Opportunities to finance pandemic preparedness.

In the past 2 years, the World Bank has taken a series of steps to become more actively engaged in pandemic preparedness and response. The World Bank took a leading role in the response to the 2014–16 Ebola outbreak in west Africa, has provided leadership within the Global Health Security Agenda, and created the Pandemic Emergency Financing Facility (PEF) to provide funds during outbreaks of specific infectious diseases.1World BankPandemic Emergency Financing Facility (PEF).http://www.worldbank.org/en/topic/pandemics/brief/pandemic-emergency-facility-frequently-asked-questionsGoogle Scholar Although these activities are important and should be supported, the World Bank has a window of opportunity to do much more in bringing attention to, and concrete funding for, pandemic preparedness. Every 3 years, the World Bank undergoes a process to replenish the International Development Association (IDA), with the current effort known as IDA18. IDA is a part of the World Bank Group, and is designed to help the 77 poorest countries of the world by providing loans on soft terms as well as grants. These funds are not earmarked; governments determine their priorities on the basis of a set of investment areas that are agreed on during the replenishment dialogue that involves low-income countries, donors, and the World Bank itself. These IDA funds are made available in predetermined amounts to individual low-income countries. There are also amounts reserved for regional integration projects and programmes, using the same set of agreed investment areas, which are over and above the amounts specified for individual countries. The IDA18 negotiation process, which must be concluded by the end of 2016, is at a crucial phase, with 50 donor countries asked to increase their contributions from 3 years ago of US$52·1 billion to as much as $90 billion. IDA is one of the best, if not the very best, significant multilateral funding mechanism to address critical pandemic challenges on a sustained basis in low-income countries, and could do so by funding fundamental public health infrastructure. Public health priorities often receive limited funding in low-income countries because (i) health budgets are often driven primarily by immediate health needs and vertical programmes, with readily defined metrics for success, and (ii) finance ministries are often less inclined to support resource commitments for longer-term payoffs. This remains true despite the fact that all countries are obligated to build public health capacity to prevent, detect, and respond to potential public health emergencies of international concern under the International Health Regulations (IHR), and despite disastrous recent public health events, including the west Africa Ebola outbreak and the spread of Zika virus. So where does pandemic preparedness, in the World Bank context, currently stand? And where could it be? The Bank is clear in its recognition of the importance of pandemic preparedness, the necessity to build public health infrastructure aligned with the IHR, and the objectives of the Global Health Security Agenda. It is also a critical international actor in its support of the Sustainable Development Goals, in particular, Target 13 to “strengthen the capacity of all countries, in particular of developing countries, for early warning, risk reduction and management of global health risks”, and the need for whole-of-society approaches to adequately address pandemic preparedness and mitigate the consequences of biological threats.2World BankInternational Development Association (IDA) 18: special theme—governance and institutions.http://documents.worldbank.org/curated/en/368341467989536274/International-Development-Association-IDA-18-special-theme-governance-and-institutionsGoogle Scholar That said, the current IDA18 proposal is modest, with an expressed goal of supporting between 15 and 25 IDA countries in (i) developing pandemic preparedness plans, and (ii) supporting the development of frameworks for multisectoral pandemic preparedness, response and recovery. With the amount of money currently being considered for IDA18, IDA could go well beyond supporting even 25 countries in pandemic preparedness. IDA18 could commit to supporting at least half (if not all) of the 77 poorest countries in developing pandemic plans. IDA18 could also support regional programmes for pandemic planning, and concretely provide funding to improve country-level public health infrastructure in order to meet IHR core capacity requirements. IDA18 could also be used to support PEF financing. These activities would move the global community towards real pandemic preparedness. The next intergovernmental discussion on IDA18 will be held at the World Bank annual meeting in October, 2016, with finalisation of the contribution commitments and investment areas concluded before Jan 1, 2017. Before the World Bank Group annual meeting in October, 2016, donor countries and low-income countries can review their positions on what is absolutely critical for development and what can be done over the next 3 years to enhance pandemic preparedness and population health, and request modifications to the IDA18 guidance. For our collective health security, we need to marshal sustained technical and financial support for pandemic preparedness in low-income countries. IDA18 is the right instrument to encourage the poorest nations of the world to expand public health investment. We declare no competing interests.