Funding Challenges Facing Public-Private Partnerships in Powering a Global Pandemic Warning System
HSR.health Chief Medical Officer preparing to see COVID-19 patients early in the pandemic.
In life, we all have periods that truly change our perspectives and alter our focus. As an anesthesiologist and healthcare worker on the frontlines, the COVID-19 pandemic represented just such an event. We were dealing with an unknown deadly invader with little or no knowledge on how to treat or mitigate its effects. Consequently, we donned biological containment suits to protect ourselves, and separated critically ill patients on ventilators from their families to prevent further spread. Sadly, many of these patients died without their family by their side and forced front line providers, particularly nurses, to take on the role of both healer and extended family. As this saga unfolded in early 2020, and we began to secure the necessary equipment, knowledge, and manpower required to fight off this deadly disease, a glimmer of hope began to appear. The hope came from the realization that the ability to prevent this global catastrophe from happening again was a truly attainable goal if the global community harnessed the technological and scientific resources to drive innovations that defied gravity and bureaucratic rules to save lives.
According to the World Health Organization, there have been nearly 800 million confirmed cases of COVID-19, including close to 7 million deaths as of April 2023. COVID has shone a glaring, unending spotlight on how fragile our systems are – the very systems we take for granted that provide the foundation to ensure and nurture secure healthy lives, both at home and around the world. The loss of life and loss of the everyday things we took for granted will leave lasting, traumatic scars no matter how resilient we are. The health, economic, emotional, and spiritual toll has been debilitating.
But what if we could have had much earlier indications of this impending global crisis? What if our global world had an integrated and coordinated system that could have prevented or mitigated against the devastating toll of life? What if?
Recently, I had the honor of joining other thought leaders at the  Milken Institute Financial Innovation Lab: Innovative Finance Models for a Global Early Warning System (EWS) for Pandemics session in New York City. The session was an opportunity for leaders to discuss and devise new business models, policy recommendations, capital structures, and financial technologies to achieve one big, ambitious and bold goal: support the creation of a global pandemic early warning system.
The Innovation Lab focused on two key components necessary for the development and maintenance of a global early warning system: data needs and innovative financing models. The data discussion centered around the types of data needed as well as the infrastructure development for data curation, discoverability, accessibility, storage, sharing and governance, privacy, and analytics. The discussion on financial models concentrated on creating incentives for the private sector to invest in the development of an early warning system. At its core the need for public-private partnerships was seen as critical to provide the accessibility, interoperability, and standardization needed for a robust early warning system. The global pandemic demonstrated in clear terms that this was not just a health crisis. The pandemic ushered in quarantines, mask mandates, product shortages, idled factories, business closures, and businesses scrambling to figure out new ways to keep their doors open. Supply chain issues and inflation is a byproduct that we are still grappling to handle.
Financing New Approaches
Despite the economic devastation caused by the COVID-19 pandemic, estimated at $13.8 trillion globally[1], the uncertainty over the frequency or severity of future global disease threats and the economic effects has become a black swan. Private sector investment will require the development of models that can incorporate health risk data to predict and quantify the market impact of major global health emergencies. Moreover, these insights will most likely need to identify the sector and geography that will be most severely impacted. Traditional investors, such as hedge funds, could then utilize this information to make sector or region-specific investment decisions based on health risks.  Such a framework would encourage greater private investment in developing and implementing an early warning system. An initial step would be to pilot the utilization of disease surveillance data, for example those around zoonotic spillover and other new disease emergence risk, in the development of novel financial instruments that would provide both sector and region-specific insights on economic indicators that could be utilized in investment decisions.
The venture philanthropy approach to the development and maintenance of an early warning system is gaining some traction. The concept involves the creation of a data insights exchange to develop a model library – or catalog – that could be utilized by stakeholders across both the financial and healthcare communities that anticipate and assess health risks. For example, risk indices around supply chains, business disruption, and insurance may be particularly valuable for the financial sector. Traditional investors would be incentivized to provide seed funding for the development of such risk insights as well as an insights exchange. Such investment may require a longer time horizon to achieve an ROI, which can be addressed by promising larger multiples on the original capital. The insights exchange would price models and services based on a tiered approach. The offering would range from pure curated data to the development of advanced dashboards with significant operational support.
Stakeholder Engagement: Why a Global Early Warning System Must Be Part of ESG Discussions
It is critical that a governance structure for the insights exchange also involves public sector stakeholders for several reasons. Firstly, the public sector is providing a significant amount of financing toward the development of an early warning system. However, a more important consideration is that the insights created through the exchange must be utilized by public sector agencies responding to health emergencies. If health departments are to use the early warning system to make operational decisions, then these entities must have confidence in the process utilized to develop the models housed in the library. Another opportunity for public-private partnerships may be around environmental, social, and governance (ESG) data. Governments around the world are starting to create incentives around the collection and reporting of ESG data. The insights exchange could serve as an ideal infrastructure to incorporate ESG data points given the overlap with the datasets needed to support early warning predictions. It is apparent that if structured properly an early warning system will produce multiple opportunities for public-private partnerships both to foster social and environmental justice and in the prediction of global health risk emergencies.
The sustainability of such a system can only be assured through the development of models that incentivize private sector investment, foster public-private partnerships, and create a data infrastructure that is standardized, interoperable, and capable of predicting global health emergencies.
A Look Ahead
We have been through a lot, but the tough part starts now. We cannot afford to let the last three years and the millions of lives lost and families impacted be in vain. We must act and act now to develop an early warning system. This is literally a life and death situation and will require collective action between public and private sectors. No one sector can solve and address the magnitude of the challenges and the predicted frequency of viruses alone.
The recent Milken convening brought together the right stakeholders to achieve the collaboration necessary for the development and deployment of key solutions for the advancement of mankind, such as an early warning system. The Milken Institute and its Financial Innovations Lab should be commended for doing so. I look forward to working with the Institute and all stakeholders to address the challenges in building, financing, and deploying a pandemic early warning system to advance the capacity of global public health and bring benefits to other sectors and save lives around the globe.
[1] Source: Projected economic losses through 2024, from IMF, Centre for Economic Policy Research, Statista