Preparing for a Global Outbreak: New Solutions to the Next Generation of Pathogens

This piece is part of our month-long focus on health in the lead up to the 2018 World Health Assembly. 

This week, the world’s leading global health policymakers and practitioners gather in Geneva as part of the 71^st World Health Assembly to discuss how to achieve universal health coverage and health for all. For a decade, The Rockefeller Foundation has remained a leading voice in health for all. To us today, the initial answer is clear: the only way to make health for all a reality for everyone, everywhere is by focusing on community health – and in particular, making community health more integrated, responsive, and digitally-enabled.

In other blogs posted over the past 10 days, we’ve explored using data analytics as well as building new, agile partnerships to reach those vulnerable to preventable death and disease. Today, we want to explore how the use of innovative financial tools and products should serve as a third leg to the stool of The Rockefeller Foundation’s approach to community health. First, let’s consider the case of Ebola.

Just two years ago, the world was on edge as the West African Ebola outbreak quickly spread across several countries. We watched the number of cases grow exponentially each day and couldn’t help but think that we were headed toward a global pandemic similar to those that had wiped out populations before us. While that didn’t happen, Sierra Leone, Guinea, and Liberia suffered severe losses, both in lives affected and socioeconomic upheaval. When the WHO declared an end to the emergency in March 2016, the numbers told the story of not only tragedy but also of serious flaws in our systems.

The 2014 Ebola epidemic in numbers:

• 28,639 cases
• 11,316 deaths
• $3.6 billion from the donor community
• Estimated losses of $2.2 billion in GDP [CDC]

The local health systems were not resilient enough to respond to the crisis, and the international development community’s handling of the epidemic was marred by miscalculations and inefficiency. Like natural disasters, the Ebola outbreak created immediate funding requirements which did not come. It took almost five months into the epidemic before the World Bank made the first major assistance pledge of $200 million and the WHO declared Ebola a public health emergency. By the time the money arrived, it was not enough. As the situation escalated, the country response plans were not getting funded, and the number of cases increased, even more, creating a perpetual cycle that resulted in more significant loss of life and higher costs than if the response had the appropriate resources from the onset.

So where are we now?

“Lessons learned include the recognition that West African and other countries need effective systems to detect and stop infectious disease threats, the need for stronger international surge capacity for times when countries are overwhelmed by an outbreak and the importance of improving infection prevention and control in healthcare settings.” [CDC]

On May 8, 2018, The Democratic Republic of Congo confirmed two cases of Ebola and declared a new outbreak. Immediately that day, the WHO declared an emergency and released $1m of contingency funding and a team of experts to work alongside the government, the affected community and partners on the ground. The immediate goal is to stop the spread to neighboring provinces and countries.

“This is a concerning development, but we now have better tools than ever before to combat Ebola,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO and our partners are taking decisive action to stop further spread of the virus.” [WHO]

As of 15 of May, a total of 44 cases have been reported, 3 of which have been confirmed. There are still issues of infrastructure and country preparedness, but the recent response indicates that there is hope and an openness to try new solutions.

Innovative Finance: New Solutions to Old Problems

Addressing the world’s most critical development challenges will require more capital than government and philanthropy can provide on their own. The UN estimates that we face an annual USD 2.5 trillion funding gap to achieve the Sustainable Development Goals in developing countries alone. Through The Rockefeller Foundation’s Zero Gap portfolio, we utilize grant funding and program-related investments (PRI) to fund the early stage R&D and piloting of the next generation of market-making investment vehicles and products to mobilize large-scale institutional and retail investment towards the SDGs. Innovation is needed to develop novel financial mechanisms that address critical market failures preventing the mobilization of new and additional private sector capital against the SDGs.

One promising financial product is called African Outbreak and Epidemic Insurance and comes from the African Risk Capacity (ARC), a specialized agency of the African Union. ARC is charging ahead with a solution that does not rely on humanitarian appeals or executive decisions from international development organizations to contain future disease outbreaks in Africa. Instead, ARC is developing the first-ever sovereign insurance product for outbreaks and epidemics, which would enable African countries to tap into the $100+ trillion available in global capital markets to contain disease outbreaks. When early signs of a disease outbreak are detected, insured African governments will receive payouts to execute prepared and vetted response activities. Insured countries will benefit not only from having immediate funds available to fight the disease but also from having built their own capacity to respond to the crisis. The Ministries of Health in Guinea and Uganda will implement the first pilot in 2019 to insure against Ebola, Meningitis, Marburg and Lassa Fever, chosen based on the potential to for outbreak and impact on the population and economies.

The idea is far from a naïve pipedream. ARC has used a similar mechanism to provide drought insurance since 2014. ARC’s drought insurance helps countries build resilience to extreme weather events and protect vulnerable populations from food insecurity. Receiving relief funds at an early stage allows countries to begin combating the situation before any calls for humanitarian aid are even made.

If a solution like African Outbreak and Epidemic Insurance had been in place, Sierra Leone, Guinea, and Liberia would have had funds available when they were needed most to execute targeted plans for managing the crisis. According to the U.S. Centers for Disease Control, had the Ebola response launched much earlier, the total number of cases could have been contained at less than 5,000.