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International Social Justice In Pandemic Preparedness

In the wake of the Ebola crisis that began in West Africa in 2013, a series of reports have recommended strengthening and scaling up investments in global health security as an urgent priority. Expert assessments by the Harvard-London School of Hygiene and Tropical Medicine (LSHTM) Independent Panel on the Global Response to Ebola (November 2015), the U.S. National Academy of Medicine's (NAM) Commission on Creating a Global Health Risk Framework for the Future (January 2016), and the UN High Level Panel on the Global Response to Health Crises (February 2016) urge far-reaching improvements in nations' public health capabilities and infrastructure, in international leadership for preparedness and response, and in research and development related to infectious diseases.

Emphasizing the urgent need to invest in preparedness, the Harvard-LSHTM Panel called upon the global community and countries to agree on a clear strategy to ensure that governments invest domestically in building core public health and system capacities, and to mobilize adequate external support to supplement these efforts, especially in poorer countries. Highlighting infectious diseases as one of the biggest risks facing humankind, the NAM Commission on Creating a Global Health Risk Framework for the Future argued that reinforcing public health capabilities should be a top priority and estimates that $4.5 billion must be spent annually to prepare the world for the next global health crisis, whether it is a resurgence of Ebola, SARS.

Or bird flu, a swiftly moving threat like Zika, or some entirely new disease. Stressing the need for all countries to meet the full obligations of the International Health Regulations 2005 (IHR), the UN High Level Panel noted that building a global health architecture that is better prepared to respond to health crises will require additional financial resources, and stresses the need to mobilize domestic and international funding, especially for low-income countries, to support the implementation of the IHR's Core Capacity requirements.

This Corona-Virus pandemic is much more than a health crisis; it's also an unprecedented socio-economic crisis. Stressing every one of the countries it touches; it has the potential to create devastating social, economic and political effects that will leave deep and longstanding scars.

Every day, people are losing jobs and income, with no way of knowing when normality will return. Small island nations, heavily dependent on tourism, have empty hotels and deserted beaches. The International Labour Organization estimates that 195 million jobs could be lost. The World Bank projects a US$110 billion decline in remittances this year, which could mean 800 million people will not be able to meet their basic needs.

Identifying Gaps And Estimating Funding Needs

The first International Sanitary Conference took place in Paris in 1851 in response to a cholera epidemic that ravaged Europe for nearly 15 years. A hundred years later, in 1951, member states of the newly-constituted WHO adopted the International Sanitary Regulations, which were replaced by and renamed the International Health Regulations in 1969. Narrowly focused on six serious infectious diseases (cholera, plague, yellow fever, smallpox, relapsing fever, and typhus), IHR (1969) depended on official country notification of disease outbreaks and did not establish a formal internationally coordinated mechanism to contain disease spread or ensure country commitment to standards. Further, some countries were reluctant to report diseases for fear of trade and travel restrictions (WHO 2009).

The resurgence of cholera, plague, and Ebola in the 1990s exposed the limitations of IHR (1969), which led to calls for their revision in 1995, and a call to WHO in 2001 to support countries in strengthening their capacity to detect and respond rapidly to communicable disease threats (WHO 2009). All this while, the IHR remained largely unchanged. Negligence persisted among countries, and the capacities of most countries to detect and respond to disease outbreaks remained low. This inertia was shaken by SARS, which made its first appearance in November 2002 in China's Guangdong province (Huang 2004). The disease spread rapidly around the globe.

Concerns raised by SARS intensified the IHR revision process, and by 2005, the scope of the regulations was broadened to cover all public health threats, including existing, new, and emerging threats and those caused by non-infectious disease agents. The revised IHR (2005) required countries to report all possible hazards with the potential to be public health emergencies of international concern, regardless of cause, and provide this information in a timely manner.

