Pandemic preparedness: new global funds or existing health systems?

Advocates strengthening existing health systems through integrated, results-based financing—not new vertical pandemic funds—conditioned on country ownership and MDG-aligned priorities.

The World Bank Group's 2015 reports emphasize health systems strengthening as the foundation for pandemic preparedness, prioritizing integrated, results-based financing over vertical or fragmented funds. While announcing new multi-donor financing mechanisms like the Global Financing Facility and the 'Power of Nutrition' fund, the Bank explicitly frames them as tools to support country-led health system goals—not standalone disease-specific or emergency-focused vehicles. These initiatives are tied to broader commitments to MDG achievement, maternal and child health, and nutrition, underscoring that effective pandemic readiness depends on resilient, equitable, and well-funded primary health systems rather than parallel global funds. No mention is made in the excerpts of advocating for new dedicated pandemic preparedness funds separate from health systems investment.

Advocates pandemic preparedness through strengthening existing health systems—not new global funds—with integrated, country-led planning and financing via platforms like GFF.

The World Bank Group in 2019 emphasized strengthening existing health systems—not creating new vertical pandemic funds—as the foundational strategy for pandemic preparedness. It explicitly stated that 'strong health systems that reach all people... are the only way to ensure protection from major disease outbreaks,' and prioritized integrating preparedness into national health system governance, surveillance, and multisectoral response capacities—particularly through IDA support for pandemic preparedness plans in low-income countries. While it supported innovative financing mechanisms like the Global Financing Facility (GFF), these were framed as catalytic, country-driven platforms to bolster health systems—not standalone emergency funds. The Bank co-signed a Global Action Plan with WHO and others to mobilize resources 'for health, invest them better, and strengthen health system capacity,' affirming systems strengthening as the core architecture for resilience.

Advocates strengthening national health systems—not new global funds—as the foundation for pandemic preparedness, with integrated investment and global coordination.

The World Bank Group's 2020 reports emphasize strengthening existing health systems—not creating new vertical global funds—as the core strategy for pandemic preparedness. They stress that resilient, well-functioning national health systems—capable of prevention, early detection, rapid response, and robust treatment—are essential, especially in aging economies, and must be stress-tested and continuously invested in. While acknowledging the need for global coordination, technical assistance, and support for low-income countries, the documents frame financing as part of broader fiscal and structural investments in human capital and health infrastructure, not as a call for new fragmented global health funds. The focus is on integrating preparedness into domestic systems and leveraging multilateral support to bolster national capacities rather than establishing parallel funding mechanisms.

Advocates strengthening existing health systems—not new vertical funds—as the core of pandemic preparedness, using adaptable, integrated financing to build resilient, equitable, and primary-care-led national capacities.

The World Bank Group in 2021 advocated for pandemic preparedness through strengthening existing health systems—not by creating new vertical global funds—emphasizing integrated, primary health care as foundational for prevention, detection, and response. It prioritized upstream investments in surveillance, laboratory networks, veterinary-human health linkages, and universal health coverage, while leveraging and adapting existing mechanisms like the Global Financing Facility (GFF) and the Health Emergency Preparedness and Response Program to avoid fragmentation. The Bank explicitly supported catalytic, rapid financing *within* its institutional framework (e.g., IDA, MPA) to bolster country-level systems, including vaccine deployment infrastructure, cold chains, and community health workers—framing system resilience as inseparable from equity, human capital, and inclusive recovery.

Advocates pandemic preparedness through strengthening existing health systems and multisectoral national institutions—not new vertical global funds—using integrated, country-led financing and multilateral partnerships.

The World Bank Group in 2022 advocated for pandemic preparedness through strengthening existing health systems—not new vertical global funds—by integrating emergency response into country-led, system-wide investments. It emphasized financing mechanisms like the Health Strategic Preparedness and Response Program and the Global Financing Facility to bolster primary health care, universal health coverage, and social protection systems, while explicitly supporting multilateral partnerships (e.g., COVAX, ACT-A) rather than standalone global pandemic funds. The Bank stressed that resilient health systems must be adaptive, equitable, and climate-smart, and that rapid financing (e.g., via grants under the Health Emergency Preparedness and Response Program) should reinforce—not bypass—national institutions and delivery platforms.

Advocates strengthening health systems *and* new global funds like the Pandemic Fund—conditioned on fiscal realism, country leadership, and coordinated financing to avoid fragmentation.

The World Bank Group (WBG) in 2023 advocated for a dual-track approach to pandemic preparedness: strengthening existing health systems as the foundational, long-term strategy—especially primary care and public health—while simultaneously supporting new, dedicated global financing mechanisms like the Pandemic Fund (hosted at the Bank) to provide catalytic, long-term, and technically supported investments in preparedness for developing countries. This approach is conditioned on addressing fiscal constraints—such as declining government spending capacity and rising debt service—that threaten both health system resilience and progress toward universal health coverage, and it emphasizes country-led coordination across vertical funds (e.g., Pandemic Fund, Global Financing Facility, Health Emergency Preparedness and Response Program) to avoid fragmentation and maximize synergies.

