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6
Sustainable Financing for Global
Disease Surveillance and Response
“At this time of global economic downturn, we face a crossroads. We
can cut back on health expenditures and incur massive losses in lives and
fundamental capacity for growth. Or we can invest in health and spare
both people and economies the high cost of inaction.”
—Ban Ki-moon
Secretary-General of the United Nations
Remarks at the Forum on Global Health:
The Tie That Binds (June , 00)
International funding is necessary to develop and sustain a global zoo-
notic disease surveillance and response system. Developing an international
financing framework especially to assist resource-constrained countries will
be challenging. The existing international aid architecture for combating
zoonotic diseases is fragmented, and fostering multisectoral cooperation
between human and animal health at the local and global levels has proven
difficult. Donor funding is unpredictable, especially during a global eco-
nomic crisis. At the same time, innovative financing tools and mechanisms
can provide new ways to modify the existing international aid architecture
to create long-term, predictable funding streams. This chapter provides
an overview of the current environment for investing in zoonotic disease
surveillance and discusses possible financing solutions.
FUNDING ANIMAL DISEASE SURVEILLANCE
As discussed in Chapter 2, the development and implementation of
animal disease surveillance—usually as part of national animal health in-
frastructure, especially in the United States—was a result of the recognition
that herds free of selected diseases could translate into broader social and
economic benefits. Public investment in animal health helped facilitate ex-
port growth by enabling the movement of disease-free animals and related
products into new markets and countries. The resulting disease surveillance
systems were structured around defined hierarchal relationships address-
ing governance and geography (local, state, federal), with the government
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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
having oversight in the collection, summary, validation, and reporting of
disease surveillance information.
Decentralized Disease Surveillance as an Emerging Concept
An important characteristic of animal disease surveillance has been the
centralized manner in which data have been captured. This provides for the
establishment of defined standards and processes and can help to ensure
accuracy and consistency in reporting. It is a clear-cut approach that is most
achievable with adequate resources, expertise, legal frameworks, aligned
objectives, and sustained commitment; unfortunately this is not the case in
many countries. During an international response to a zoonotic disease, a
number of different stakeholders may often hold or withhold information
or resources depending on their particular incentives and objectives. A more
centralized approach can mitigate some of this, but the growing reality is
that the open economy and globalization are presenting both challenges and
opportunities for how future disease surveillance systems will be defined
and funded. The issues can be complex and layered, but possibilities are
emerging as paradigms shift, relationships change, communities evolve, and
technology advances.
Investing in Human and Veterinary Health
Infrastructure and Disease Surveillance
The level of global economic interdependence is increasing, and econo-
mies are increasingly bound to the overall sanitary status of a country.
It would seem only logical that governments and industry would make
the necessary and ongoing investments in human and animal health and
veterinary infrastructure, but that is not always the case. The public and
government officials often have short attention spans and are challenged
by competing interests for limited resources. As a result, ongoing invest-
ment often takes a back seat to more pressing issues. Government invest-
ments may not be commensurate with the significant value of national
resources—with proportionally little designated for disease surveillance.
This is particularly the case for the veterinary sector. Complicating these
issues is the lack of continuity and leadership in ministries of agriculture,
where time spent in office can be politically short-lived. This transience
filters down through multiple layers in the organization because a change
in ministers is usually accompanied by a broader reorganization. Coupled
with low salaries in the public sector, this situation requires repetitive cycles
of basic training. Furthermore, this hinders the effectiveness of countries
as member states within important international organizations. Each year,
the World Organization for Animal Health (OIE) convenes its 174 member
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SUSTAINABLE FINANCING
countries and territories to discuss and approve new international health
standards. OIE estimates that a full one-third of the chief veterinary of-
ficers who come each year are newly installed. By the time these heads of
delegation learn how best to represent their countries, many are replaced
and the cycle continues.
