New World Bank pandemic fund must prioritize prevention

COVID-19 has been a cruel teacher. And the harsh lessons we’ve learned will be wasted unless we can apply them to the next disease crisis. Sadly, it’s already upon us. 

The ongoing monkeypox epidemic — now a pandemic by some definitions — has shown yet again the critical importance of investing in global public goods such as disease surveillance, diagnostic technologies and vaccine research. 

But one message that hasn’t stuck is that emerging infectious diseases can pack surprises for which no amount of preparation is sufficient.

We were arguably more ready for monkeypox virus than for any other virus. Scientists have over 50 years of experience with it. Numerous countries have been preparing for it since the threat of bioterrorism was realized with the 2001 anthrax attacks, and we now have a monkeypox vaccine and treatment. The United States, the country with the most recorded cases in 2022, has direct experience controlling monkeypox on its own soil since 2003. Dr. Dimie Ogoina, an expert in Nigeria, even warned about the possibility of monkeypox transmission through sexual contact back in 2019.

Nevertheless, we find ourselves at a point where public health experts (including one of us, who worked at the Centers for Disease Control and Preventionbranch that deals with monkeypox) are concerned that the virus will establish itself in the human population for many years to come. 

All this underscores the limitations of the current paradigm favored by the public health sector to address infectious diseases after they’ve emerged rather than preventing them in the first place.

Fortunately, earlier this year, the World Bank announced it would create a new fund for pandemics. While its scope is still being decided, it will likely support aspects of prevention alongside initiatives to prepare for and respond to pandemics. 

The bad news is that influential voices don’t seem that interested in preventing the root causes behind the rise in epidemics and pandemics. Billionaire and philanthropist Bill Gates, for example, completely overlooks this in his recent TED talk and other writings on pandemics.

Some, such as the World Health Organization (WHO) Independent Panel for Pandemic Preparedness and Response, have even cautioned against it. In June, the panel advised the World Bank that investing in prevention could “sap resources from achieving the goals of rapid identification and containment of pandemic threats that will remain inevitable despite vast resources spent in pursuit of prevention.” 

In making this argument, the panel ignores the science. Most pathogens that cause emerging infectious diseases (including SARS-CoV-2 and monkeypox virus) originate in animals and then spill over into people. Pandemics, and the outbreaks that lead to them, however, can be prevented through actions to reduce risk of spillover such as stopping deforestation and regulating wildlife trade. 

Furthermore, focusing only on containing pathogen spread after spillover has occurred is inherently unjust because the tools of containment are simply not accessible to so many people. COVID-19 vaccines have been available since early 2021, yet only 26 percent of Africans have gotten a dose compared to 80 percent among Americans and Canadians (a similar story is playing out with monkeypox). It’s also unfortunately common for emerging infectious diseases to be ignored when they don’t greatly impact socioeconomically privileged groups, as we’ve seen with HIV and monkeypox.

In the coming months, the World Bank will be defining the scope of its new fund. To achieve the fund’s goals, it is critical that this fund invest in actions to reduce risk of spillover. This will require that the Bank pursue three actions.

1) It must explicitly state that a key goal of this fund is to address spillover. There are currently no major global efforts focused on spillover prevention. This is a huge gap in the global commons that carries lethal consequences. The World Bank can fix this easily while the fund is in its infancy.

2) It must ensure that the animal health and environmental sectors are included as equal stakeholders alongside the public health sector. While the World Bank has made clear that the WHO will be heavily involved in the fund, there are no such commitments for other multilateral agencies (e.g., the UN Environment Programme, the World Organisation for Animal Health) that have as much a role in pandemic prevention and preparedness.

3) It must work with countries and organizations to increase donations to the fund. So far, less than $2 billion has been committed globally, far short of the recommended $20 billion annual minimum. While that sounds pricey, it is expected that the United States will need $7 billion just to control monkeypox virus for the foreseeable future and has spent over $3.5 trillion to address COVID-19.

What Gates and the WHO Independent panel don’t seem to get, the World Bank can get right. We need to reduce risk of spillover to prevent outbreaks before they begin alongside efforts to contain pathogen spread after spillover. This is akin to medical thinking that has broadened from a focus on treating symptoms to its current acceptance of the importance of preventative health care. Pandemics are no different — traditional public health thinking needs to evolve quickly to prevent more pandemic catastrophes.

Neil M. Vora, MD is the pandemic prevention fellow at Conservation International and a practicing physician working in pandemic response.

Nigel Sizer, Ph.D. is a tropical forest ecologist and the executive director of Preventing Pandemics at the Source.