It's Not There, So Build It: Pandemic Response, the UN, and the World Bank

The Stocking Report, the evaluation of the WHO’s response to Ebola, was released yesterday. The report is very critical of the WHO, and calls for a number of reforms. It also requests that the “High-Level Panel on the Global Response to Health Crises should…identify procedures to take specific health matters to the United Nations Security Council and consider incentives and disincentives needed to improve global health security.”

When I joined the Centre for Policy Research, my colleague Sebastian von Einsiedel, drawing on his work for the 2004 High-Level Panel on Threats, Challenges and Change, said that he worried about pandemics. I was not persuaded. But over the last year, I have realized how wrong I was.

I have been persuaded, in part, by this piece by Bill Gates. But in the margins of the World Humanitarian Summit and the reviews of Peacekeeping and Peacebuilding, as I have looked at responses to sudden-onset crises and tried to match that to the scale of any potential pandemic… it is clear that the panel is right and that we are simply not equipped.

Here is the worry. Ebola was not a serious pandemic. It had a low R₀ – the number of infections expected based on one initial infection – and it was in countries that have weaker international links than many others. The response was not great (see here for the failure of the international aid system, and here for the failure of the US military). In total, over 11,000 people died – which is horrible, but also 140 times fewer than the number that die of tuberculosis every year. Bill Gates’ pandemic model for a Spanish Flu-like epidemic suggests 33 million people dead in less than a year.

So what could be done? I have no idea, whatsoever, about the medical side of response. But over a decade working on conflict-response has taught me that (a) everything costs money, and (b) nothing happens until the money starts flowing. So I want to make a few proposals here that could provide the international system with a financial and legal infrastructure to rapidly respond to a pandemic.

This draws on two pre-existing instruments:

1. The World Bank’s Catastrophic Deferred Drawdown Option (DDO). This allows the WB to automatically release funds to a pre-qualified borrower on a declaration of a state of emergency

2. The World Food Programmes’ Working Capital Financing Facility. This allows the WFP, in essence, to leverage its reserves and its understanding of future donor contributions to spend money in advance of its arrival. It is similar to a line of credit, but it is still slightly shocking in the world of international organizations.

The response of a global pandemic could follow two basic pathways:

1. A declaration by the Director-General of the World Health Organization of a Public Health Emergency of International Concern (PHIEC), also known as a pandemic.¹

2. A joint letter by the Secretary-General to the Presidents of the Security Council and the General Assembly (modelled on A/69/389–S/2014/679, which created UNMEER). In this letter, the SG would state his/her intention to:

   1. Drawdown a WB-PHIEC DDO;

   2. Mobilize and move staff as required;

   3. Waive both staff rules and regulations and procurement rules and regulations as pertains to the pandemic, and for the duration of the pandemic, with the future oversight of an independent audit body.

There is a prior step that is required, which is for the General Assembly to pass an enabling resolution that sets up the architecture, today, prior to an actual pandemic. Such a resolution would need to:

1. recognize the scope of the threat posed by PHIECs and instruct the Secretary-General, in consultation with the Director-General of the WHO, to ensure that the Presidents of the General Assembly and the Security Council remain informed of any developing PHIECs;

2. authorize the Secretary-General, in recognition of this threat,  to negotiate a PHIEC-DDO with the World Bank, that would allow the United Nations to access a pre-set amount of financing (say $1.5 billion) to respond to a pandemic, and commit the UN to:

   • working with Member States to secure prompt repayment of the PHIEC-DDO from voluntary contributions directly to the World Bank on behalf of the United Nations;

   • re-paying any excess amount that donors do not directly repay, through the regular budget. Based on the successful WFP model, this should be unlikely to occur, but may be legally required. However, a separate agreement amongst a large group of donor nations may suffice;

3. require the SG to pre-negotiate memoranda with the WHO and other major members of the UN family that allow for the flow of funds to enable their response within 48 hours;

4. require the SG to develop, for Member State scrutiny within 12 months, a system of accelerated HR and procurement rules and regulations (“emergency measures”) that could be put in place in the case of a pandemic, and to secure the approval of the requisite General Assembly bodies to these measures.

An alternative pathway that relies on the Security Council exists. But the Council has had difficult prior discussions on the issue of pandemics, and the politics around the issue do not appear to be conducive for the Council to set up the mechanisms outlined above. But, in theory, one could also foresee a process that unfolds as follows:

1. The Secretary-General alerts the Security Council, under Article 99, of a threat to global peace and security;

2. The Security Council, drawing on a pre-negotiated text, authorizes the Secretary-General to take the measures outlined in 2 (a) to (c) above.

The necessary precursor would be for the Security Council to adopt a resolution, now, that declares pandemics (or PHIECs) a threat to peace and security, and requests the SG to conducts steps (B) to (D) above. It would also need to specify the language in a series of operative clauses that would mandate the SG to take these measures as required.  But although the instinct might be that the Council is a better option, given the threat of pandemics, the General Assembly has the right level of universality for a pre-planned response such as this.

Perhaps the right format to prod the GA into action would be a meeting where Bill Gates could present the Gates Foundation’s pandemic models, and MSF could draw its stark lessons from the Ebola response.  Rumour has it that Chancellor Angela Merkel is particularly exercised about the systemic risk that Ebola exposed, the support of a few key Member States to see this process through would need to accompany the leadership of the Secretary-General.

The next phase, which is more technical and more difficult, is the negotiation of a response plan. My worry is that what we currently see are negotiations around what should happen without adequate attention to both the resource mobilization and the need for political will/legitimacy. This proposal – flawed as it may be – seeks to address that gap prima facie, so that we can all concentrate on figuring out how to respond.