An expert’s point of view on a current event.
May 30, 2021, 6:00 a.m.
This week, the World Health Assembly (WHA), the governing body of the World Health Organization, is looking at how best to prepare for and ideally prevent future pandemics. The WHA takes as its starting point recommendations from the independent panel for pandemic preparedness and response, which published its results earlier this month. The report is more sound and specific than previous comparable commissions, but it has also sparked a debate about whether and how a global governing body for pandemic measures can be created.
There are important lessons to be learned here from the global fight against HIV. Twenty years ago the impossible became the inevitable with the creation of a fund as is now being discussed. Conventional technocrats said AIDS drugs were too complex, too expensive, and health systems too weak to distribute the drugs widely in low-income countries. We both started our careers at this time and joined a transnational movement of people living with and affected by the deadly virus.
Contrary to these gloomy calculations, the movement sought investments of billions of dollars annually – and won them. These came through the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a multilateral fund for community-led efforts to fight the three diseases. These resources were a moral imperative and the only sensible answer to a global health crisis. While it is difficult to pinpoint PEPFAR and GFATM precisely, it is estimated that GFATM helped save 38 million lives over the past two decades, while PEPFAR saved an additional 20 million lives.
Today the world is grappling with the question of preventing the next pandemic – and every time that question is raised we think of the Global Fund. In March, the Foreign Affairs Committee of the US House of Representatives took the first steps and passed a bill for the committee that provided for a new pandemic-oriented fund similar to the GFATM. President Joe Biden’s original budget proposal, which included $ 800 million for global health security, included a portion aimed at a catalytic health security funding mechanism. Since then, 120 members of the House of Representatives have endorsed the new fund, including a majority of Democrats in the House of Representatives, and they have written a letter to Biden asking him to raise at least $ 2 billion in seed money into his budget.
However, the proposed $ 2 billion seed funding is a bare minimum and largely focused on helping countries meet the cost of meeting the International Health Regulations (IGR). IHR was designed and adopted as a global to-do list for disease outbreak containment, and expanding compliance is a top priority. McKinsey & Company estimated that it would take an initial investment of $ 85 billion to $ 130 billion worldwide over the next two years, followed by annual investment of $ 20 billion to $ 50 billion worldwide, to put in place surveillance and response systems to mitigate future risk Dramatically reduce pandemics. The size of the investment may be the most salient feature – and it actually takes a massive, bold effort. But money alone will not prevent or contain future pandemics. The structure, mandate and domicile of the new fund are immensely important.
However, to be truly successful, two important lessons must be learned from GFATM. First, prevention must be extended to address the root cause of many pathogens: environmental degradation. Second, GFATM’s successful governance model, which involves communities of the most affected people, should be incorporated into the management of any future fund.
The GFATM shows that a close focus on biomedical solutions – diagnostics and drugs – does not stop or prevent pandemics. A pathogen spreads from one person to another; a pandemic is spreading through a broken system. Outbreaks arise from the severe wounds in the planetary ecosystem. Despite efforts to take a holistic approach, prevention is struggling to contain the HIV pandemic. There were 1.7 million infections in 2019 compared to 2.1 million infections in 2015, an important but insufficient improvement.
Every new fund must define and finance a comprehensive prevention approach. It should avoid a narrow focus on interventions that focus solely on the surveillance of human health and disease, and it should ensure that pandemic prevention is also understood as requiring direct action to reverse the types of environmental degradation that are predominant Majority of new disease outbreaks.
The disease that causes COVID-19 is the result of a zoonotic spillovers from animals to humans. There were six times more zoonotic spillover events in 2010 than in 1980. Zoonotic diseases account for 60 percent of emerging infectious diseases, most of them from wildlife. What is noteworthy is that there is a question that spillover prevention asks versus investing in human health. Such a binary view cannot be successful. The new fund needs to focus on the environmental and climate interventions needed to prevent new outbreaks from occurring, while building resilient health systems to combat them.
In addition, GFATM provides lessons on how to manage a successful fund and how donor-funded interventions can be rooted and sustained in communities and developing countries. Today there is consensus on funding the country plans to meet the IHR, but less attention is paid to who is planning, monitoring and doing this vital work. When GFATM was launched almost 20 years ago with the mantra “Nothing About Us Without Us”, people living with HIV from around the world and others hardest hit by AIDS, tuberculosis and malaria took their places at the decision-making tables in Countries and boardrooms – and never leave.
To be effective, the new fund must have “long-term COVID-19” people, key employee representatives, infectious disease-hit communities and health workers on its board and act as technical experts while helping with country plans. No response to an outbreak can be successful without collaborative collaboration and the heroic dedication of health workers. Outbreaks start and end in communities, and involving these groups from the start will create buy-ins and provide frontline knowledge.
Health in Harmony offers a successful model for improving human health while healing the planet. The organization works with indigenous peoples in Indonesia, Brazil and Madagascar to build skills and change local contexts. Crucially, this work begins by listening radically to these communities that universally do not want to clear the forest, but do so for lack of other options. Their model is proven by data: in Borneo, working with the community in shifting deforestation-based activities to health care and organic farming has improved health outcomes, saved millions of dollars in carbon, and not only stopped deforestation but reversed it.
Such a fund is not impossible as long as a mobilized, angry and grieving civil society demands action. The new Fund for Prevention and Public Health must be financed in full at the level of the estimated needs. It must fund country compliance with the IHR and have a governance structure that reflects the expertise and priorities of those most affected by pandemics. And it must include a comprehensive definition of pandemic prevention, including environmental and health interventions, on its behalf. If these criteria are not met, it is entirely possible that no amount of money will avert the next global crisis. If so, the goal of making sure nothing like COVID-19 happens again might be within reach.