The COVID-19 pandemic appears to be uniting the world’s major powers and donors in a spirit of strong solidarity – with the notable exception of the political powers of the United States and China – and major global health entities are beginning to describe their strategies related to this coronavirus.
So far, the World Health Organization is fulfilling its mandate in occupying center-stage, globally, and leading on clinical, technical and epidemiological information on COVID-19. The Global Fund has instituted new flexibilities within its grants. Major countries such as the United States, the United Kingdom and some countries in Western Europe have announced their own economic stimulus packages. Below we summarize some of the measures put in place by the WHO, the Global Fund, the World Bank Group, PEPFAR, and the G20.
Strengthening WHO’s mandate and ability to respond
On the public-health front directly, the G20 countries agreed, at an ‘extraordinary’ summit held virtually on March 26 (see more below) to share data and materials, strengthen WHO’s mandate, and to “quickly work together and with stakeholders to close the financing gap in the WHO Strategic Preparedness and Response Plan”, which WHO says needs “at least $675 million for critical response efforts in countries most in need of help through April 2020”. WHO also noted that as the outbreak evolves, funding needs are likely to increase.
The G20 committed to “provide immediate resources to the WHO’s COVID-19 Solidarity Response Fund, the Coalition for Epidemic Preparedness and Innovation (CEPI) and Gavi, the Vaccine Alliance” but the promise of “immediate resources” was quickly mitigated by saying this would be “on a voluntary basis,” per country. It is not yet clear what the result of that commitment translates into, in terms of countries’ decisions about their respective additional resources for WHO.
In mid-March WHO launched its COVID-Solidarity Response Fund, which in two weeks has raised $108 million from more than 200,000 individuals and organizations.
So far, the critical response efforts funded by WHO – more of which presumably will be funded by the Solidarity Fund – include activities to track and understand the spread of the virus, ensuring patients get the care they need, buying and shipping essential supplies such as masks, gloves and protective wear for frontline workers, producing and disseminating guidance and advice for health care workers, accelerating efforts to develop vaccines, tests and treatments.
Concretely, this translates into helping countries with critical supplies, information and training, for example: supplying 1.5 million diagnostic kits to 120 countries; the buying and shipping of emergency medical supplies to 745 countries, including 795,000 surgical and N95 masks, 987,000 gloves, 96,000 gowns, 22,000 goggles; producing 40 technical guidance documents for healthworkers, schools, the workplace and the general public; launching the WhatsApp-based Health Alert Messaging Service (which reached more than 10-million users within three days); and building countries’ response capacities with multilingual online courses on the OpenWHO platform, which has had more than one million enrolments.
The bottom line
As for actual money pledged for fighting the pandemic and its economic impacts, the big money from the major global donors and countries seems mostly dedicated to economic stimulus packages, given the business fallout as a result of near- or total lockdowns in many countries. More than $4.6 trillion has been pledged or put into COVID-19-related initiatives, Devex has reported. This includes government-supported initiatives worth $2.9 trillion focusing on mitigating the economic impacts of COVID-19, including $1 trillion from/for the United States (the U.S. later announced a $2-trillion package). Country-specific initiatives account for two thirds (67%) of the $2.9 trillion, while multi-region initiatives account for the remaining third.
Multilateral insitutions are supporting 65 initiatives worth $1.1 trillion, and the European Union is investing $1 trillion into 11 initiatives, Devex said, including $41 billion into coronavirus-related health expenditures in Eastern and Western Europe. Once again it is difficult to grasp what this will mean, practically, for countries.
The Global Fund’s commitments on COVID-19
In early March the Global Fund issued new guidelines allowing countries some flexibility in using savings from grants or reprogramming 5% of their approved current grants for HIV, TB, malaria or health systems strengthening – amounting to up to $500 million across the portfolio – for COVID-19 related activities, “to mitigate the potential consequences of the pandemic on existing programs to fight HIV, TB and malaria”. The Global Fund recommends that particular attention should be given by countries to health-worker protection, communication with affected communities, maintenance of essential services, supply chain coordination, early replenishment of stocks, disinfection of assets, and waste management. (See separate article in this issue for details on the Global Fund’s new guidelines and on countries’ responses so far.)
The Global Fund has also updated its funding request submission dates for 2020 (see separate article in this issue), to provide greater flexibility for applicants to submit their funding requests as soon as they are ready.
