The Covid-19 pandemic has reminded us of the brutal truth that diseases do not yield to national borders. Whether we are prepared for or vulnerable to the next pandemic is a matter of the global community, not just individual countries.

So far, we are all vulnerable — but we don’t need to be. Something as intuitive as an insurance fund could be scaled globally to help protect the most vulnerable, and by extension, all of us.

We witnessed the failure of the global community over Covid-19 firsthand in Africa. Low- and middle-income countries (LMICs) faced the brunt of the consequences, having ill-prepared and underfunded health systems while wealthy countries hoarded vaccines. Even South Africa had to take out a loan from the World Bank to cover vaccine costs.

There simply must be better pandemic preparedness and regional coordination in response to pandemics, especially for the African continent — one that enshrines health justice and equity in international law and practice.

But what exactly is needed to prepare for the next pandemic for a continent with limited financial resources and research capabilities?

As Covid-19 has taught us, preventing pandemics is better than responding to them. While the next pandemic will present heavy demands to African and international health bodies, if we begin preparations now, they could be manageable.

That is one reason why conversations around pandemic preparedness and prevention are taking centre stage in health policy discussions globally. The December 2021 special session of the World Health Assembly called for a global accord on pandemic prevention and response. But no consensus has been reached, and we are left without any proposed treaty; the sharp divide between the wealthy and poor countries created especially troublesome complications around responsibilities in the proposed accord. 

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The complicated negotiations led to the establishment of the Intergovernmental Negotiating Body (INB) to draft and negotiate an international agreement on pandemic prevention, preparedness and response. The INB has been receiving submissions from member countries, but they lack concrete policy suggestions to achieve the goal of vaccine equity. 

For developing countries, the key issue in pandemic preparedness is funding. Poorer countries cannot afford to outbid wealthier countries for vaccines or treatments. Apart from unfair pricing mechanisms, further restrictions on access made it difficult even for the few willing to pay the price tag, such as South Africa.

There has been some intent shown toward funding future pandemics, such as the WHO’s recent push to create a sustainable financing mechanism for its work. The World Bank has also published a white paper proposal for a Financial Intermediary Fund for Pandemic Preparedness, Prevention, and Response aimed at strengthening capacity in LMICs.

One of the most ambitious is the Coalition for Epidemic Preparedness Innovation’s (CEPI) 100 days mission aimed at delivering a vaccine for the next pandemic disease within 100 days by investing in research and development.

While the current rhetoric around vaccine equity is commendable, it must be supported with concrete action. There must be a mechanism in place to ensure that all countries can access vaccines at the same time in the event of a pandemic. The monkeypox outbreak has further shown how verbal commitments are not sufficient. While monkeypox has been endemic in Africa for decades, few are vaccinated. 

The pandemic insurance fund is a novel concept that could solve many problems around equitable vaccine distribution. The PIF would work similarly to standard health insurance, except it would operate at a global scale. WHO member countries would contribute about $1 per person per year for each of their citizens towards a fund that would be available to all countries, including LMICs, in the event of another pandemic. The PIF is a way to lock in contributions to health equity rather than rely on the hope that wealthier countries will do the right thing in our next global health emergency.

The pandemic insurance fund should be at the top of the health agenda for Africa. I expected that the discussions and submissions to the INB sessions, especially from African member states, would focus on practical suggestions on how to be better prepared for the next pandemic. The lack of funds for the purchase of vaccines was arguably the biggest factor for Africa’s poor handling of Covid-19.

I also expected submissions to highlight practical steps in formulating policies for the creation of regional research and development facilities on the continent. I expected African governments to take the lessons learned from the pandemic to begin to work toward health autonomy.  

But governments and their health ministries have failed to raise the specifics of the challenge that faced Africa and is likely to face Africa in the next pandemic. Africa must push for a pandemic insurance fund instead of hoping wealthy countries will have enough goodwill during the next pandemic. DM