The fact that many developing countries request technical support and
financial resources from the international community undoubtedly reflects
the poor internal state of affairs in their human and animal health infra-
structures. In addition, the veterinary workforce is limited even though
many infectious diseases are discovered by the veterinary community (e.g.,
viral cancers, retroviruses, lentiviruses, transmissible spongiform encepha-
lopathies such as bovine spongiform encephalopathy, rotaviruses, papillo-
maviruses, coronaviruses, ehrlichioses) and later turn out to be of human
and animal health importance. Veterinarians and animal health profession-
als are an essential component in detecting zoonotic diseases earlier and
therefore preventing infection in humans. But more fundamental issues may
also be inhibiting long-term growth and sustainability. Money is a neces-
sary, but insufficient, condition for sustained change.
The international community jolted into action when it became clear
that the highly pathogenic avian influenza (HPAI) H5N1 strain was on Eu-
rope’s doorsteps and could pose a human health risk at a global level. The
United Nations World Health and Food and Agriculture Organizations,
the World Bank, and OIE sponsored international conferences. Banks,
aid agencies, and nations themselves pledged nearly $3 billion to combat
the disease and address the alarming human and animal health concerns
(Government of Egypt, 2008). In many ways, the response was a positive
example of the international community coming together to attack a global
threat. But putting out a fire and addressing the underlying causes of the
fire are two different goals.
A recent World Bank report (2006a) on the extent of the needs and
gaps in the development of a financing framework for the next pandemic
emphasizes the need for medium- and long-term planning. The main con-
cern for this strategy is the endemic nature of HPAI H5N1 in the Southeast
Asia region. So far, most of the economic impact of HPAI H5N1 in the East
Asia region is occurring in the rural economies. The gross domestic prod-
uct (GDP) impact in East Asia economies has been restricted to a 0.1–0.2
percent loss in countries such as Vietnam. However, the economic impact
associated with severe acute respiratory syndrome resulted in a 2 percent
loss of the regional East Asian GDP in 2003 (World Bank, 2005).
Short-term emergency actions such as disease control or eradication1
1 In animal health, eradication of a specific disease is considered on a nation-by-nation
status.
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0 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
and improving infrastructure—including ongoing disease surveillance—
while not mutually exclusive, are not a single endeavor. Eradicating a
disease requires specific skill sets and large financial outlays for direct field
activities such as vaccination or herd depopulation (culling). Building an
adequate and sustainable human and animal health infrastructure that in-
cludes critical components such as disease surveillance, on the other hand,
requires raising the overall levels of technical capacity, building human and
financial capital, and fostering collaboration between the public and private
sectors. The scope goes beyond any one disease to the ability to proactively
address multiple potential emerging diseases and to permanently raise the
country’s sanitary status.
Independent, international financial support can actually hamper long-
term sustainability of a recipient country’s infrastructure. In many coun-
tries, funding for human and animal health infrastructure competes with
other government programs for public funds. Most of that money is tied
up in salaries for existing personnel, so little remains for program opera-
tions. Tight budgets mean that capital improvements are difficult to carry
out. Therefore, what the international community may regard as “bridge
funds” until the country can put in place a more sustainable approach
becomes the primary source of funding, underwriting a variety of program
activities, ranging from field supplies and diagnostic equipment to vehicles
and fuel for data collection. Ironically, the presence of a disease makes pos-
sible a coveted inflow of resources that might not otherwise be available
and reduces the need for elected officials to make tough choices regarding
the priority of human and animal health within the national agenda. The
inflow of external resources also relieves the immediate pressure to establish
longer-term national solutions. When external resources are withdrawn,
the infrastructure regresses, but the impacts may not be felt until the next
disease crisis.
Countries are at varying stages of advancement regarding their national
infrastructure, but two factors stand out as making a critical difference: the
level of interaction between the public and private sectors, and continuing
leadership. Those countries whose veterinary infrastructures are on the up-
swing benefit from a private sector that invests its time and resources into
strengthening the national infrastructure—similar to its efforts to develop
new animal feeds, secure better genetics in its breeding stock, or push into
new markets. In countries where animal health infrastructures are weak,
mutual distrust or apathy may exist between the two sectors. This can be
reflected in allegations of corruption, incompetence, and lack of vision and
continuity. Simply injecting external resources under these conditions can
mask these underlying problems and prolong the difficult tasks of fortifying
national infrastructure and improving relations between the two sectors.
