World Health Assembly to Vote on New Pandemic Agreement and IHRs Amendments

Introduction

In May 2024, the World Health Assembly is slated to vote on two legally binding instruments proposed by the World Health Organization (WHO). These are a new Pandemic Agreement and amendments to the International Health Regulations (IHRs). These policies aim to standardize and coordinate national-level pandemic preparedness and are designed to complement other emerging initiatives such as the World Bank’s Pandemic Fund, the WHO International Pathogen Surveillance Network (IPSN), and the Medical Countermeasures Platform (MCP).

Cost Estimates for Pandemic Prevention, Preparedness, and Response

There have been diverse estimates regarding the cost of supporting these pandemic prevention, preparedness, and response (PPPR) instruments and how these costs can be financed. For instance, the G20 High Level Independent Panel (HLIP) suggests global and country level investments of US$171 billion over five years, with an unspecified amount annually thereafter. The World Bank estimates an additional US$10.3 to US$11.5 billion will be needed to boost One Health as an accessory to PPPR.

Estimates from Different Reports

A report by McKinsey & Company estimated PPPR to cost anywhere from US$85 to US$130 billion over two years, with annual costs thereafter of US$20 to US$50 billion. The WHO and World Bank estimate that PPPR investment requires US$31.1 billion a year, including US$10.5 billion in official development assistance (ODA). If costs related to addressing antimicrobial resistance (AMR), health system strengthening, and elements of manufacturing medical countermeasures are included, then PPPR costs could reach nearly a quarter of a trillion dollars over the first five years of this endeavor, with further investments required to maintain capacities thereafter.

REPPARE's Analysis of the Estimates

REPPARE reviewed these estimates and the supplemental evidence and material provided by the WHO Secretariat in support of the International Negotiating Body (INB) for the Pandemic Agreement and International Health Regulation Working Group (IHRWG). The analysis focused on the robustness of the cost estimations and whether the associated financial recommendations are justified as having appropriate returns on investment in support of the current pandemic preparedness agenda.

Concerns Raised by REPPARE's Analysis

Four cross-cutting concerns emerged from the REPPARE analysis. These include the lack of reliability of PPPR estimates, unconvincing justification for PPPR value for money, an unprecedented cost threatening to absorb global health financing, and unrecognised opportunity costs with the potential for net harm.

Need for More Robust PPPR Baseline Estimates

Given the weak reliability of PPPR estimates and the unconvincing justification for PPPR value for money, there is a clear need for more robust PPPR baseline estimates as well as projected costs to fill identified gaps. The estimates for PPPR, even if correct, represent a significant alteration in global health policy and would constitute anywhere from 25% to 55% of current ODA spend for health.

Unrecognised Opportunity Costs

The proposed unprecedented investments for PPPR fail to consider the significant opportunity costs associated with redirecting scarce resources from global and national health priorities of greater burden. It is therefore vital that cost estimates are accurate and reliable.

Conclusion

Given the poor evidence underlying pandemic cost and financing estimates, it is prudent not to rush into new pandemic initiatives until underlying assumptions and broad claims of a return on investment are properly assessed. These must be based on robust evidence, recognized need, and realistic measures of risk. WHO Member States will be better served by having transparent estimates that reflect reality and risk before they engage in such an uncertain and high-cost endeavour. What are your thoughts on this matter? Do you agree with the concerns raised by REPPARE's analysis? Share this article with your friends and let us know your thoughts. Don't forget to sign up for the Daily Briefing, delivered every day at 6pm.