G7 Shared Understanding on Enhanced Finance-Health
Coordination and PPR Financing
The COVID-19 pandemic has had unprecedented public health, economic, and social impacts
on the international community, and prompted an unprecedented range and size of policy
actions globally. Collective efforts, at national, regional, and global levels, were called for to containand mitigate such impacts. The public health response measures alone proved to be insufficient,calling for additional socio-economic policy interventions such as ring-fencing economic activities tocontain the spread of the virus. Faced with devastating socio-economic costs, all possible sourcesof financing, both public and private, have been explored.
These unprecedented responses and financing have exposed the need for enhanced financehealth coordination and the need to further strengthen the Global Health Architecture (GHA).
Public health and economic responses were complicated by the lack of coordination mechanisms toidentify necessary actions and allocate resources based on gap assessments across the entire
matrix of possible response measures. Where funding needs were identified, existing multilateralmechanisms and pooled funds were not sufficient or quick enough to activate. The recognition of theneed to strengthen the GHA, including improving pandemic PPR (prevention, preparedness, andresponse), led to the establishment of the Access to COVID-19 Tools Accelerator (ACT-A), the G20
Joint Finance-Health Task Force (G20 JFHTF), and the Pandemic Fund (PF). These were big
achievements, but further challenges remain to address the need for greater coordination, including
across finance and health, and appropriate funding to strengthen the GHA.
Building on the lessons learned and the collective efforts thus far, the G7, working with theG20 and other relevant stakeholders, should continue to tackle the remaining challenges inboth governance and financing of the GHA. The global community should be better prepared for
future pandemics and other health emergencies, including through moving towards Universal Health
Coverage (UHC) and promoting a One Health approach.
With this recognition, we, G7 Finance Ministers and Health Ministers, hereby present ourShared Understanding to further strengthen GHA governance through enhanced FinanceHealth coordination and PPR financing.
1. GHA Governance: Further Strengthening the Finance-Health Coordination
To better prepare for future health emergencies, a multi-sectoral and integrated approach isrequired. Given their multi-sectoral nature, effectively preventing, preparing, and responding topandemic risks and mitigating their health, economic, and social impacts require both health and1

financial expertise. To improve the efficiency and functionality of the GHA, finance and health experts,
at national, regional, and international levels, need to collaborate to identify potential vulnerabilities,
assess any functional and financing gaps, and map existing mechanisms and associated funding toaddress them. That would enable coordinated actions, including the reallocation of financial
resources when necessary.
Coordination among various stakeholders in the GHA needs to be strengthened with further
political support. Successful PPR requires continuous gap assessments, which would, amongothers, enable updated monitoring of risks and vulnerabilities and help navigate effective
coordination and resource allocation. The G20 JFHTF, with a broad-based membership and tangible
achievements such as the first gap assessment and support for the subsequent establishment of thePF, is the most suitable platform to enhance coordination among various stakeholders in the GHA.
We call for further strengthening of the G20 JFHTF to enhance Finance-Health Coordination
towards a more resilient GHA. This should be supported by further bolstering its Secretariat
that works in cooperation with the World Health Organization (WHO), the World Bank (WB),
the International Monetary Fund (IMF), and other International Organizations (IOs).
2. PPR Financing: The Pandemic Fund and complementing Surge FinancingWe need to continue our efforts to fill PPR financing gaps, based on successive gap
assessments by the G20 JFHTF. As a key milestone, we welcome the launch of the PF, lookforward to the successful execution of its first call for proposals, and encourage active participationand contributions to the PF from a broader donor base.
Despite this progress, financing for pandemic “response” remains under-addressed andcalls for particular attention. As we saw with COVID-19, pandemics create large and immediatedemand for rapid funding to address health needs, including basic services, equipment, and theproduction cycle of medical countermeasures from their R&D to last mile delivery. On the other hand,
broader response measures, such as mitigation of impact on societies and economies that isnormally financed nationally, and more structured interventions related to the strengthening of healthsystems fall outside the scope of this exercise.
Response financing from various sources, including domestic and external resources,
should be effectively and quickly mobilized to contain the impact of pandemics at their earlystage. Recognizing the multi-layered landscape of response financing, each layer should bestrengthened. As the First layer, domestic resource mobilization should serve as an initial basis forany response measures where possible. As the Second Layer, existing multilateral mechanisms andfinancing instruments for pandemic response, such as catastrophe bonds, the IDA Crisis Response
Window, the IBRD Crisis Buffer, and the WHO Contingency Fund for Emergencies as well as other2

multilateral and private financing, should be appropriately funded and more efficiently utilized in an
innovative and coordinated manner. 1
Even with the above efforts to addressing financing needs, the COVID-19 pandemic hasrevealed some limitations of the existing functions, including: setting aside resources in normal
times has a significant opportunity cost; market-based disaster or emergency risk financing has beenshown to be insufficient; and creating a new mechanism or fundraising calls after an outbreak occurs
takes time, with financing being provided too late and/or too limited for any meaningful action due tothe lack of pre-agreed actions.
This points to a need for exploring an innovative Third Layer, or a new dedicated “surge”
financing framework that allows us to complement existing mechanisms through better
coordination and deploy necessary funds quickly and efficiently in response to outbreaks
without accumulating idle cash. Based on the results of the mapping exercise by the WHO andthe WB, willing donors may pre-commit for a future disbursement, in line with their national budgetaryprovisions and processes, in the event of a health emergency upon hitting pre-agreed triggers to beconfirmed by donors and health experts.
We call on the international community to optimize and strengthen each layer of response
financing, including exploring an innovative surge financing framework that could beactivated in case of a pandemic outbreak. For this purpose, we aim to work with the G20 JFHTF
and our international partners so that the WHO and the WB will collaborate further and jointly conduct
a comprehensive, coherent, and coordinated mapping exercise on how the existing financing
sources, particularly untapped funding streams, can be used to respond to pandemics, how theexisting mechanisms could be better coordinated, where possible financial and functional gaps
remain, and how we can work together to narrow identified gaps, in time for the G20 Joint Financeand Health Ministers Meeting this summer. Building on their work, we will continue to contribute tofurther discussions at the G20 on the improvement of surge financing.

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We thank the World Bank for their useful inputs.

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