The conditions for sustained investment begin by taking a more inte-
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SUSTAINABLE FINANCING
grated approach and creating the foundation for addressing critical com-
petencies, such as current and future disease surveillance—starting with a
shared vision between the public and private sectors. Essential to this vi-
sion is the establishment of trust, transparency, and clearer communication
between the two sectors. Although financial resources are also important,
they are not a panacea. Equally important are changing attitudes, building
bridges for collaboration, and continuing leadership. When these happen,
an environment of empowerment prevails that weans countries from the
belief that little can happen without external resources; much is within
the country’s control, and is less reliant on international organizations or
funding. If sustained, the process leads to a set of priorities with measurable
outcomes that gauge incremental progress.
Any type of centralized disease surveillance requires a sustained com-
mitment over time on the part of both the public and private sectors. The
private sector sees investment in veterinary infrastructure as good business
practice, and decreased exposure to disease is a way to protect the private
sector’s investment and to open new market opportunities. The public sec-
tor helps ensure that benefits accrue from the greater public good of an
elevated sanitary status. However, in practice, financial resources across
countries have varied, ranging from those largely reliant on public expendi-
tures (e.g., United States) to those raising resources from the private sector
(e.g., Australia and New Zealand) to appropriate and implement public
sector activities.
CURRENT FUNDING EFFORTS
Regardless of the proportions of fiscal contributions from any sector
or the relationship between them, the funding needs for developing and
sustaining a global disease surveillance system for emerging and reemerg-
ing zoonotic diseases will be significant. Recent concerns about a potential
highly virulent human influenza pandemic have resulted in coordinated
international action to help countries improve their ability to detect dis-
ease outbreaks. The funding efforts for these actions have been led by the
World Bank, which has used two main mechanisms to provide assistance
to countries with avian influenza and to prepare for a possible pandemic.
These mechanisms are the Global Program on Avian Influenza (GPAI) and
the multi-donor trust fund known as the Avian and Human Influenza (AHI)
Facility.2
2 The Global Program on Avian Influenza sanctions loans, credits, or grants up to $500
million from the concessional arm called the International Development Association. The
program uses an integrated approach developed with the United Nations World Health and
Food and Agriculture Organizations and the World Organization for Animal Health. The
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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
GPAI and the AHI Facility were conceived as concerted efforts by
the United Nations (UN) and some multilateral and bilateral agencies to
respond to the growing threat of HPAI H5N1 and to prepare for the next
influenza pandemic. In September 2005, the United Nations Secretary-
General appointed a System Influenza Coordinator (UNSIC). UNSIC was
a key factor in developing a strong partnership among technical agencies
such as the World Health Organization (WHO), the Food and Agriculture
Organization of the United Nations (FAO), and OIE, and other bilateral
and multilateral partners, including the World Bank. The partnership
focused on developing a flexible and responsive framework to provide
financial and technical support at country, regional, and global levels. Both
urgent and long-term needs were targeted. The 2008 progress report by
UNSIC and the World Bank provides an analysis of the response to HPAI
H5N1 and the state of pandemic readiness (UNSIC and World Bank,
2008). Although it does not provide detailed information on spending for
areas such as laboratory and human capacity building, there is a detailed
breakdown by sector of the funds disbursed by October 2008: 24 percent
for animal health, biosecurity, sustainable livelihood; 36 percent for human
health and pandemic preparedness; 14 percent for information, education
and communication; 11 percent for supporting implementation monitor-
ing, evaluation, and internal coordination; and 15 percent designated as
other (UNSIC and World Bank, 2008). Although these World Bank opera-
tions identify funding to support country, regional, and global levels of
HPAI H5N1 pandemic preparedness, they also support the discussion in
Chapter 5 about the importance of and challenges to country incentives
to report an outbreak.
