The Cost ofPandemic Preparedness
Unclear and unaffordable?

What do you need to know?
Our analysis of costings for the World Health Organization’s (WHO) proposed
pandemic prevention, preparedness, and response (PPPR) instruments foundthat the estimates lack reliability at both the domestic and international level.
Methodology is opaque, based on unevidenced assumptions, while failing toconsider the effects of diversion of finances and opportunity cost.
There are, therefore, major questions regarding value for money, and indeed whether the proposed
investments will produce net benefit. There is a significant concern that they will absorb adisproportionate level of global health funds, with highly uncertain levels of return.

Why do you need to know this?
The World Health Assembly will meet in May–June 2024 to vote on
two proposals for reforming the role of WHO regarding pandemics:
The Pandemic Agreement and amendments to the International HealthRegulations (IHRs), both of which will be legally binding on States.
Unprecedented financial requests are being proposed to support PPPR.
The estimates range from US$31.1 billion a year to US$171 billion over
five years with unspecified annual commitments or US$285-$430
billion over ten years with additional funds of US$10.3 to US$11.5
billion annually sought to implement One Health.

These costs are likely tosignificantly distort global
health and official development
assistance budgets, redirecting
scarce resources from global
and national health priorities
of greater burden (Figure 1).

Figure 1. Major PPPR cost estimates
ORGANIZATIONTOTAL PPPR ESTIMATES IN $US BILLION

G20 High-Level Independent
Panel (HLIP) (basic)$171 over five years with unspecified annual funding thereafter

G20 HLIP (full)$206 over five years with unspecified annual funding thereafter

WHO/World Bank

$31.1 annually

McKinsey & Co.

$285–$430 over ten years with $20 to $50 annual funding thereafterWorld Bank to add One Health$10.5–$11.5 annually

Accurate and reliable cost estimates are essential to guide decisions of Member States on whether
to support PPPR investments. A re-analysis, based on a review of key underlying assumptions andincluding consideration of the place of PPPR within the broader public health sphere, would provide
more clarity regarding expected costs and benefits.

Method
We analysed the data and evidentiary materialcited within four key documents G20 (n=1), joint World Bankand WHO (n=1), and WHO Secretariat (n=2) as well as theprimary (n=1) and secondary (n=10) sources cited in the policy
documents to support their claims. Our analysis focusedon the robustness of the cost estimations and whether theassociated financial recommendations are justified as having
an appropriate return on investment to support the current
pandemic preparedness agenda.

Concerns resulting from our analysis?

There is a general lack of accurate PPPR cost estimations due to inconsistent definitions
about what constitutes pandemic preparedness, and inconsistent monitoring and reporting
mechanisms.
Estimates are based on a small evidence base that is self-referential and under-scrutinized,
creating a circular evidence and citation base resulting in a false perception of rigor,counter-verification, and consensus.

?

Claims of return on investment use problematic and crude baselines for comparisonand fail to properly examine wider economic impacts and disease burdens, thus creating
a false perception of value for money.
Return on investment estimates are further based on highly unreliable assumptions ofoutbreak risk and the effectiveness of proposed interventions. For example, the models
examined assumed that:
PPPR can mitigate 100% of all economic impacts from an outbreak(although HLIP later reduced this to 75%).
A “Covid-like” outbreak will occur every 40 to 50 years.
A vaccine that stops transmission is developed within one to three years.
Economic impacts are all directly a result of an outbreak without disaggregating direct costs(hospitalizations, therapeutics, lost income due to illness and death) from indirect costs
associated with policy responses (lockdowns, travel bans, stimulus injections).
The estimates fail to consider significant associated opportunity costs threatening to shiftscarce resources from greater disease burdens with resultant negative health outcomes.

?

The estimates constitute anywhere from 25% to 40% of current global official development
assistance for health (ODA), representing a disproportionate investment for an unknown
future disease burden with questionable value for money. This defies traditional practices
in public health, which would weigh any benefit of pandemic prevention against other disease
burdens and health financing needs (Figure 2).

Figure 2. Comparison of global official development assistance (ODA) proposed for PPPR,
in comparison with total global health ODA during and before the COVID-19 outbreak
Organization/
Initiatives

PPPR EstimatedODA (US$)PPPR as % of 2022
ODA

PPPR as % of 2019
Pre-Covid ODA

G20 HLIP (basic)$15 billion per year

38.3%

67.6%

McKinsey & Co.

$9.6 billion per year

24.4%

43.2%

WHO/World Bank

$10.5 billion per year

27%

47.2%

Tuberculosis$1.1 billion in
ODA in 2022 (actual)

2.8%

Malaria$2.4 billion in
ODA in 2021 (actual)

6.1%

WHO total budget$3.9 billion in
ODA in 2022 (actual)

this repres
ents
massive u
nderinvestment whencomparedto PPPR
estimates
for ODAand relati
ve disease
burdens

Recommendations
1. There is a clear need to commission better

4. Given the poor evidence and analysis

baseline and preparedness cost estimations toaccurately determine the scale and potential
trade-offs of the pandemic preparedness
financing required.

2. An appropriate determination of financial

underlying pandemic cost and financing
requirements, it is prudent not to rush into
new pandemic initiatives until underlying
assumptions receive proper assessment.

5. WHO Member States should support

need must weigh these costs against otherpriorities in global health as well as country
level disease burden needs.

3. Understanding relative disease burden andeconomic impacts is crucial for identifying
the cost-benefit and return on investmentof pandemic financing as well as how to best
select interventions that promote overallpublic health outcomes.

proportional pandemic preparedness efforts
based on substantiated investment need,careful deliberation, and rational reflection.
This does not appear to be in place oraddressed in current proposals.

We need balanced,
evidence-based investment

The full REPPARE research report is available on our webpage.
Or contact Professor Garrett W. Brown g.w.brown@leeds.ac.uk or reppare2023@gmail.com.
Study supported with funds from the Brownstone Institute, USA.
Policy brief edited and designed by Research Retold www.researchretold.com.