Every country needs to act immediately to prepare, respond, and recover. United Nations Secretary-General Ant�nio Guterres has launched a US$2 billion global humanitarian response plan in the most vulnerable. Developing countries could lose at least US$220 billion in income, and the United Nations Conference on Trade and Development has called for US$2.5 trillion to support them. Drawing on with the past experience with other outbreaks such as Ebola, HIV, SARS, TB and malaria WHO will help countries to urgently and effectively respond to COVID-19 as part of its mission to eradicate poverty, reduce inequalities and build resilience to crises and shocks.

Preparing A Financing Proposal, A Compelling Investment Case And A Change Management Strategy

Once a country has developed a costed and prioritized plan, the next steps are to work out how to finance this plan and then how to implement it effectively. This requires three key components:
first, a realistic financing proposal to ensure inclusion in domestic budgets and, where relevant, win the support of development partners; second, a compelling investment case that ensures sustained economic and political support for improving preparedness; and finally, a change management strategy that facilitates the committed engagement of relevant stakeholders.
Points to look out during the Pandemic Preparedness:
  • Ensuring economic stability and growth of the country
  • Contributing to universal health coverage
  • Improving security and protecting social stability
  • Managing externalities to regional and global community.

Identifying Sources Of Finance And Means Of Mobilizing/Allocating Funds To Preparedness

There are vast differences across countries in how much of their public resources they spend on health, a metric that is a good proxy for the extent to which health is prioritized by governments.12 World Bank data suggests that in 2014 the share of health in aggregate government expenditure in 190 countries ranged from 2.4 percent in Timor-Leste to 27.9 percent in Andorra, with a mean of 11.8 percent.

Unsurprisingly, higher income countries devote a larger share of government expenditure to health (17.8 percent in the high-income OECD countries) than do lower-income countries (9.8 percent in the low-income IDA countries). Estimates of financing required for preparedness vary dramatically; depending on whether underlying health system capacities need to be strengthened first or whether only a limited set of specific preparedness capacities must be created.

The post-JEE costing exercises in Tanzania and Pakistan suggest that just $0.5 to $1 per capital per year may suffice. An analysis of self-assessed requirements under IHR in several other countries, such as Bangladesh, Nepal and Indonesia, also result in similar modest estimates.

Ways to get the funds for Pandemic Preparedness:
  • Domestic vs. International Funding
  • Improved Tax Collection
  • Priorities for Donor Investments in Preparedness
  • Strengthening Regional Preparedness( Each state should be kept ready for the pandemic)
  • Engaging the Private Sector in Financing Preparedness

We know that it is only a matter of time before the next pandemic hits us. We also know that there is a good chance that it will be severe. It may mean death on a slow fuse, spreading insidiously through populations, unrecognized for years, like Corona pandemic today or HIV in the 1980s. Or it may strike people down with stark violence and lightning speed, plunging national economies abruptly into chaos, like Ebola in West Africa in 2014�15. Whatever its mode of attack, the next large-scale, lethal pandemic is at most only decades away.

Even if we escape the terrifying prospect of a lethal pandemic of global scope, the possibility that any of the outbreaks or epidemics that are occurring all the time might become such a pandemic can still cost many lives and cause huge disruption to economies and societies. The economic impact of infectious disease outbreaks is caused by the contagion of fear. And in our 24-hour media, highly interdependent world, fear spreads extraordinarily rapidly.

Of course, the money has to be there, too. Otherwise, unfortunately, none of the assessments and plans will matter. Between achieving real health security and aspiration rhetoric, the difference is dollars. This is the challenge before the WHO and world that sought to be addressed.

We are well aware that others have called for better funding of preparedness before with limited success. Yet we hope that three differences can make more success: first, the recommendations are specific and time bound: second, they are practical and supported by tools; and third, the recommendations include mechanisms to change policy makers' incentives.

Award Winning Article is Written By: Puneet Jangid - GLS Law College, Ahmedabad

Awarded certificate of Excellence
Authentication No: SP02455910650-1-920

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