Financing pandemic prevention, preparedness and response: lessons learned and perspectives for future

Ndembi et al. Globalization and Health (2024) 20:65 https://doi.org/10.1186/s12992-024-01066-4 Globalization and Health Open Access CO M M E N T Financing pandemic prevention, preparedness and response: lessons learned and perspectives for future Nicaise Ndembi1, Nebiyu Dereje1*, Justice Nonvignon1, Merawi Aragaw1, Tajudeen Raji1, Mosoka Papa Fallah1, Mohammed Abdulaziz1, Benjamin Djoudalbaye1, Aggrey Aluso2, Yap Boum II3, Gwen Mwaba4, Olive Shisana5, Ngashi Ngongo1 and Jean Kaseya1 Abstract Background The attainment of global health security goals and universal health coverage will remain a mirage unless African health systems are adequately funded to improve resilience to public health emergencies. The COVID19 pandemic exposed the global inequity in accessing medical countermeasures, leaving African countries far behind. As we anticipate the next pandemic, improving investments in health systems to adequately finance pandemic prevention, preparedness, and response (PPPR) promptly, ensuring equity and access to medical countermeasures, is crucial. In this article, we analyze the African and global pandemic financing initiatives and put ways forward for policymakers and the global health community to consider. Methods This article is based on a rapid literature review and desk review of various PPPR financing mechanisms in Africa and globally. Consultation of leaders and experts in the area and scrutinization of various related meeting reports and decisions have been carried out. Main text The African Union (AU) has demonstrated various innovative financing mechanisms to mitigate the impacts of public health emergencies in the continent. To improve equal access to the COVID-19 medical countermeasures, the AU launched Africa Medical Supplies Platform (AMSP) and Africa Vaccine Acquisition Trust (AVAT). These financing initiatives were instrumental in mitigating the impacts of COVID-19 and their lessons can be capitalized as we make efforts for PPPR. The COVID-19 Response Fund, subsequently converted into the African Epidemics Fund (AEF), is another innovative financing mechanism to ensure sustainable and self-reliant PPPR efforts. The global initiatives for financing PPPR include the Pandemic Emergency Financing Facility (PEF) and the Pandemic Fund. The PEF was criticized for its inadequacy in building resilient health systems, primarily because the fund ignored the prevention and preparedness items. The Pandemic Fund is also being criticized for its suboptimal emphasis on the response aspect of the pandemic and non-inclusive governance structure. *Correspondence: Nebiyu Dereje Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Ndembi et al. Globalization and Health (2024) 20:65 Page 2 of 9 Conclusions To ensure optimal financing for PPPR, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems. Keywords Pandemic, Fund, Financing, Global Health Security, PPPR Background The health systems in Africa, already limited in capability and capacity, face the daunting challenge of addressing emerging and reemerging public health emergencies [1]. This challenge is set against a backdrop of economic vulnerabilities, including significant debts and populations with generally low socioeconomic status and health literacy. Infectious diseases still have a severe impact on the African continent, accounting for over 227 million years of healthy life lost every year and producing an annual productivity loss of over $800 billion [1]. Compounding this situation are the disproportionate impacts of climate change on public health and the ongoing wars and conflicts in various regions of the continent [2]. Such circumstances severely impede Africa’s ability to effectively engage in pandemic prevention, preparedness, and response (PPPR). Building strong, resilient health systems in Africa that can adequately handle public health emergencies is crucial. However, the severe underfunding of health systems, as evidenced by the low domestic investments of African governments, contrary to the commitments of the Abuja declaration, specifically on spending 15% of the budget on health, could further worsen the already weak health systems [3]. The attainment of global health security (GHS) goals and universal health coverage (UHC) will remain a mirage unless African health systems are adequately and efficiently funded to improve resilience to emerging and reemerging public health emergencies. GHS agenda mainly targets infectious disease prevention and control while the UHC prioritizes universal, timely, and quality access to essential healthcare services for everyone [4, 5]. However, both initiatives have impacts on strengthening one another. A strong health system built by the UHC can significantly contribute to the success of the GHS agenda and vice-versa [4, 6, 7]. To ensure this, various scholars indicated the need for integration (building capacity for GHS within the comprehensive UHC framework), investment (unified financing to strengthen the overall health system), building a resilient health system, and addressing the inequity gaps [4–9]. This is critical in Africa where the infectious disease burden is high and resources are limited. As we anticipate the next pandemic, improving investments in health systems and building a solid buffer to adequately finance PPPR promptly, ensuring equity and access to medical counter-measures is crucial, and mechanisms must be placed in the ongoing Pandemic Agreement negotiations [10, 11]. The pandemic financing system is a fundamental element to ensure the realization of the envisioned safe and equitable world for everyone by the Pandemic Agreement [11]. In this article, we analyzed the African and global pandemic financing initiatives and put ways forward for the consideration of policymakers and the global health community. Methods This article is based on a (...truncated)