Pandemic preparedness was included on the agenda of the spring meetings of the World Bank and the International Monetary Fund, held in April in Washington, just over four years after the World Health Organization declared covid-19 a global pandemic. Millions of people have died and billions of dollars have been spent in the period since, but there are some important lessons from the pandemic that have yet to be learned. A clear example is that low- and middle-income countries are still unable to invest in solutions before they are approved. The United States and the United Kingdom employed this “at risk” strategy to great effect during the Covid-19 crisis. Low- and middle-income countries need the same opportunity.
When a pandemic breaks out, governments must act quickly and invest heavily in technological solutions that may not yet be proven. Expanding vaccine production when medical trials were ongoing, rather than waiting for regulatory approval, proved critical during the Covid-19 pandemic. The United States and the United Kingdom, in particular, made early and substantial investments in vaccine development and production, securing doses at risk. In exchange for bearing much of the risk of technological failure, these countries were first in line when the vaccines were determined to be effective—a benefit to their own citizens. But these investments also helped other countries by accelerating vaccine development and production.
Our analysis showed that it would have been cost-effective for countries, including low- and middle-income countries, to invest at risk in increased vaccine production during Covid-19.
At the time I was working in the UK Government, carrying out analysis to demonstrate the cost-effectiveness of risk investing. For example, the United States’ Operation Warp Speed, which as of December 2020 had cost 13 billion dollars (almost 12 billion euros), was self-financing if it shortened the pandemic by just 12 hours. Likewise, greater investment in production capacity could have accelerated one year global vaccination efforts, with an estimated savings of $1.75 trillion.
Clearly, we need to do things better when the next pandemic hits. This could even happen without coordinated global investment—a major challenge. In contrast, our analysis showed that it would have been cost-effective for countries, including low- and middle-income countries, to invest at risk in increased vaccine production during Covid-19. Vaccines would have been available faster, fewer people would have died, and economies would have recovered sooner. (That said, high-income countries can and should take the lead in investing in research and development, which benefits from coordination.)
I spent much of the spring and summer of 2020 trying, unsuccessfully, to persuade low- and middle-income countries to follow the UK’s lead; Most of these countries did not buy vaccines at risk. A work document The World Bank determined that between 60% and 75% of the delay in deliveries of Covid-19 vaccines to low- and middle-income states could be attributed to the fact that these countries signed purchase agreements after the high income. Although it is undoubtedly difficult to do something new in the middle of a crisis, in conversations with various parties involved, two problems emerged: politicians feared being accused of corruption if the vaccine was a fiasco, and institutions like the World Bank could not offer loans. to buy a vaccine that did not yet exist.
In 2020, politicians feared being accused of corruption if the vaccine was a fiasco and institutions like the World Bank could not offer loans to buy a vaccine that did not yet exist.
To overcome these problems, multilateral development banks (MDBs) must establish financing mechanisms that allow risk purchasing in a pandemic, as well as mechanisms for high-income countries to de-risk these loans. Unlike the vaccine donations and commitments during Covid-19, which were too little, too late, these measures would actually offer low- and middle-income countries enough resources to respond to the next pandemic.
When low- and middle-income countries need to purchase vaccines, diagnose and treat on the scale needed to combat a pandemic, the MDBs are their only realistic source of funding. But current procurement rules prevent the purchase of these countermeasures at risk. The rules should therefore be revised to allow these types of purchases, in recognition of the unique challenges of a global health crisis. MDBs can also coordinate with involved parties to create model procurement contracts and establish compensation and liability frameworks to streamline processes and minimize delays.
High-income countries can help by guaranteeing these loans in case experimental vaccines fail. This would reduce financial risk for low- and middle-income earners and ease politicians’ fears about their potential liability. In exchange for this relatively modest burden on their balance sheets, high-income countries can facilitate significant investments that promise substantial global health benefits and large economic returns. During Covid-19, many of us in the UK Government recognized that this was one of the most effective ways to use our limited cash support, and even proposed such a measure, without success.
Covid-19 taught us that developing novel mechanisms in the midst of a pandemic is practically impossible. International policymakers must put in place the necessary frameworks now to ensure that low- and middle-income countries can afford medical solutions at risk in the next pandemic, to reduce its duration and improve equitable access to care. As demonstrates our work in the Market Shaping Accelerator from the University of Chicago, any delay puts millions of lives and billions of dollars.
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