Prioritizing investments to mitigate pandemic risk in resource-limited settings


Preparing for a pandemic is challenging because of a multitude of factors, many of which are unique among natural disasters. Pandemics are rare events, and the risk of occurrence is influenced by anthropogenic changes in the natural environment. In addition, accountability for preparedness is diffuse, and many of the countries at greatest risk have the most limited capacity to manage and mitigate pandemic risk.

Unlike most other natural disasters, pandemics do not remain geographically contained, and damages can be mitigated significantly through prompt intervention. As a result, there are strong ethical and global health imperatives for building capacity to detect and respond to pandemic threats, particularly in countries with weak preparedness and high spark and spread risk.

Investments to improve pandemic preparedness may have fewer immediate benefits, particularly relative to other pressing health needs in countries with heavy burdens of endemic disease. Therefore, characterizing pandemic risk and identifying gaps in pandemic preparedness are essential for prioritizing and targeting capacity-building efforts. Thinking about risks in terms of frequency and severity, notably using probabilistic modeling and EP curves, can quantify the potential pandemic risks facing each country and clarify the benefit-cost case for investing in pandemic preparedness.

No single, optimal response to a public health emergency exists; strategies must be tailored to the local context and to the severity and type of pandemic. However, overarching lessons emerge after multiple regional epidemics and global pandemics. For example, because of their high spark and spread risks, many LMICs would benefit most from building situational awareness and health care coordination capacity; public health response measures are far more cost-effective if they are initiated quickly and if scarce resources are targeted appropriately.

Building pandemic situational awareness is complex, requiring coordination across bureaucracies, across the public and private sectors, and across disciplines with different training and different norms (including epidemiology, clinical medicine, logistics, and disaster response). However, an appropriately sized and trained health workforce (encompassing doctors, nurses, epidemiologists, veterinarians, laboratorians, and others) that is supported by adequate coordination systems is a fundamental need—the World Health Organization has recommended a basic threshold of 23 skilled health professionals per 10,000 people (WHO 2013a).

Increasing the trained health workforce also will increase the capacity to detect whether any particular population (for example, human, farm animal, or wildlife) is suffering from a pathogen with high pandemic risk. Increasing the health workforce also will improve the overall resiliency of the health system, an improvement that can be applied to any emergency that results in morbidity and mortality shocks.

Additionally, building situational awareness will require sustained investment in infectious disease surveillance, crisis management, and risk communications systems. Investments in these capacities are likely to surge after pandemic or epidemic events and then abate as other priorities emerge. Hence, stable investment to build sustained capacity is critical.

Risk transfer mechanisms such as catastrophe risk pools offer a viable strategy for countries to manage pandemic risk. Further developing these mechanisms will allow countries to offload portions of pandemic risk and response that are beyond their immediate budgetary capacity. For this reason, risk transfer solutions should be designed with the needs and constraints of LMICs in mind. However, countries must have predefined contingency and response plans as well as the absorptive capacity to use the emergency financing offered by such solutions. Broad and effective use of pandemic insurance will require parallel investments in capacity building and emergency response planning.

Finally, researchers must address the significant knowledge gaps that exist regarding LMICs’ pandemic preparedness and response. Improving the tracking of spending and aid flows specifically tied to pandemic prevention and preparedness is vital to tracking gaps and calibrating aid flows for maximum efficiency. Systematic data on response costs in low-income settings are scarce, including data regarding spending on clinical facilities, supplies, human resources, and response activities such as quarantines. Bridging these data gaps can improve pandemic preparedness planning and response through evidence-based decision making and support efforts to prevent and mitigate epidemics and pandemics.