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The World Bank has rolled out a new Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response (FIF) in an improbable and harmful timetable. Backing of the fund by the Biden administration as part of its strategy to strengthen health security and prepare for biothreats only accelerated the speed.

As a physician, human rights advocate, and global health equity expert, I can unequivocally state that the formation of this new fund, christened as The Pandemic Fund in early November, is fundamentally backward. However well-intentioned it may be, the speed, approach, and structure raise more concerns than solutions.

What is The Pandemic Fund?

According to the World Bank, a financial intermediary fund (FIF) is an arrangement that leverages public and private resources to support international initiatives. It enables the international community to provide a direct and coordinated response to global priorities. In the case of The Pandemic Fund, the goal is to provide a coordinated effort for new pandemics, particularly when it comes to strengthening pandemic prevention, preparedness, and response initiatives in low- to middle-income countries.

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So far, more than $1.4 billion in financial commitments by 19 donors — 15 governments, three philanthropic organizations, and one nonprofit organization — have already been announced, and more are expected to follow.

What’s the issue?

For starters, the breakneck speed at which The Pandemic Fund was established leaves little to no room to analyze and implement what’s working with existing mechanisms to ensure proper structures and processes for effectively making grants.

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In late June 2022, the World Bank shared draft plans for establishing the fund and supposedly welcomed feedback from civil society organizations. The fund was officially established barely two months later by the governing board at its inaugural meeting in early September.

Money flooded in from both public and private donors, and first calls for grant proposals for spending this money are expected to start this month.

Seven weeks from the official establishment of the fund to accepting grant proposals is an unrealistic timeline for civil society organizations to come back with a proper review of the proposal requirements and the process. In addition, the mechanisms for giving away this money are not fully established.

A dollars first, proposals second, civil society engaged … maybe last approach to rolling out this fund means huge issues when it comes to ensuring this money will effectively go to empowering lower- and middle-income countries for pandemic preparedness.

As with so many things in global health, I fear that the fund’s donors will have more power than recipient countries, since that is where the money is being generated from.

Participatory or neocolonial global health architecture?

The World Bank says it wants to make The Pandemic Fund a participatory, inclusive mechanism. Its development shows it is anything but that.

With rushed timelines for civil society feedback, an expedited process for selecting civil society representatives, and a failure to learn from successful global health mechanisms like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the World Bank has not done nearly enough to make The Pandemic Fund all that it hopes to be.

The new fund’s current governance model is exclusionary, leaving out — or at best tokenizing — key stakeholders like governments of lower- and middle-income countries and affected communities. In fact, only two representatives from civil society organizations were added as interim members of the fund’s board as an attempt to correct this obvious misstep. Additionally, no resources were provided to support their membership, and the time commitments make it nearly impossible for these members to significantly engage with the fund, since they hold full-time, high-demand jobs leading their organizations.

The fund also reinforces a uniquely Western approach to health care and development rather than truly partnering with and empowering lower-to-middle-income countries to find solutions that work for them. It is akin to hosting a dinner party, having full control over the menu and environment and seat assignments, then inviting someone to it and asserting all is well as they “had a seat at the table.”

Having a seat at the global health table means being a partner from the beginning, not being the recipients of force-fed predetermined structures, even if the feeding is done in a very benevolent manner.

What does actual progress look like?

The good news is the World Bank need not look too far afield to find a playbook for a workable structure. There are many success stories of collaboration between national governments, domestic and international civil society organizations, corporate and philanthropic actors, donor countries, and global mechanisms such as the World Health Organization, UNICEF, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. These can serve as a guidebook for the World Bank.

While the Global Fund isn’t perfect, it takes a useful approach to funding and grants. Instead of sprinting to raise funds before receiving proposals and engaging civil society, it collaborates with low- and middle-income countries on the preparation and implementation of grants, and monitors and assesses activities through various review structures and mechanisms to ensure that program funding achieves its intended purposes. Imbedded in this structure is an increased sense of partnership and citizen engagement that fosters equity versus the fault power imbalance that emerges from a donor/recipient relationship.

It isn’t too late for The Pandemic Fund to put low- and middle-income countries and civil society organizations at the center of ideation and decision-making instead of inviting them to the table for scanty breadcrumbs.

Vineeta Gupta is a maternal and child health physician and a human rights lawyer who currently serves as the secretariat director at ACTION Global Health Advocacy Partnership.


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