Interview with Nina Schwalbe, CEO and Founder of Spark Street Advisors and Senior Scholar at Georgetown University Center for Global Health Policy and Politics
1. The emergence of a new pandemic is no longer a question of if but when. Do you consider that we are now better prepared than we were in 2019?
Yes and no, but mostly no. One of the major lessons from COVID-19 was that there was no meaningful collective mechanism to respond.
On the positive side, we now have a global Pandemic Agreement. Countries sat together to work through how they can do better next time. And because of many of the failures exposed during Covid-19, they also sat together to substantially improve the International Health Regulations (IHR), which outline how individual countries should respond when they detect a pathogen with potential for international spread. The stronger, more robust and revised regulations, as well as the treaty, definitely make us more prepared.
But it’s not enough. The public health response failed during COVID-19. In addition to the death toll, economies suffered, people suffered, children were kept out of school. On these fronts, we are no more prepared than for Covid-19.
And in some areas, we are worse off. In every country, people now distrust public health decision-makers overall and scientists in particular. They increasingly turn to the internet for health information. My biggest fear is that next time, people simply won’t believe the science. The anti-science movement makes us decidedly less prepared.
And finally, on the “no”: there has been waning financial commitment crimpling the three institutions that are most critical for pandemic preparedness, prevention and response (PPR): the Global Fund, Gavi and the WHO. The recent replenishment of the Global Fund reached only 60% of its target: 11 billion dollars out of 18 billion. This institution has almost single-handedly reduced global transmission and turned HIV from a death sentence into a manageable condition. Underfunding the Global Fund is a serious setback. The G7 also dropped the ball on Gavi, which similarly did not meet its replenishment goals, despite being a frontline institution for PPR. And the WHO is reeling from the US withdrawal, no other countries have stepped up to the plate.
2. As G7 President, which initiative could France lead to improve our collective response to pandemics?
France has an impressive history here: it drove the creation of the Global Fund and Unitaid, and championed an airline solidarity tax to finance responses to infectious diseases. The airline tax was brilliant: recognizing that in an interconnected world, travel spreads pathogens. France was also one of the first countries to name an AIDS Ambassador. These examples illustrate the kind of leadership France has provided and can provide again. Against his backdrop, there are short-term priorities that the G7, with France’s leadership, could champion.
France could for example accelerate the ratification of the Pandemic Treaty. To move forward, countries must finalise agreement on an annex containing a few remaining operational details (sharing pathogen and genomic sequencing data, equitable access to vaccines, drugs and diagnostics). Yes, 2 countries opted out of the negotiations, but 192 countries now have the opportunity to do the right thing. They are looking to the G7, because that is where power and financing lie. France could lead this charge by being among the first countries to ratify.
Another area is One Health: the interaction between people, animals and environment. France is uniquely positioned to champion this issue because of its strong and successful history with farming, agriculture and public health.
The next big issue is the role of industry. When governments finance the development of medical technologies, those products should be accessible at cost to the public that funded them. It is the duty of governments to ensure that publicly funded science benefits the public. France could take a leading stance on this issue.
And of course, financing. We cannot return to 2012 levels, simply because the world has changed and has become more complex. We need more investment, not less. A financing agenda led by France would send a powerful message.
3. Given decreasing Official Development Assistance levels and growing calls for domestic resource mobilization and private-sector engagement, how could France convince G7 partners to continue investing in global health as a public good?
COVID-19 showed that public health is not a national challenge but a global one. That is why global health is a global public good. No country can manage it alone.
And let’s be clear: when we talk about domestic resource mobilization, what we often mean in practice is shifting costs onto households. In most countries, people already bear the largest share of health costs: through out-of-pocket expenses, time off work, and barriers to accessing care. Are we really saying that citizens should bear even more? If governments abandon their responsibility to protect their populations, then what is the role of government?
But we don’t need to reinvent the wheel. There are existing institutions that are already providing these global public goods for PPR, including the Global Fund, Gavi and the WHO. France could lead by example with its own ambitious pledge and challenging peers to match it. This type of “crowding-in” financing works. When one major economy leads, others follow.
France has an opportunity to reclaim its role as a global health leader. Thanks to France’s leadership on HIV, millions can now live healthy lives, have sex safely, and build families without fear. Are we ready to say “welcome back, HIV” ? I hope the answer is no. But that requires leadership, and financing, from France and its G7 partners.
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