRNA programme’s final outputs “are threatened now by lack of funding”, she said, urging investment in “end-to-end research and manufacturing capabilities in low and middle-income countries” to prepare for future pandemics.

“In 2023, the African continent had 155 outbreaks and for less than 10 of there, vaccines are available,” she noted.

“With Rift Valley Fever,  this is going to be an opportunity to develop a single vaccine using an antigen using mRNA to both for the vaccination of animals, livestock and humans,” said Terblanche, adding that such an approach should be prioritised  from a research and development and product development perspective.

Image Credits: Prachatai/Flickr, Wildlife Conservation Society .