1
Introduction1
The world has problems with coordinated international response to outbreaks, particularly with paying for pandemic preparedness and mobilizing money for response. The 2014 Ebola outbreak brought these problems to light, but the basic tension is not new, as summarized in the Economist observation (2004) about famine, “If help arrives before people start starving, fewer will die. But it is only when people start to die that the money to save them starts flowing in.” The Institute of Medicine (IOM) workshop on pandemic financing aimed to illuminate the financing tools available to alleviate this tension, closing the gap between the infectious disease event and the response, and ways to fund the systems that could help prevent the outbreak in the first place.
As part of the Global Health Risk Framework initiative described in Box 1-1, the Institute of Medicine convened a 2-day workshop on financing pandemic preparedness and response. The workshop planning committee invited a range of speakers to respond to the statement of task shown in Box 1-2. The planning committee then put together an agenda dividing the day into sessions on marshaling funding for response, identifying triggers and modeling risk, the management and administration of funds,
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1This workshop summary is a description of the discussion as it occurred at the August 27-28 workshop. The material is presented roughly in the order it was discussed, and the report is organized into sections corresponding to the sessions shown on the meeting agenda. Views and opinions presented are those of individual speakers and do not reflect the consensus of the group; the planning committee; the National Academies of Sciences, Engineering, and Medicine; or the workshop sponsors.
BOX 1-1
The Global Health Risk Framework Initiative
Since the 2014 Ebola outbreak, many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond health. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak.
With encouragement and input from the World Bank; the World Health Organization; and the governments of the United Kingdom, the United States, and West African countries; and support from various international and national organizations (Ford, Gates, Moore, Paul G. Allen Family, and Rockefeller Foundations; Dr. Ming Wai Lau; the U.S. Agency for International Development; and the Wellcome Trust), the U.S. National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert Commissiona on improving international management and response to outbreaks. As part of this effort, the Institute of Medicine convened four workshops in the summer of 2015 to inform the Commission report. These workshops examined questions of governance for global health, pandemic financing, resilient health systems, and research and development of medical products. Each workshop gathered diverse perspectives on a range of policies, operations, and options for collaboration to improve the global health system. A published summary from each of the workshops has been independently written and reviewed, and their release will be coordinated.b
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a For more information see http://nam.edu/initiatives/global-health-risk-framework (accessed October 30, 2015).
b Summaries from the other three workshops can be found at http://iom.nationalacademies.org/reports/2016/GHRF-Governance; http://iom.nationalacademies.org/reports/2016/GHRF-Health-Systems; http://iom.nationalacademies.org/reports/2016/GHRF-Research-and-Development.
and financing preparedness and giving incentives. (See Appendix B for the workshop agenda.)
WELCOME AND INTRODUCTION
Dr. Victor Dzau, president of the National Academy of Medicine, opened the meeting with brief remarks about the Global Health Risk Framework initiative. He explained that the immediate impetus for the program was the 2014 Ebola outbreak in West Africa, which killed more than 10,000 people and had disastrous social and economic consequences in Guinea, Liberia, and Sierra Leone. Dzau described the outbreak as the failure of multiple systems at the international, national, and local levels (see
BOX 1-2
Statement of Task
An ad hoc committee will plan a 2-day public workshop on the financing of global response to pandemic threats, clarifying where the money for surveillance, detection, and response should come from and how it should be spent. The workshop will examine the role of the World Bank’s proposed Pandemic Emergency Financing Facility, an organization that will coordinate international financial response to pandemics, particularly how the facility might ensure rapid deployment and prompt remuneration of health workers and minimize transaction times on other expenses.
Speakers will articulate roles for the private sector, especially the reinsurance industry, to bring together multiple financial backers to pool their risks against a global emergency. The workshop will also explore possible underwriting functions of banks, insurers, and investment houses, and analyze how these organizations could ease the financial shock of an epidemic and control the costs of response, including the cost of developing new drugs and vaccines.
The workshop will also give some attention to questions of accounting, describing a system for transparent reporting and auditing of funds. To this end, participants will discuss the management obligations of the investors, creditors, and regulators involved with emergency finance.
The public workshop will feature invited presentations and panel discussions. The planning committee will organize the workshop, select speakers and panelists, and serve as discussion moderators. Commissioned papers may be required to inform workshop discussions. A designated rapporteur will prepare the workshop summary in accordance with institutional guidelines.
Figure 1-1). Financial concerns were a common cause of the slow response, from the ability of international organizations to fund their response to the concerns of the governments of the affected countries that acknowledging the outbreak would hurt their economy.
Dzau presented the opportunity now before the workshop audience and the international community as one of planning to mitigate the consequences of the next infectious outbreak. This concern with future vulnerability motivated the donors mentioned in Box 1-1 to commission the Global Health Risk Framework initiative. He described the international commission and their task to recommend a new strategy for coordinated action against pandemics. The commissioners will be drawing support in this program from the four IOM workshops described in Box 1-1, of which the August 27-28 meeting was the third. Dzau closed his comments by stressing the importance of building political will for change and learning from the lessons of Ebola and other outbreaks before memories fade.
SOURCE: Dzau, 2015.
