Challenges of tracking funding for pandemic preparedness and response

In this issue of The Lancet Global Health, the Global Burden of Disease 2021 Health Financing Collaborator Network aims to assess global health spending on pandemic preparedness and response.¹ Detailed financial data is needed to support policy, governance, and ongoing decision making for pandemic preparedness and response. We need to know how much public health infrastructure costs in order to plan for the future. To support a mutual accountability framework, in which partners agree to be held responsible for commitments they have voluntarily made to each other, we need a way to track nations that have committed to supporting pandemic preparedness and response and how much of a commitment has already been disbursed. We need to know how much funding a national government is putting aside to support pandemic preparedness and response activities and over what period of time, in order to calculate gaps in spending and needs for direct foreign investment. We also need to ensure investments are aligned with evolving requirements and national and regional priorities.²

The Global Burden of Disease 2021 Health Financing Collaborator Network's study highlights the difficulties of finding and analysing financial data associated with pandemic preparedness and response. Pandemic preparedness and response funding is not captured explicitly in reporting by national health accounts, leading to great variation in what is and is not captured, and it is virtually impossible to define out-of-pocket expenses in health security. There is no single reporting mechanism used by nations to report direct foreign investments in pandemic preparedness and response, nor is there a single place or consistent language used to track funding by non-governmental entities, philanthropies, or international organisations.

We have been tracking the flow of funding in health security since 2016,³ and this information is publicly available from the Global Health Security International Disease and Events Analysis website, with data downloadable from the Global Health Security tracking website. We have documented more than US$400 billion of committed funds, of which more than $300 billion has been disbursed, tagged to specific indicators of WHO's Joint External Evaluation (JEE) tool as well as funding for declared public health emergencies of international concern. Our estimates differ from the amount identified by the Global Burden of Disease 2021 Health Financing Collaborator Network, which highlights the variability in sources and how researchers determine what should be included in the definition of pandemic preparedness and response funding. Our analysis draws from over 100 sources, but most of those data are not formatted to account for pandemic preparedness and response indicators, and thus require subject experts to read, evaluate, and code each line of data. Crucially, despite our extensive work in the field and discussions with policy makers and researchers, we have been unable to find sufficient publicly available or detailed accounting to differentiate funding at the JEE indicator level and to publish national or subnational spending on pandemic preparedness and response. Others researchers have used alternative mechanisms to try to capture some of this funding, including using data directly reported to WHO through questionnaires.⁴ These data are sorely needed to enable detailed analysis of the gaps in global pandemic preparedness and response funding.

The Global Burden of Disease 2021 Health Financing Collaborator Network conclude that funding for pandemic preparedness and response has not historically been prioritised, but that funding could be made available if countries and donors did prioritise it. Our current analyses find that approximately $124 billion will be required over the next 5 years to build and sustain sufficient capacity for every nation in the world to meet its obligations under the International Health Regulations to prevent, detect, and respond to potential public health emergencies.⁵ This estimate does not include the funds required to build global manufacturing capacity, supply chain management, or research and development. Nor does this current assessment yet include a full accounting of subnational capacity requirements, infection prevention and control, or more robust health-care systems, as called for in the latest edition of the JEE.

Pandemic preparedness and response has substantial funding requirements. The Global Burden of Disease 2021 Health Financing Collaborator Network argue that there are funds are available, but that we just need to agree to prioritise spending on pandemic preparedness and response in order to access them. As the world begins to rebuild in the post-pandemic era, and with the launch of the Pandemic Fund,⁶ we need to make capacity building for pandemic preparedness and response a priority. We also need to enable evidence-informed decision making. Doing so requires that we build a strong foundation for sharing data and tracking global funds, with a reporting system that can provide access to more robust and standardised national and subnational financial data. Such a platform will be essential to establish and track best practices in pandemic preparedness and response spending, clearly articulate gaps, and make smart investments to support a safer future.

This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on February 14, 2023

I declare no competing interests.