Global Fund Director of Communications Seth Faison gave this comment to the GFO on 1 April:
“We see a potentially catastrophic scope for COVID-19 in countries where the Global Fund has grants, threatening to derail HIV, TB and malaria programs, overwhelm community and health systems, and cause death at a speed and scale likely not seen since 1918. We are doing our best to take swift action to respond to the COVID-19 crisis alongside the WHO and global health partners. Our partners in countries now using Global Fund resources to prepare for COVID-19 are already working hard to purchase essential health products to limit the spread of the virus, and to prepare diagnostic tools as well as health systems and equipment to treat those affected by the disease. In virtually every country, health workers are one step ahead of governments and general populace in recognizing the seriousness of the pandemic and the importance of taking strong measures.
While there is limited confirmed data so far on the direct impact of COVID-19 on HIV, TB and malaria programs, we are highly concerned about negative impact. People living with TB are clearly more vulnerable to COVID-19; Malaria interventions including mosquito net distribution, seasonal malaria chemoprophylaxis and treatment of childhood fever require face-to-face interactions that may be restricted when systems are overwhelmed; people living with HIV with compromised immune systems, are also likely to be prone to Covid-19. Providing continuing access to treatment during closures and lockdowns will be a big challenge, and the most vulnerable people will likely get the least access to quality health care. For all these reasons, we’re doing as much as we can.”
World Bank Group
Also in early March, when the world was beginning to realise that COVID-19 was not just a problem for China and its immediate neighbours (WHO had not yet declared a pandemic), the World Bank Group announced a $12-billion financing package to support countries in their responses to SARS-CoV-2, the virus that causes COVID-19. (On 17 March announced a further $2 billion, bringing the total to $14 billion.) The funds come from three of the group’s five branches: the International Bank for Reconstruction and Development (IBRD), the International Development Association (IDA), and the International Finance Corporation (IFC).
The funding is intended to support national health systems, disease containment, diagnosis, treatment and the private sector, Devex reported. The $8 billion coming from the IFC will go to financial institutions which will in turn lend to businesses. This will include those in the health care sector and other related sectors experiencing increased demand for their services as a result of the pandemic. The group’s initial support will focus on countries identified as the most vulnerable, according to WHO’s risk and vulnerability assessments.
PEPFAR, USAID and the United States
The $2-trillion package announced by President Trump on March 27 includes some funding for the United States’ international development efforts – including the World Bank’s IDA and IFC, and the African Development Bank – but most of it is focused on the country’s domestic response to COVID-19.
PEPFAR head Deborah L. Birx, the U.S.’s Global AIDS Coordinator, and Angeli Achrekar, the principal Deputy U.S. Global AIDS Coordinator, released a statement on March 23 saying that PEPFAR was “deeply committed to continuing global progress toward controlling the HIV epidemic – country by country, community by community.”
The statement continued to say that in joining the world in confronting “the unique challenges posed by the novel coronavirus (COVID-19), we are dedicated to doing what is needed to serve, support, and protect our clients, communities, staff, and partners around the world.
To advance these efforts, the statement said, PEPFAR would be taking action in four priority areas: (1) ensuring continuity of care for people living with HIV, (2) leveraging PEPFAR-supported health systems and infrastructure, (3) reducing exposure of staff and clients to health care settings that may be overburdened and/or sources for potential exposure to COVID-19, and (4) Providing flexibility for our programs in how to optimally serve our HIV clients in areas affected by COVID-19.
On March 26, when the global number of COVID-19 infections was around , the G20 nations held an ‘extraordinary’ video summit convened by Saudi Arabia’s King Salman, who is the current President of the G20. The summit focused on collective commitments, described in a 3-page statement released by the G20 declaring: “We are determined to spare no effort, both individually and collectively, in order to protect lives, safeguard people’s jobs and incomes, restore confidence, preserve financial stability, revive growth and recover stronger, minimize disruptions to trade and global supply chains, provide help to all countries in need of assistance, and coordinate on public health and financial measures.”
The summit did not, however result in immediate investments of tangible cash for fighting the pandemic, focusing instead on broad commitments to safeguard the global economy, address international trade disruptions, and enhance global cooperation, the statement said.
As more concrete information becomes available from other major global health donors and partners, and from countries, the GFO will report further on additional funding to assist countries that have Global Fund grants in their responses to COVID-19.
- ‘Global Fund Issues New Guidance in Response to COVID-19’, 4 March 2020
- The Global Fund’s news release on supporting countries in response to COVID-19, 23 March 2020
- The Global Fund’s COVID-19 hub
- Devex’s ‘World Bank, IFC look to quickly deploy COVID-19 Funds’, 20 March 2020