Pandemic Preparedness & Health System Resilience

The pandemic response over the past two years has forced countries to redistribute resources away from other pressing health needs. Health systems around the world need increased support to improve primary care provision and resilience, which will help to address the backlog of urgent non-COVID needs and better prepare for additional COVID outbreaks as well as future pandemics. Specific capabilities such as surveillance and robust supply chains will enable improvements in future pandemic preparedness as well as other health system needs.

However, there has been little concrete action toward building health system resilience globally. The ACT-A pillar focused on strengthening health systems, including national preparedness and response plans, is seriously underfunded.

Some steps are being taken to prepare the world for the next pandemic. The World Bank approved a financial intermediary fund (FIF) for pandemic prevention, preparedness, and response. The FIF was formally established at the FIF Governing Board meeting on September 8-9, and the first call for proposals will open in November. Between government, philanthropic, and non-profit donors the FIF has achieved $1.29 billion in funding. The projected need for the fund is $10.5 billion per year over the next five years for investments to strengthen the capacity of low- and middle-income countries.

CEPI has launched the 100 Days Mission, an effort to ensure that safe, effective, and affordable vaccines can be developed and deployed within 100 days of the discovery of a new pathogen threat. This strategy includes global surveillance systems, point-of-care testing capacity worldwide, and expanded global manufacturing capacity at the ready to ensure that new vaccines can be equitably distributed. However, fundraising for this effort is off to a slow start, with about $1.5 billion raised, less than half of the $3.5 billion target.

At the Global Fund’s Seventh Replenishment Conference, over US $14.25 billion has been raised for the next three years. Commitments come from public and private sector partners, and non-governmental organizations. With a goal of US $18 billion, the Global Fund aims to build back progress toward ending HIV, tuberculosis, and malaria, build resilient and sustainable health systems, and strengthen pandemic preparedness. Many partners have increased their commitments by over 30% from the sixth replenishment with several countries pledging for the first time.

Continued investments in LMIC-based manufacturing are encouraging, though many challenges remain. As detailed in our recent blog post, developments with expected longer-term benefit include:

• As part of WHO’s technology transfer hub, Afrigen Biologics in South Africa developed its own version of Moderna’s mRNA vaccine, using the publicly available sequence. Afrigen plans to share this with other LMIC manufacturers but production at scale is not likely before the end of 2023.

• The Partnership for African Vaccine Manufacturing released a framework, detailing a plan to build sustainable vaccine development and manufacturing capacity across Africa to prioritize 22 diseases. This effort is expected to cost $30 billion over 20 years.

• Moderna and BioNTech have committed to establishing manufacturing capacity in Africa. Moderna will develop an mRNA facility in Kenya with assistance from the US government. This facility is expected to produce drug substance for up to 500 million doses of vaccine each year for use across Africa. BioNTech plans to launch modular factories called “Biontainers” to manufacture mRNA vaccines in Rwanda, Senegal, and possibly South Africa.

These and future investments in LMIC manufacturing will need to also focus on developing the supportive ecosystem that can support sustainable capacity. This includes ensuring demand, a trained workforce, robust regulatory pathways, and financial models that address the challenge of keeping extra capacity at the ready for future health crises.