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March 13, 2020

Global Health Security and Management of Disease Outbreaks


Linking health care delivery, new forms of innovative financing, research & product
development and enhanced global collaboration

On 6th March 2020, the Global Preparedness Monitoring Board (GPMB) called for a scaled up global
response to COVID-19, including in finance, given the profound health, social and economic impact
around the world. The G20 HEALTH AND DEVELOPMENT PARTNERSHIP (G20HDP) strongly supports the
recommendations of the GPMB and the urgency of the response required by the international
community. However, as with the 2008 financial crash, there is a requirement for urgent remedial
action to contain this crisis and in parallel this must be accompanied by the urgent development of a
new comprehensive framework to protect global health security in the future. When the world emerges
from the COVID-19 epidemic, we must already have in place the new framework that ensures the world
is significantly better equipped to prevent a future pandemic.

The continued spread of COVID-19 across the world represents a threat to us all, but particularly to
those with weakened immune systems, the elderly and those living in countries with low capacity.
Moreover, it places serious threats to the functioning of our health care systems and to the health of
the workforce. If not contained, the expected impact of COVID-19 on weaker health systems in low-
and middle-income countries will be devastating. Our G20HDP Partners represent the heart of
innovation and delivery within the global health community, with daily experience of fighting a wide
range of infectious diseases including hospital acquired infections owing to antimicrobial resistance
(AMR), TB, HIV-AIDS, malaria, as well as building health system capacity and resilience. We also
understand the complex nature of novel pathogens, which require advanced medical research to help
the world prepare for, and hopefully prevent, the next pandemic.

Political leaders and leaders in science and health policy have been aware of the increasing evidence
that demonstrates that as a result of globalisation, mass migration, climate change and increased
urbanisation, there is a growing risk of an aggressive pandemic that could impact billions of our citizens.
This is particularly the case in countries with weak health systems or a lack of political will to take
necessary steps and which would debilitate the global economy. That risk is now clearly manifesting on
a daily and hourly basis as COVID-19 spreads around the world. Investments in preparedness, including
financing to stop outbreaks at their source, should be a priority.

Scientists estimate that there are over one and a half million unidentified pathogens around the world
that pose a potentially serious threat to public health.1

However, as we have seen in the aftermath of the SARS, MERS and Ebola outbreaks, the willingness to
continue funding Research & Development (R&D) into emerging pathogens is challenging.

The Coalition for Epidemic Preparedness and Pandemic Response (CEPI) was created in Davos in 2017
to develop vaccines and treatments against some of these potential threats, but until now

1
Daszac, Peter (2020) ‘We Knew Disease X Was Coming. It’s Here Now.’ (27 February 2020), The New York Times [online].
Available at: https://www.nytimes.com/2020/02/27/opinion/coronavirus-pandemics.html.

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many governments in the G20 and beyond have not considered funding for this research and product
development as an essential investment. The result is that the international community is largely
reactive, with the consequences we are seeing today.

Despite significant commitment from certain governments, funders and the private sector to
combating COVID-19, all countries must prioritize the development of vaccines, therapeutics, rapid
diagnostics, medical countermeasures, and other lifesaving tools to manage both existing major health
threats as well as create systems to manage the next outbreak of disease.

On 6th March 2020, the coronavirus crash wiped $9 trillion off stocks, only a few months after being
identified for the first time ever and is likely to cost $2 trillion in lost global trade.2

Global markets continue to fall. SARS, MERS and Ebola have had equally devastating impacts on global
trade and national economies. Persistent pandemics, like TB are often dealt with separately even
though it kills as many people globally every 12 hours as the COVID-19 outbreak did in its first three
months combined.

A 2019 Economist Intelligence Unit special research paper3 calculated drug resistant TB alone (9% of
the global TB population is drug resistant to standard treatment) would create a US$17.8 billion future
annual GDP loss globally from DR-TB deaths in a single year by 2035 and India alone could carry 41% of
that global loss. Some political leaders have dismissed these figures as alarmist. However, after the
economic crash caused by COVID-19, finance ministers and central bank governors from the G20 issued
a joint statement, recognising for the first time the existential threat a global health emergency poses
to humanity and to the global economy.

G20 leaders together with the International Monetary Fund (IMF), the World Health Organisation
(WHO), and the World Bank (WB) and the United Nations (UN) in collaboration with the private sector
and other stakeholders must now take up the challenge and devise a new framework for global health
security. Pandemic risk is increasing, and the global response cannot be treated as ‘disaster relief’, as
we are witnessing today. Finance ministers and central bank governors must redefine health spending
on R&D and system strengthening for this new global framework as legitimate public investment.

2
Global Preparedness Monitoring Board (2020) The Global Preparedness Monitoring Board calls for a Scaled-Up Global
Response to COVID-19: Estimated Costs and Funding Sources, GPMB [online]. Available at:
http://apps.who.int/gpmb/assets/pdf/GPMB_6March2020statement.pdf.
UNCTAD (2020) ‘Coronavirus: Can policymakers avert a trillion-dollar crisis?’ (9 March 2020), UNCTAD [online]. Available at:
https://unctad.org/en/pages/newsdetails.aspx?OriginalVersionID=2300.

