The Pandemic Treaty will succeed only with investment to build strong health systems

As the 77th World Health Assembly takes place this week, negotiations around the Pandemic Treaty are front and center of conversations.

The treaty has been beset by delay and misinformation. The vested interests of pharmaceutical companies, lobbying groups, and conservative British broadcaster Nigel Farage bleating about “defending sovereignty” are threatening to derail the treaty process entirely.

Signing a Pandemic Treaty is critically important for a global response to emerging health threats. The crucial commitments quietly peeking through the text set out the fundamental need for countries to develop, strengthen, and maintain strong health systems to ensure they’re ready for the next pandemic.

The ability to respond to pandemics is only as good as the strength of health systems around the world. The treaty is destined to fail if most countries don’t have the means to develop the health systems they need.

Over half the world — 4.5 billion people — still do not have access to essential health services. This severely limits the world’s ability to respond to emerging health threats such as pandemics.

The Covid-19 pandemic was the canary in the coal mine. Over 90% of countries experienced disruptions in health services due to Covid-19. The world shut down; millions died; health inequities soared; and the resulting huge economic losses are still affecting economies today.

It’s obvious what was missing: Nations had not built robust, responsive health systems at scale globally, nor did they have enough well-resourced and protected health workers to adequately manage the threat.

Without strong, responsive health systems in all countries of the world — which is the most fundamental viability of the treaty — the response to the next pandemic will fall short.

The failure to build resilient health systems is not the fault of the World Health Organization. The WHO’s commitment to championing health, health systems, and a better future for all is the cornerstone of the global approach to health.

Instead, the blame lies with existing power dynamics. Corporations, governments, and funders who tie decisions to election cycles and donor-driven metrics sacrifice the long-term benefits of healthier and more productive populations.

Here’s the reality: Many countries do not have the resources to strengthen their health systems, which threatens the health of all global citizens.

The solutions are actually rather simple:

First, leaders must acknowledge that the current approach to global health challenges does not work. The status quo of siloed investments focused on specific diseases, for example, is unsustainable. Billions in investments have not yet built the resilience required for the challenges ahead.

Investing in strong health systems — which means investing in the health workforce — solves many of the most pressing challenges at once. Whether it’s the need for universal health coverage, pandemic preparedness, or adaptation and resilience against climate change, the solution is one and the same.

Health systems are countries’ main line of defense against pandemics and other health emergencies, including the growing threat of climate change. A strong health workforce can identify infectious disease outbreaks when they first occur and know best what interventions and investments are needed to save the most lives in the fastest way possible.

Second, it’s essential to create the fiscal space needed for governments and funders to make the necessary investments to strengthen health systems, thinking differently and boldly at scale and across sectors.

The current system of global financing — multilateral and bilateral funding, and philanthropy — isn’t sufficient to meaningfully improve global health. The debt crisis, which is debilitating many countries around the world, is a powerful example. Africa spends more on debt service costs than on health care. Innovative thinking and approaches, such as the Global Fund’s Debt2Health initiative which converts debt repayments into spending on health, can help.

More broadly, funding must be longer-term, flexible, and exponentially larger for countries to strengthen their health systems and build out their health workforces.

Third, funding must be focused on country priorities and national plans, rather than on the agenda of the funders.

Take the example of Malawi, where Seed Global Health, the organization I lead, works. Health Minister Khumbize Chiponda knows firsthand the country’s greatest needs and how to align funding to meet these priorities most efficiently. She has developed one plan and budget for the health system, but now needs funders to follow to reduce duplication, administrative and reporting costs, siloed investments, or even failed projects which do more harm than good. Money will go further and more effectively if it is aligned with country priorities.

Finally, the value of better health to economic growth, productivity, and security must be recognized: Nearly one-quarter of growth in middle- and low-income countries from 2001 to 2011 grew out of improvements in health.

Annual funding of $31 billion for pandemic preparedness would save trillions in the kinds of losses experienced during the Covid-19 pandemic, and which occur annually on smaller scales with cholera, Ebola, and other outbreaks. Weak health systems in turn can often drive migration across borders, putting pressure on the host country’s resources. Health is a fundamental prerequisite for stable communities.

A robust Pandemic Treaty is a crucial necessary step to prepare for the next pandemic, but it is not sufficient. Any hard-won agreements in the treaty risk failing if strong health systems are not in existence to leverage the treaty’s results.

The world can no longer afford to tackle individual problems — pandemics versus climate change versus noncommunicable diseases versus … — with different forward paths. It’s time to accept, and act on, one foundation of strong health systems for global health, well-being, and protection.

Vanessa Kerry, M.D., is the CEO of Seed Global Health.