Challenges in international health financing and implications for the new pandemic fund

Abstract

BackgroundThe failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing.Methods/ResultsThe article outlines eight challenges associated with global health financing instruments and development aid for health within the global health literature. These include misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Using available information about the Pandemic Fund, the article positions the Pandemic Fund against these challenges to determine in what ways the financing instrument recognizes, addresses, partially addresses, or ignores them. The assessment argues that although the Pandemic Fund has adopted a few measures to recognise and address some of the challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed.ConclusionIt remains unclear how the Pandemic Fund is explicitly addressing challenges widely recognized in the global health financing literature. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers four sets of policy recommendations for how the Pandemic Fund and the PPR financing architecture might respond more effectively to the identified challenges.

Sustainable financing of immunization programs: A narrative review of the literature

“…For effective public financial management, the strategic interventions identified in literature were: improving vaccine demand forecasting, budgeting, and procurement 8,[10][11][12][15][16][17][18][19][20] , where accurate market assessments 11,12,15 and ensuring reliable cost and expenditure data by mapping budget processes 11,[18][19][20] were highlighted as critical findings; establishing credible regulatory bodies [10][11][12]16,17,[19][20][21] , to expedite approval processes 11,12 and evaluate program targets 10,19 ; and alternative financing models and funding strategies [1][2][3]6,7,[10][11][12]14,17,19,21,23,25,26 , such as Advanced Market Commitments (AMC) 1,11,12,17 , investing in R&D 1,…”

“…Pooled procurement mechanisms (PPM) have emerged to ensure equitable access to COVID-19 vaccines, although with varying success [1][2][3]6,7,10,11,19 . By leveraging collective purchasing lower, negotiating favorable pricing arrangements with vaccine manufacturers becomes a reality -enhancing procurement efficiency 1,2 .…”

“…Countries have taken heterogeneous approaches to account for immunization in their national health budgets and expenditures; however, evidence for best immunization finance practices is limited 1 . There is increasing evidence showing the diversion of resources alongside budget reallocation to counter existing universal healthcare services and systems strained by COVID-19, such as routine immunization programs 2,3 . As the world emerges from the disruptions caused by the pandemic, there is an urgent need to re-focus the attention on the control and prevention of other vaccine-preventable diseases (such as measles or pertussis) to recover lost ground and to equip immunization programs with the capacity to withstand unforeseen shocks.…”