3
The Economist Intelligence Unit (2019) It’s Time to End Drug-Resistant Tuberculosis The case for action, The Economist
[online]. Available at: https://www.eiu.com/graphics/marketing/pdf/its-time-to-end-drug-resistant-tuberculosis-full-
report.pdf.

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There are significant resources in pension and sovereign wealth funds which can be invested in new
innovative and blended finance initiatives. There are currently USD 200 Trillion existing in capital
markets globally. 1% of global capital markets can be used to close the entire SDG Gap. Less than 50%
of that would close the gap in health-related SDGs.4

Private investors are keen to invest in social impact financial instruments, provided the financial
regulators set out clearly the regulatory and fiscal regime. As with all private investments, the investors
want to understand how a new financial instrument is regulated, whether there are tax benefits, and
how return on investment is determined. The IMF, together with central bank governors and finance
ministers, should urgently address these issues and encourage private and institutional investors to
participate in scaled up blended and innovative finance initiatives to help meet the funding
requirements of a new health security framework.

Organisations like Unitaid, Gavi, GHIT and R&D focused pharmaceutical companies have significant
experience in blended financing for health and could be called upon to demonstrate practical examples
of both public private financing and partnerships that have over recent years produced promising
results.

Product Development Partnerships (PDPs), such as MMV, the TB Alliance and PATH often working with
private sector partners understand how to bring together public, private and philanthropic finance to
advance R&D to develop and scale lifesaving health products. Their knowledge has led to significant
breakthroughs in scientific research.

In 2008, the world faced a potential systemic collapse of the banking and financial system. The
immediate reaction of leaders at that time saw them come together, particularly within the G20.
Finance ministers implemented urgent new regulation and central bank reserves were deployed to save
the banking system.

The Financial Stability Board of G20 finance ministers and central bank governors was created with
agreed new powers to address resilience in the financial systems. The IMF Article IV consultation and
surveillance procedure was strengthened regarding resilience of national financial systems. As a result
of the COVID-19 crisis, we must have a response of equal gravity and urgency to that in 2008.

The IMF must incorporate into its Article IV multilateral surveillance procedure an assessment of the
resilience of national and regional health systems. This should be done in cooperation with the WHO.
In addition to the WHO’s GPMB, the financial stability board should expand its mandate to include
health system resilience and oversee the establishment of a multi-billion dollar fund that represents an
“Advance Impact Commitment” which funds end to end solutions in innovation and product
development in healthcare and strengthening weak health systems.

Today, despite warnings, the evidence and outbreaks, among others, of Ebola, SARS and MERS, we have
not put in place adequate mechanisms needed to prepare, pre-empt, and hopefully, prevent a new
pandemic. Hence, we need much greater investment and increased incentives for R&D into the
pathogens that pose the greatest threat to our health.

4
USAID Centre for Innovation and Impact (2019) 2019 Impact Brief [online]. Available at:
https://www.usaid.gov/sites/default/files/documents/1864/USAID_2019_CII_Lookbook_web.pdf.

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Rapid diagnostics are needed to identify the pathogens and new vaccines to prevent worldwide
infection from those pathogens. There is also need for greater investment and incentives for seeing
how existing treatments can be used to combat new pathogens.

In 2008 and 2009 heads of government, finance ministers and central bank governors used all of the
levers of government together with central bank reserves to stabilise the crisis and build a framework
to prevent a future systemic crisis. We believe the recommendations outlined below will help to create
a framework for the future which will protect the health of citizens and support economic growth.

Given the need to be proactive on future outbreaks, we recommend:

1. A strengthened IMF Article IV consultation in cooperation with the WHO, to regularly evaluate
national health systems resilience;
2. The expansion of the G20 Financial Stability Board to include within its mandate health system
resilience and the promotion of public/private investment in innovation and product development;
3. An annual meeting of G20 finance & health ministers as part of the official G20 Presidency agenda;
4. That the G20, IMF, EU, WB and the Development Banks including the IsDB and the WHO join efforts
and actions and establish with urgency a multi-billion dollar financing instrument for the
development of affordable vaccine, medicines and diagnostics, providing incremental funding for
global clinical research as well as regulatory alignment and market preparation. This fund can also
support push/pull incentives for optimized pricing through advanced market commitments/results-
based delivery funding. This instrument should be focused on addressing global health threats
where commercial incentive is lacking;
5. That the G20 and the IMF examine steps necessary to encourage significant expansion of innovative
financing initiatives and promote the scaling up of innovative and blended finance for health;
6. The review of the regulatory regime for the approval of innovative medicines and vaccines to
ensure earlier patient access;
7. That the G20 and the IMF collaborate with the WHO and funders above to prioritize essential digital
and data investments to strengthen the resilience of health systems, the quality and availability of
early warning and disease surveillance information, and ensure an adequate supply of health
workers, vaccines and other treatments as they become available;
8. That the World Bank’s pandemic bond issue, created in 2017, which was designed to help fund the
response to any widespread outbreak of a number of diseases, including coronavirus, should be
triggered and potentially unlocked on April 9th. The G20HDP urges this funding to be channelled
into the R&D response for COVID-19.