Preventing pandemics costs far less than controlling them. To get there, we need long-term political support, sustained financial commitment and effective governance of the health sector
The Covid-19 pandemic was a stress test that brought to light the lack of preparedness for major health crises around the world. In many low- and middle-income countries health systems struggled to save lives and meet the needs of citizens. Disruptions to basic health services, such as maternal health and routine childhood immunisations, put women and children especially at risk of preventable illness and may have life-long consequences for many of them. The treatment of non-communicable diseases also suffered a serious blow.
The impact has been severe thus far: the World Health Organization recently reported that global excess mortality associated with Covid-19 was around 15 million, one of history’s worst death tolls and far higher than official estimates.
New disease outbreaks are threatening to inflict more human and economic suffering. Climate change, urbanisation, deepening poverty and conflicts are only compounding these stressors, contributing to a rise in acute shocks to health systems worldwide.
A big lesson from this pandemic and past health emergencies, including Ebola and Zika, is clear. Countries must prepare better for the next pandemic. Not doing so runs an extreme risk to a country’s human capital – people’s lives, their health and their skills – and to the economy. Moreover, preventing pandemics costs far less than controlling them. A recent G20 high-level independent panel report highlighted the fact that while global economic losses from Covid-19 exceeded $20 trillion, the estimated financing for prevention, preparedness and response measures would just be a fraction of this amount.
So how can countries better prepare?
First, governments must prioritise foundational, long-term investments in resilient health systems for all citizens in order to break the “panic and neglect” cycle. In most countries, pandemic prevention, preparedness and response remain vastly underfunded, siloed and insufficiently integrated within service delivery systems. Joint World Bank–World Health Organization studies estimate that the total annual financing need for pandemic prevention preparedness and response is $30 billion, with the largest capacity gaps in low- and middle-income countries.
Most of this funding will need to be raised domestically. Yet World Bank research also shows that the projected increase in government health spending in 2026 will cover only about 60% of the necessary annual investment needed to strengthen and maintain public health preparedness and response capabilities in low- and lower middle-income countries. Considering this reality, significant international financing will be needed to support poorer countries.
Second, sound governance of the health sector is crucial to the success of pandemic prevention, preparedness and response. Countries need evidence-based decision-making processes, and agile, risk-informed planning and budgeting processes that mobilise government at the national, sub-national and local levels. They need quality legal and regulatory frameworks and strong public health institutions.
This kind of robust governance is especially key to ensuring that a One Health approach really works, bringing together human, animal and environmental sectors for interventions that ultimately save lives.
Setting an example
In Uganda, thanks to existing emergency response structures, the government quickly activated the country’s emergency operations centre and the national task force, well before the first Covid-19 cases were detected there. The Philippines also exemplified effective cross-sectoral actions by leveraging both disaster and public health legislation, and inter-agency emergency coordination mechanisms for the country’s Covid-19 response.
Crisis preparedness is integral to the mission of the World Bank Group, and we have long been supporting developing countries in building stronger health systems. Our $30 billion global health portfolio includes more than 200 projects that help countries take a comprehensive approach to improving health outcomes, especially for poor and vulnerable people, by strengthening primary health care and key public health functions.
For example, in Africa, through our Regional Disease Surveillance Systems Enhancement and the Regional Sahel Pastoral Support projects, we are helping to improve regional cooperation on public health, to upgrade veterinary laboratories and to prevent antimicrobial resistance. Our investment project to support the Africa Centres for Disease Control and Prevention is enhancing disease detection capability and enabling health authorities in the region to pool resources.
The new Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response – to be housed at the World Bank and working in close collaboration with the World Health Organization – is a further, important step to help strengthen country systems. The fund will bring additional, dedicated resources to the task, incentivise countries to increase their investments, enhance coordination among partners and serve as a platform for advocacy.
The world already failed a major test in preparing for and responding to the Covid-19 pandemic. It is in everyone’s best interest that we learn from this and take immediate action. Pandemic prevention, preparedness and response anchored in strong health systems that reach everyone, everywhere – especially the most vulnerable – are critical to ensuring people can live out their full productive potential and countries can build more resilient, inclusive and prosperous futures. It takes long-term political support, sustained financial commitment and effective health sector governance to get us there.