At their recent meeting in Bali on July 15-16, G20 Finance Ministers reaffirmed their commitment to coordinated action to bring the COVID-19 pandemic under control and better prepare for the next global health emergency. A central topic was the creation of a new financial intermediary fund (FIF) for pandemic preparedness and response (PPR), under the supervision of the World Bank and with the World Health Organization playing a role. technical and central coordination. The goal is to fill part of PPR’s $10.5 billion annual funding gap and help build critical capacities to protect global health, including genomic sequencing and drug manufacturing.
Now is the time to move towards a more promising “health for all” approach, starting with an inclusively governed IFF and economic interventions that enable low- and middle-income countries to invest in their own health systems.
Over the next month, the G20, World Bank and WHO will finalize the design of the FIF, under strong external pressure to develop an equitable and inclusive governance structure. The Indonesian presidency of the G20 has enabled preliminary agreements which go in the right direction. For example, a consensus is emerging that the governance of the IFF should include low- and middle-income countries, non-G20 partners and civil society. In addition, G20 countries recognize that the FIF should build on the existing global health framework for PPR, with a central role for WHO. This is a positive change from the World Bank’s May 2022 white paper which proposed a deeply retrograde and insular conception in which donors (mainly rich countries) would make all the decisions and consult others (or not ) as they wish.
The next step is for the G20 to recognize more explicitly that an effective PPR mechanism, as a global common good, requires an IFF model based on universal contributions (depending on capacity) and representation, as well as universal access to the benefits. The world desperately needs an IFF governance structure that can help close critical gaps quickly and effectively. This requires a decision-making body that is nimble, but also widely seen as legitimate and therefore capable of making tough decisions without months of consensual diplomacy.
But while all current FIF stakeholders seem to agree on the principle of inclusive governance, design discussions are still ongoing with only the founding donors in the room. Low-income countries and civil society representatives stay out. The G20 should set a deadline: by August 1, 2022, all stakeholders should be fully included in design conversations through a constituency-based model that gives equal weight to all voices, regardless of their financial contributions. This includes a voting role for civil society, an increasingly important norm in global health governance.
The IFF should mark a long-awaited break with the current approach, which treats PPR as a favor that rich countries return to poorer countries. Nothing could be further from the truth. Recall that it was South Africa’s novel approach to low-cost, high-impact genomic sequencing that helped the world detect and understand the new Omicron variant last November, a tremendous public service global. But around a third of all countries currently lack the resources and capacity to do genome sequencing, with huge gaps in Africa and Latin America in particular.
These are also regions where the hoarding of vaccines by countries in the North means that COVID-19 continues to circulate among largely unvaccinated populations and mutates at rates that have left public health officials and pharmaceutical companies struggling to cope. follow. The FIF will only work if all countries – starting with the G20 – are bought in and all countries do their part to detect, contain and confront outbreaks with the full kit of diagnostic, treatment and prevention tools.
The inclusion of WHO in the FIF is a central element of the governance structure. Integrating it into the design of the FIF should include WHO chairing the technical advisory group that will assess and weigh the evidence and data needed to inform priorities. The WHO is not only the main center of scientific expertise and coordination for global health; it also represents 194 countries, which gives it essential legitimacy.
While the FIF is supposed to increase existing donors and national investments in the field of PPR in public health, there are already signs that its fundraising could cannibalize the resources of proven complementary mechanisms like the Global Fund and the Coalition for Epidemic Preparedness Innovations. If the FIF ends up sapping resources for the rest of the global PPR framework just to become the shiny new deliverable of this year’s G20 summit, it will have done more harm than good for global health security.
The scale of financial needs, especially in low- and middle-income countries facing massive debt crises and soaring inflation, far exceeds what even the most effective FIF will be able to provide. As part of its PPR commitments, the G20 should redouble its efforts to bring China and private creditors to the table to renegotiate the growing debt burden through its common framework, or face the risk of many other Sri Lankan type debt defaults and social and social growth. political unrest in the months and years to come.
To ensure the success of the IFF and broader PPR global efforts, the G20 must take all the steps in its power to provide debt relief and free up fiscal space in low- and middle-income countries. This includes expanding the Common Framework and the Debt Service Suspension Initiative, and developing effective ways to ensure private sector participation; removing austerity conditions from International Monetary Fund loans that encourage countries to cut public spending in areas like health; increase liquidity through additional allocations of special drawing rights (the IMF’s reserve asset); and exploring more creative financing mechanisms such as the debt-for-health swaps used by the Global Fund.
The new IFF proposal and broader G20 and World Bank actions on PPR cannot afford to deliver “health to the few” – the wealthiest and most privileged. It is a morally bankrupt and woefully inefficient approach. Now is the time to move towards a more promising “health for all” approach, starting with an inclusively governed IFF and economic interventions that enable low- and middle-income countries to invest in their own health systems.