IMF 2020 stance: Prioritize strengthening existing health systems with targeted fiscal reprioritization and concessional multilateral financing—not new global funds.

In 2020, the IMF emphasized strengthening existing national health systems—particularly in emerging market and developing economies—as the priority for pandemic preparedness, citing severe capacity constraints in infrastructure, personnel, and medical supplies. It advocated for immediate fiscal reprioritization toward health spending, donor-supported concessional financing, and multilateral emergency funding (e.g., via the Catastrophe Containment and Relief Trust), rather than proposing new standalone global funds. The IMF stressed that effective pandemic response depends on robust, coordinated domestic health systems capable of rapid scaling, supported by external assistance and debt relief—not vertical or fragmented global financing mechanisms.

Prioritizes strengthening existing health systems and supporting COVAX over creating new pandemic-specific funds.

The IMF's 2021 reports emphasize strengthening existing health systems—particularly through increased, well-targeted public spending on health care infrastructure, vaccine production and distribution, and equitable access—as the central pillar of pandemic preparedness; they support global financing mechanisms like COVAX to address immediate inequities but do not advocate for new standalone pandemic funds, instead framing health system resilience as integral to broader fiscal sustainability, social protection, and inclusive recovery efforts.

IMF 2023 reports call for global coordination on pandemic response but do not take a position on new global funds versus strengthening existing health systems.

The IMF's 2023 reports emphasize the need for global coordination to strengthen pandemic preparedness, including resolving bottlenecks in vaccine and treatment distribution and supporting public investment in new vaccine technologies and systematic responses to future epidemics. However, the excerpts do not explicitly address whether pandemic preparedness financing should flow through new global funds or be embedded within existing health systems, nor do they discuss trade-offs between vertical funds and health systems strengthening or fragmentation concerns. No position is stated on fund architecture, financing mechanisms, or health system integration versus dedicated pandemic funds.

AIIB prioritized strengthening existing health systems through integrated infrastructure investment over creating new vertical global pandemic funds in 2020.

In 2020, AIIB advocated for strengthening existing health systems—particularly their physical, organizational, and digital infrastructure—as the foundational approach to pandemic preparedness, rather than creating new vertical global funds. It emphasized that resilient health systems require integrated investments in hospitals, supply chains, health workforce capacity, data systems, and cross-sectoral coordination—not standalone financing mechanisms. The Bank positioned its COVID-19 Crisis Recovery Facility as a vehicle to support country-led, infrastructure-based health system upgrades (e.g., CDC upgrades, hospital equipment, lab networks) in alignment with its long-term mandate, rejecting fragmentation in favor of embedding health resilience within broader productive infrastructure development.

AIIB favors strengthening national health systems over new global pandemic funds, using targeted grants (e.g., Pandemic Fund) only as complementary support for systemic resilience.

AIIB prioritizes strengthening existing health systems—particularly infrastructure, supply chains, and digital health capacities—over creating new vertical pandemic funds, as evidenced by its 2023 investments in health facility modernization (e.g., Indonesia), Results-based financing for sovereign clients, and integration of the One Health Approach. While it accepts and deploys grants from the newly established Pandemic Fund (e.g., for Cambodia), it frames such funding as complementary support for systemic resilience—not as a substitute for foundational health system investment. Its Emergency Response approach and Special Fund Window for Less Developed Members are designed to enhance adaptive capacity within national systems rather than establish parallel global financing mechanisms.

AIIB advocates strengthening existing health systems and multisectoral infrastructure over new vertical pandemic funds, prioritizing integrated, nationally owned pandemic preparedness.

AIIB's 2025 position emphasizes strengthening existing national and regional health systems—including core public health capacities, pandemic preparedness, One Health approaches, and cross-border cooperation—rather than advocating for new vertical global funds. It prioritizes integrated, multisectoral infrastructure investments (e.g., WASH, diagnostics, infection control) embedded within broader health system strengthening and policy-based financing, aligning with UHC goals and addressing systemic gaps identified in Asia. The Bank explicitly references the need to scale up surveillance, diagnostics, and treatment infrastructure through sustainable national financing and coordinated MDB action—not standalone pandemic funds.

Advocates reforming and expanding existing regional financial safety nets—not creating new global health funds—for pandemic preparedness, emphasizing coordination over fragmentation.

The ADB's 2025 reports emphasize strengthening *existing regional financial safety nets*—particularly the Chiang Mai Initiative Multilateralization (CMIM) and AMRO’s new Rapid Financing Facility—as the preferred mechanism for pandemic preparedness financing, rather than creating new global vertical funds. They argue that the pandemic revealed the inadequacy of CMIM’s narrow short-term balance-of-payments mandate and call for expanded flexibility, longer maturities, and adaptation to 'noneconomic shocks' like health crises—but frame this as reforming and scaling up *existing regional architectures*, not establishing new global health funds. The ADB stresses coordination among existing institutions (IMF, MDBs, regional arrangements) to avoid fragmentation, and positions MDBs—including itself—as complementary providers of advisory services, capacity development, and emergency budget support alongside financial safety nets.