The Covid-19 pandemic has highlighted the urgent need for collective actions and additional investment in pandemic prevention, preparedness, and response. To address the gaps, under the initiative of the United States, the World Bank approved in June the implementation of a new Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response (FIF) on the basis of the White Paper published the month before.
The announcement of this new mechanism raises a lot of questions among experts, civil society, and even several States. Now that FIF has been officially established and its Governing Board is discussing how the FIF will be structured, what will be its priorities and scope, Global Health Advocates proposes the following recommendations:
- Clarify the real added value of the FIF in the current global health architecture.
- Funding modalities of the FIF must respect the principles of additionality, appropriation, transparency, accountability, and equity.
- Prioritize funding to the existing gaps in pandemic prevention, preparedness, and response
- Ensure the principle of effective inclusion of all stakeholders within the governance of the FIF is respected
Clarify the real added value of the FIF in the current global health architecture.
- This new instrument should not duplicate forms of intervention or cover areas already covered by other entities. The FIF must avoid creating competition between existing international institutions and ensure a good complementarity with specialised organisations by capitalising on their specific expertise.
- We welcome the inclusion of the Global Fund to fight HIV/Aids, tuberculosis, and malaria, and of Gavi, the Vaccine Alliance as implementing entities. However, it will be necessary to ensure that these organisations effectively benefit from FIF funding.
- Regarding governance of the local implementation of FIF activities, the FIF should not create new structures but rely on existing frameworks.
- We welcome the preliminary discussions that took place during the first Board meeting aiming at including more implementing entities, beyond the 13 pre-selected ones. Based on their added value and their operational relevance (as suggested in the operation manual), we suggest that the accreditation , which should be implemented soon, be extended to organisations such as UNITAID and regional centers for disease control such as the Africa CDC, whom expertise and role in PPR are well known and recognised.
- The FIF should further explain the articulation of its activities with those of the GFF and the HEPRF, two mechanisms supported by the World Bank aiming at strengthening primary health systems, resource mobilisation for health, and PPR in LMIC.
Funding modalities of the FIF must respect the principles of additionality, appropriation, transparency, accountability, and equity.
- WHO and the World Bank estimated that $10.5 billion of additional funding will be needed per year during the next 5 years to strengthen capacities in LMICs to prepare and respond to future health threats. As different crises pressures national budgets and funding dedicated to health ODA, the FIF should ensure the principle of additionality is respected. It should adopt clear conditionalities guaranteeing safeguards to secure long-term financing beyond ODA budget lines. It should also define more clearly the way it will scale up private sector funding beyond philanthropic and foundation contributions.
- We agree with the directions taken during the first Board meeting in favour of compliance with the principles of transparency, efficiency, and accountability. For these principles to materialise, the FIF should ensure the predictability, regularity, and durability of the allocated funding by implementing a strong and flexible multiannual funding framework. This way, the instrument will be better suited to the functioning of its potential local, regional, and international implementing entities and further guarantee respect for the principles of sovereignty and country ownership. The Fund should also ensure centralised, exhaustive, and timely information sharing related to its funding and its operations
- We welcome the creation of a result framework implementation that the Secretariat will monitor to ensure the follow-up of the activities and implementation of the projects based on predefined indicators. Regarding the proposal to implement an activity evaluation of the FIF in the long term, we suggest that this audit be done by an independent entity outside the World Bank and that it contributes to evaluating the impacts of the FIF on health system strengthening and PPR. This would distinguish the FIF from other previous mechanisms of the World Bank (PEF, HEPRF) which have never been evaluated.
- Finally, we question the emphasis on the role played by the private sector and multilateral development banks (which increase LIC debts by mainly providing loans with diverse concessional levels) as it has not always proved its efficiency in increasing access to health care for all. The FIF must adopt conditionalities to guarantee funding implemented by multilateral development banks meets the principles of equity, and sustainability and that they are not conditioned to economic policies which are not favorable to investment in social sectors, apart from considerations linked to transparency and anti-corruption measures.
Prioritise funding to the existing gaps in pandemic prevention, preparedness, and response
- We support the adoption of a One Health approach by the FIF. It must lead to a stronger collaboration between sectors at the local, regional, and international levels, in integrating experts in other fields (climate, social sciences, animal health, etc.) within the Technical Advisory Panel. In terms of prevention, the FIF should contribute to strengthening health monitoring systems, including at the community level. It should facilitate collaboration, intel sharing, the regulatory harmonization and provide technical support to governments in the elaboration of their flexible and adaptive emergency plans and response strategy to epidemics.
- Regarding PPR, the support provided by the FIF must contribute, as a matter of priority, to the strengthening of primary and community health systems and benefit firstly the most vulnerable populations, including women and girls. In this regard, the FIF should contribute to address the main gaps such as the reduction of financial barriers to access to health, the recruitment and training of healthcare professionals (including on animal health subjects) as well as the improvement of working conditions, notably at the community level, including the consolidation of supply chains. In terms of response, its priorities must include the effective continuity of essential services during crisis time.
- The FIF must include as a priority the sustainable strengthening of local production capacities in the Global South as well as technology transfer and know-how. It should be addressed through stronger and coordinated support to R&D and to initiatives toward aiming at increasing health sovereignty such as MAV+, the Medicines Patent Pool (MPP) and other WHO initiatives (mRNA hub and C-TAP). In addition, the private sector activities in this field must be accountable when financed by public funding. The FIF must monitor and assure that the right conditions are attached to R&D funding to ensure universal access, which could include reserving supplies to LMICs, reasonable prices guarantee and supporting open access to technologies, data, and intellectual property.
Ensure the principle of effective inclusion of all stakeholders within the governance of the FIF is respected.
- We welcome the decision to allocate 9 voting seats at the FIF Board to recipient countries. To ensure that the principles of inclusion and participation are fulfilled, we suggest granting them a seat as experts in the Technical Advisory Panel on a rotating basis.
- While the WHO has been a crucial actor in the creation of the FIF, it must also ensure the inclusion of other multilateral organisations within the decision-making bodies such as the Global Fund, Gavi, CEPI and UNITAID. Furthermore, given its central role in pandemic preparedness and response beyond normative aspects, we believe it would be more appropriate for the WHO to host the FIF Secretariat.
- We welcome the decision to allocate two voting seats to civil society organisations from both the North and the South. Moreover, we suggest including civil society representatives in the Technical Advisory Panel. The FIF will also have to guarantee the participation and the representation of women and girls at all governance and implementation levels. Finally, we underline that effective civil society participation requires sufficient funding and administrative support (including ensuring the translation of documents, timely information sharing, etc).