The Global Fund Should Be Central To A New Global Pandemic Facility

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Today we could be on the cusp of a historic breakthrough in global health financing. A broad coalition of governments and other actors, led by the United States, is working to set up a new global financing facility to fortify the capacity of low- and middle-income countries (LMICs) to fight futures, on the heels of the COVID-19 disaster of the past two years.

Respected international panels have called for a fund that would provide more than $10 billion a year for preparedness, a major share of it to LMICs to improve their pandemic preparedness and response (PPR) systems.

At the behest of the Group of Twenty (G20), the World Bank has recently published a white paper that proposes the scope, structure, and operating modalities for the new pandemic financing mechanism that would be managed by the Bank as one of its Fiduciary Investment Funds (FIF).

While the white paper has commendable features, it contains a glaring deficiency that needs to be corrected: It badly understates the role that the Global Fund to Fight AIDS, TB, and Malaria (and other multilateral health agencies including the Gavi vaccine alliance) should play in channeling preparedness resources quickly and efficiently to LMIC countries.

Following issuance of the White Paper, on a June 17 memo to its board the World Bank noted that it would be willing to include the Global Fund (plus Gavi and CEPI) as eligible entities, but that doing so will require a waiver. The review process for issuing such a waiver should be swift and minimize the burden on these agencies, and should be pro forma for the Global Fund given its eminent suitability to act as a main conduit for FIF resources to LMICs.

We have both arrived at this conclusion, even though we come to global health from different perspectives—one of us as longtime advocate, the other as a former World Bank health manager, independent policy analyst and advisor to global health organizations.

The Global Fund (and Gavi) was established in the early 2000s to channel multilateral donor money to LMICs to combat the prevailing epidemics of HIV, tuberculosis, and malaria (and vaccine-preventable childhood illnesses). Over the past two decades the Global Fund has proven that it can rapidly deploy billions of dollars for drugs, tests, and vaccines for these diseases and for COVID-19 and achieve impressive results while pandemic building up country systems to address future threats (in 2021 this amounted to $5.1 billion).

There are four compelling reasons why the Global Fund needs to be at the center of the FIF.

Proven Competence

Since its founding in 2002, the Global Fund partnership has saved over 44 million lives, and mortality has dropped by nearly half for each of the three diseases in countries where the organization invests. In contributing to these dramatic gains, the Global Fund and its partners have built many of the skills and know-how required to fight other pandemics, in key areas such as disease surveillance, laboratory and diagnostic services, and training and equipping frontline health workers. An independent review by one of us last year estimated that a third of Global Fund grants for the three diseases are going into these areas, similar to the findings from a paper published last year in The Lancet Global Health. The Global Fund has further burnished its pandemic preparedness and response track record by serving as the largest funder of non-vaccine interventions to LMICs during COVID-19, awarding $4.2 billion to date through its COVID-19 Response Mechanism (C19RM).

Purpose-Built For Public And Private Investments

Some unlike the other global health institutions that were set up to finance the activities of LMIC governments, the Global Fund was purpose-built to make grants to both health ministries and to private and non-governmental actors, including civil society organizations. Civil society actors are a consistent voice for programs designed to reach everyone in groups, including the most marginalized. NGO implementers are often closer to ground and embedded in the communities that are most seriously impacted by pandemics like COVID-19, and they can move faster in reaching those most in need.

Representative And Equitable Governance

The Global Fund is currently run by a Board with strong representation from LMIC country governments, civil society organizations, and the private sector, enabling it to amplify the voices of all stakeholders, especially in the countries where FIF financing is meant to end up. The white paper favors a more paternalistic governance arrangement in which the views—and votes—of the wealthiest countries and of global technical agencies predominate. This needs to change in the proposed pandemic FIF, and the Global Fund itself provides an excellent alternative governance model.

Efficiency

There is no time—and no need—to set up a new organization to channel the new PPR funding to LMIC health systems, or to establish new processes for grant application and reporting that would impose additional burdens for countries. The White Paper calls for utilizing the best existing mechanisms—and the Global Fund is one of these. It can respond quickly, as it has done over the past two years in awarding crucial funds to fight COVID-19 while helping protect existing HIV, TB, and malaria programs from the negative effects of the latest pandemic. It already has an independent Technical Review Panel that can be adapted to examine pandemic preparedness-related investments, reducing the need for the FIF to put in place another costly layer of technical oversight. The Global Fund has consistently received high marks for transparency and results in multilateral aid reviews. And investing in preparedness through the Global Fund will create synergies with other efforts to fight infectious diseases and strengthen health systems.

Of course, the Global Fund needs to keep evolving to be able to play a lead role in pandemic preparedness financing. The Fund will need to adapt its staffing, structures, and operating practices to enable it to effectively and efficiently strengthen the PPR capabilities of LMIC countries and with regional organizations such as the Africa Centers for Disease Control and Prevention. Technical skills in areas such as pandemic surveillance will have to be added. A permanent dedicated pandemic prevention and response team will likely have to be set up inside the Global Fund secretariat in Geneva. New operating rules will need to be put in place that allow the Global Fund to act in a matter of days (rather than the months currently spent to design and approve grants for AIDS, TB, and malaria) and to flexibly reprogram pandemic grants as conditions change rapidly on the ground. Reporting systems that generate frequent real time information and enable course correction will also be critical. We believe that the Global Fund is poised to embrace these and other needed changes.

We should not squander this once-in-a-generation opportunity triggered by COVID-19 and the ensuing impetus to commit a major new and dedicated global financing for pandemic preparedness. To capitalize on this opportunity, let’s put the Global Fund at the center of the action.

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