There is growing global commitment and momentum for adopting, achieving, and sustaining Universal Health Coverage (UHC) to achieve the Sustainable Development Goals (SDGs) by 2030. Health security—defined as, essentially, the protection from threats (notably, pandemics) to health—is integral to the attainment of UHC and the SDGs.
Since the turn of this century, SARS, highly pathogenic avian influenza MERS, Ebola and, more recently, the Zika virus outbreaks (all of which have their origin in animals) have demonstrated the ability of epidemics to devastate communities through both extraordinary losses of life and severe morbidity as well as adverse social and economic impacts that jeopardize global health security. There are also health security risks associated with ongoing malaria and TB transmission, dengue outbreaks and the seasonal outbreaks of rotavirus diarrhea that occur against a background of low immunization rates and poor standards of WASH. There are negative ripple effects throughout the health system as resources are diverted to deal with the crisis. These have underscored the need for countries to invest in preparedness—ie. in the capacity to detect, prevent and respond to infectious diseases. Recent evidence suggests that responding to outbreaks once they have happened is far more expensive than investing in preparedness.
There are a number of factors at play that place countries at increasing risk of from infectious diseases and pandemic outbreaks – population growth, increasing urbanization, as well as disasters and climate change. In addition, countries are increasingly interconnected as a result of rapid globalization. Greater integration, especially within East Asia Pacific (EAP) and with the rest of the world, also means a greater probability of transmission of emerging infectious diseases, including multi-drug resistant organisms, and can trigger re-emergence of endemic diseases (TB, leprosy, etc.). Many countries in the EAP region have moved toward closer integration through ASEAN that is allowing for freer movement of goods, labor, and services. Intraregional trade as a share of total trade in EAP has grown faster than in any other region globally, and is approaching levels seen in the European Union. In addition, intra-region private capital flows are increasing and the movement of professionals across country borders is becoming easier.
Improving the capacity of countries for preventing, detecting and responding to national, regional, and global health risks, as per International Health Regulations (IHR), is now included among the 2030 Sustainable Development Goals (SDGs). There is also growing clarity and attention on what policies, regulations, health system capacities and institutions countries need to have in place in order to prevent, detect, and respond to outbreaks, as well as new evidence on the costs of pandemics, the cost of inaction, and the economic dividend of better preparedness. The International Working Group on Financing Preparedness (IWG) has recently made several recommendations including for strengthening country and regional preparedness and response capacities for health emergencies. These include recommendations for: (i) countries to conduct a Joint External Evaluation (JEE) and an evaluation of the Performance of Veterinary Services (PVS) to assess their capacity under WHO IHR and OIE standards to prevent, detect, and rapidly respond to public health threats, and to guide the strengthening of domestic and regional surveillance and response systems; (ii) pandemic preparedness capacity to be included in the World Bank’s annual Country Policy and Institutional Assessment (CPIA) tool which is used as part of the allocation formula determining the envelope of concessionary financing that is available to eligible low and middle income countries; and (iii) the International Monetary Fund and the World Bank to facilitate the incorporation of the economic risks of infectious disease outbreaks into macroeconomic and market assessments. Investments in the ability of countries to cope with such health shocks in EAP should be viewed in a more general sense — not only as indicative of a commitment to improving welfare, productivity, and human development – but also as a signal of a commitment to provision of a conducive climate within which any adverse impacts of any emerging infectious diseases to broader economic activities can be mitigated and effectively managed.
Strengthening pandemic preparedness requires sustained financing and broader investment in health systems/public health infrastructure (including human resource, infrastructure and service delivery)to ensure long-term capacity to prevent, detect and respond to disease outbreaks. Yet, current funding levels remain inadequate while the capacity to deliver relevant health services remain suboptimal in most developing countries in EAP. This is partly because governments tend to focus on more immediate priorities, overlook pandemic preparedness for disease outbreaks in the future, and ignore the multiple benefits of health security investments when guided by the One Health principles. Global financing support is also often fragmented, uncoordinated, off budget/system and often substitutes for domestic investment. Given the complexity and multisectoral nature of pandemic preparedness, better understanding of the current financing landscape and levels of capacity would enable an informed dialogue on financing and service delivery gaps and how best countries can optimize existing resources as well as increase domestic financing and capacity to improve health security.
Pandemic preparedness planning is complex and requires an integrated framework of programs, processes, and planning guidance that can be scaled-up and adapted across several sectors at national and subnational levels. To address this complexity, several tools and frameworks have been developed (by WHO, USAID, CDC, OIE, etc.) to provide guidance and a framework for countries to develop national multisectoral pandemic preparedness and response plans. However, there is limited guidance on the essential elements that should be included in such multisectoral plans, including the lack of strategy to finance the plan. Consequently, while most countries have pandemic preparedness plans, they tend to be disease-specific, and vary in focus, breadth, and depth, and financing the plan is often a major challenge. Furthermore, poor governance and regulatory frameworks to enhance coordination of pandemic preparedness across sectors continue to be a challenge. Most countries lack a multisectoral institutional and governance framework and platforms for collaboration of pandemic preparedness planning and implementation. Another key challenge countries face is the absence of a comprehensive M&E system that ensures the players from all involved sectors – at national and sub-national level— report on the implementation progress. National pandemic preparedness should be accompanied by a robust monitoring and evaluation framework through which progress can be measured and gaps identified.
Recognizing the gaps in pandemic preparedness planning and financing, the World Bank Group in collaboration with countries, technical partners, with the support from Australia’s Department of Foreign Affairs and Trade (DFAT) have developed a health security financing framework to support countries: (i) assess current level of investment in health security, using the Health Security Financing Assessment Tool (HSFAT), (ii) Analyze additional financing needs; and identify and prioritize system bottlenecks for improved systems and capacities for universal health security: (iii) integrate financing health security to the broader macro and fiscal space analysis and UHC financing strategy, and (iv) create and increase awareness on the economic risk/consequences of pandemics among policy makers. The HSFAT is designed to complement the WHO Joint External Evaluation (JEE) as well as the World Organisation for Animal Health (OIE) PVS Pathway tool. The first health security financing assessment, applying HSFAT, will be conducted in Vietnam to assess health security arrangements as well as sources and level of financing, particularly in related to 19 action areas of JEE. It will also examine essential elements of post-emergency or recovery phase of response.