The devil’s in the detail: an appraisal of the use of innovative financing mechanisms for pandemic prevention, preparedness and response

(2025) 21:13 Tacheva et al. Globalization and Health https://doi.org/10.1186/s12992-025-01103-w Globalization and Health Open Access RESEARCH The devil’s in the detail: an appraisal of the use of innovative financing mechanisms for pandemic prevention, preparedness and response Blagovesta Tacheva1*, Garrett Wallace Brown1, David Bell2 and Jean von Agris1 Abstract This is the first published study examining whether, and to what degree, innovative financing could effectively support the financing needs of the global pandemic prevention, preparedness and response (PPPR) agenda. Back‑ ground: What is already known? In the context of global health, innovative financing encompasses a range of financial instruments that supplement international development assistance and other traditional sources of financing, with the intention of mobilising additional resources and channelling them more effectively. Examples including Advance Market Commitments (AMCs), Advance Purchase Commitments (APCs), vaccine bonds and pandemic bonds, have been used in the past to address major disease outbreaks, such as the Ebola and Covid-19 crises. Following the Covid-19 outbreak, innovative financing has been proposed as a major vehicle to fund PPPR. Results: What are the new findings? Despite recent pronouncements that innovative financing has ‘huge untapped potential’ for PPPR, there is little evidence within the literature to support such claims. This has been confirmed by our examination of four innovative financing mechanisms and their historical use in response to disease outbreaks. Our findings suggest that flaws and trade-offs in the design and application of these mechanisms have resulted in failure to deliver on their promise, raising concerns regarding their prospective use in financing PPPR. Although innovative financing could play a role, existing mechanisms in health have not generated the scale of funds proposed. In addition, the amounts generated have historically focused on specific interventions, which threaten to enhance fragmentation (disjointed financing of health) and alignment failures (not well integrated within overall national strategic plans) with and within PPPR. Conclusions: What do the new findings imply? Our findings reveal a set of innovative financing tools shrouded in unsubstantiated claims to success and effectiveness that look to have underwhelming promise of ‘value for money’ in global health. This stems from evidence suggesting design flaws, inadequate application, lack of transparency, private sector profiteering and associated opportunity costs. Thus, contrary to popular claims, they may not be the ‘silver bullet’ for bridging PPPR financing gaps and addressing costly, complex and multifaceted PPPR interventions. Keywords Innovative financing mechanisms, Financing pandemic preparedness, Pandemic preparedness and response, PPR, PPPR, Global health financing *Correspondence: Blagovesta Tacheva Full list of author information is available at the end of the article © The Author(s) 2025. 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/. Tacheva et al. Globalization and Health (2025) 21:13 Background The World Bank and World Health Organization (WHO) have provided estimates of the annual pandemic preparedness and response financing needs in a report produced for the G20 Joint Finance and Health Task Force. Supporters of the prevailing pandemic prevention, preparedness and response (PPPR) agenda are now coalescing around these new figures as the basis for future PPPR needs. The World Bank and WHO estimate that low- and lower-middle income country (LMIC) governments and donors need to invest US$31.1 billion annually in PPPR, of which US$26.4 billion needs to be invested by LMICs and US$4.7 billion at the international level. The report also acknowledges that LMIC countries are unlikely to meet their national PPPR financing requirements, estimating that there is an overall annual funding gap of US$10.5 billion to be addressed by new overseas development assistance (ODA) [1]. This represents a significant investment, especially when compared to other global health requirements, while bearing in mind the current WHO budget is roughly US$3.8 billion a year. The challenge of meeting these costs is not insignificant. The economic repercussions of the economic impact of Covid-19, the war in Ukraine and ‘donor fatigue’ pose major challenges in mobilising the new ODA requirements. In addition, the World Bank-administered Pandemic Fund, currently the main instrument for financing PPPR, has only raised US$1.85 billion to date [2]. When the Pandemic Fund issued its first call for applications to request financing for PPPR implementation activities in May 2023, the scheme quickly became eight times oversubscribed [3]. The goal of meeting this challenge has given impetus to search for financing alternatives. In this context, ‘innovative financing’ mechanisms have been championed as a possible solution to close the estimated US$10.5 billion gap in international assistance for PPPR. The World Economic Forum (WEF) argues that innovative financing can help prepare for future pandemics, citing its “huge untapped potential… to prevent outbreaks long before they reach epidemic or pandemic proportions” and save lives by making the rapid deployment of health interventions possible through the swift and efficient use of funds [4]. Moreover, the WHO Secretariat for the Pandemic Agreement has cited innovative financing as a key component for the Coordinating Financial Mechanism proposed under Article 20 (PPPR financing) of the latest draft of the Pandemic Agreement [5]. This same mechanism will also channel financing for the revised International Health Regulations, thus increasing the potential role of innovative financing for emergency preparedness more broadly [6]. Innovative financing refers to an array of financial solutions and mechanisms, “that can be used to bridge the Page 2 of 31 gap between traditional forms of development funding and the financing required to achieve development goals” [7]. We adopt a broad definition that encompasses two distinct dimensions of innovative financing (...truncated)