To achieve a unified global pandemic response, there are several strategic policy considerations that can facilitate a transition to cohesive, coordinated, transparent, flexible and local responses that will truly take us from fragmentation to integration
The Covid-19 pandemic has been an unprecedented global health crisis, resulting in millions of deaths and severe societal and economic disruptions worldwide. The pandemic exposed major gaps, inequities and fragmentation in global health governance, financing and technical infrastructure for pandemic preparedness and response.
In recognition of these systemic weaknesses, a multitude of global and regional initiatives has been launched over the past two years to strengthen mechanisms for preventing, detecting and responding to future pandemic threats. Key proposals include an international legal instrument, a ‘pandemic accord’, amendments to the International Health Regulations, a pandemic fund and similar regional efforts.
However, there is a risk that these fragmented initiatives may lead to duplication, inconsistencies, high transaction costs and continued inequities unless they align properly within a coherent global health architecture. The strategic integration of these various efforts is critical to develop a truly effective, equitable global system for pandemic preparedness and response.
Key strategic considerations should focus on priorities such as governance, financing, access to medical countermeasures, accountability mechanisms and multisectoral collaboration.
The current landscape
Since the onset of the Covid-19 pandemic in early 2020, several proposals have been developed at both the global and regional level to strengthen capacities for pandemic prevention, preparedness and response.
One key global initiative underway is the pandemic accord. An intergovernmental negotiating body is developing this new international instrument focused on better cooperation, solidarity and equity in future pandemic responses.
Another initiative is amending the IHR, last revised in 2005. A working group is reviewing potential amendments to fix inadequacies exposed during Covid-19, such as timely information sharing, travel measures and equitable access to medical countermeasures.
The United Nations High Level Meeting in New York in September 2023 sought political commitment at the level of heads of state and government to strengthen multisectoral pandemic prevention, preparedness and response, setting the tone for the proposed pandemic accord and IHR amendments.
And the G20 and World Bank have established a financial intermediary fund to provide long-term, scalable and sustainable financing for pandemic preparedness, with a focus on low- and middle-income countries.
Strategic policy considerations
The diversity of these initiatives reflects a growing momentum to address the gaps revealed by Covid-19. However, careful coordination is needed to transition into a truly unified, equitable and effective global pandemic response architecture. The following strategic policy considerations can facilitate this transition by promoting synergies, reducing duplication and incoherence, and keeping equity at the centre.
1. Ensure complementarity between global and regional instruments. Identify interlinkages between the proposed pandemic accord, IHR amendments, G20/World Bank initiatives, UN political declarations and efforts by regional entities. Harmonise and create synergies between global and regional initiatives to increase policy coherence and political momentum and reduce duplication. Global instruments should provide overarching principles and standards flexible enough to build on regional capacities and priorities. Regional instruments can implement and operationalise global commitments.
2. Prioritise equity in access to pandemic health products and health systems capacities. New international instruments should have equity and solidarity as core principles. Equitable access to vaccines, treatments, diagnostics, personal protective equipment and health personnel must be ensured, particularly for low-income countries. Legally binding provisions could cover equitable technology and knowledge transfer to boost regional and local manufacturing capacities, including through pooling intellectual property rights and providing incentives for technology sharing. Commitments must go beyond access to boost national public health capacities, health and social safety nets, and community level action, with international support aligned to national plans.
3. Establish sustainable and coordinated financing mechanisms. Predictable, coordinated financing is essential for equitable pandemic prevention, preparedness and response capacities worldwide. Initiatives such as the G20 Joint Finance-Health Task Force should be integrated within the broader pandemic response architecture. Humanitarian and development assistance for health should be coordinated with domestic health spending to maximise impact and build sustainable capacities.
4. Adopt whole-of-government and whole-of-society approaches. Pandemic response requires unprecedented collaboration beyond just the health sector, including coordination across ministries of finance, security, transportation and foreign affairs. Legal instruments and national commitments must engage relevant government stakeholders, while also tapping into the capacities of civil society, private sector and local communities. A coordinated multisectoral response should be institutionalised.
5. Develop accountability mechanisms for transparency. Independent accountability mechanisms strengthen capabilities for pandemic preparedness and response through transparent evaluation and learning. Legally binding commitments should promote accountability mechanisms and ensure action on recommendations. Accountability processes should be non-punitive and grounded in principles of transparency, learning and continuous improvement.
6. Balance binding and voluntary instruments for flexibility. Overemphasising legally binding elements may reduce political support and flexibility. The right balance is needed between binding and voluntary components. Binding agreements may be most feasible and impactful for foundational principles such as equity, transparency, solidarity and cooperation. Specific technical provisions could be maintained as voluntary standards and best practices, especially during a pandemic.
7. Organise thematic negotiations for coherence. The pandemic response architecture incorporates diverse technical issues. Organising negotiations according to thematic areas such as health systems, economic resilience and access to countermeasures can promote more focused progress. Clustering related technical elements can help develop a more coherent framework and architecture across the instruments.
8. Regional leadership and localisation. Global agreements and initiatives must empower regional and local leadership while strengthening national capacities. One-size-fits-all centralisation often undermines response agility. Legal instruments should recognise regional entities and provide avenues for decentralised regional coordination and financing under national oversight.
The Covid-19 pandemic has triggered a rare alignment of political will for strengthening global pandemic prevention, preparedness and response capacities. However, this opportunity could be squandered by fragmented initiatives operating in silos. It is critical to strategically integrate ongoing global and regional proposals into a unified pandemic response architecture to prepare the world to manage future crises equitably and effectively.
The considerations outlined here aim to promote the level of policy coherence, coordination, transparency, flexibility and localisation needed to transition from the current fragmentation into a truly integrated, equitable and multisectoral approach to pandemic prevention, preparedness and response. With continued political commitment, strategic focus and collective action, we have an opportunity not just to tweak existing mechanisms, but also to truly reform and transform the global health system to build resilience against future threats. The window of opportunity is narrow, so urgent action is needed to harmonise and synergise the current landscape of initiatives towards integrated pandemic prevention, preparedness and response capacities worldwide.