Additional resources were provided directly from bilateral sources and
the European Commission through WHO and FAO, and to a lesser extent
through OIE, and to individual countries. They showed a much better
disbursement rate than the multilateral development agencies. As Table
6-1 shows, the bilateral donors committed a total of $1.4 billion USD, of
which 90 percent was disbursed on April 30, 2008; the European Union
funds can be used to improve the health and veterinary services of the countries, prepare and
respond to the pandemic influenza, and minimize the threat to its populations. The funds go
through the World Bank’s emergency procedures and therefore can be quickly prepared and
approved. It is a trust fund located at the World Bank under a partnership that is led by the
European Commission, and other donors such as Australia, China, Estonia, Iceland, Korea,
the Russian Federation, Slovenia, and the United Kingdom. The Avian and Human Influenza
(AHI) Facility helps developing countries meet their financing gaps within their integrated
national plans to minimize risk and socioeconomic impact of the pandemic on humans and
animals. As of January 2009, the total pledged commitment to the AHI Facility was more than
$126 million equivalent (World Bank, 2009a).
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TABLE 6-1 Avian and Human Influenza Pledges, Commitments, and Disbursements as of April 30, 2008 (US$ million)
Inter-ministerial Meetings
Percentage
Donor Beijing Bamako New Delhi Totalc Commitmentd Disbursemente Disbursed Uncommitted
Australia 56 55 111 100 67 67% 11
Canada 87 87 91 40 44% —
France 31 10 7 48 50 34 69% —
Germany 29 8 4 41 41 30 73% —
Japan 155 67 69 291 297 297 100% —
Netherlands 14 7 21 22 10 44% —
Russia 24 8 32 32 29 92% —
United Kingdom 36 18 10 65 61 51 83% 3
United States 334 100 195 629 629 629 100% —
Other EU Countriesa 31 11 11 42 53 48 90% 6
Other Countriesb 33 4 4 41 33 31 94% 10
Subtotal Bilateral Donors 742 376 290 1,408 1,410 1,266 90% 30f
European Commission 124 83 111 319 241 140 58% 79
Asian Development Bank 468 468 83 13 16% 385
African Development Bank 15 15 7 4 63% 8
World Bank 501 501 313 69 22% 187
Subtotal Multilateral Development Banks 969 15 984 403 87 22% 580
Grand Total 1,835 474 401 2,710 2,054 1,494 73% 689
NOTES: Donors’ reports of amounts committed and disbursed from calendar year 2005 and to April 30, 2008. Uncommitted amounts are net of
commitments in excess of pledges.
aAustria, Belgium, Cyprus, Czech Republic, Estonia, Finland, Greece, Hungary (which has retracted its pledge due to lack of response from recipi-
ent country), Ireland, Italy, Luxembourg, Slovenia, Spain, and Sweden.
bIceland, Korea (Republic of), Norway, Saudi Arabia, Singapore, Switzerland, and Thailand.
cTotal of pledges from the three international conferences on avian and pandemic influenza (Bamako, Beijing, and New Delhi).
dCommitment is defined as the result of an agreement between the donor and recipient for designated purposes; a commitment is a firm decision
that prevents the use of allocated amount for other purposes.
eDisbursement is defined as the actual budget transfer or release of funds to the recipient for an intended purpose.
fThis number represents the portion of total donor pledges that remain uncommitted. As some donors have committed more than their pledged
amounts, this number does not correspond to the difference between the total (1,408) minus the total commitments (1,410).
SOURCE: UNSIC and World Bank (2008).
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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
committed a total of $241 million USD, of which 58 percent was disbursed
on that date; and the Multilateral Development Banks had committed on
that same date $403 million USD, of which only 22 percent was disbursed
(UNSIC and World Bank, 2008).
In countries where outbreak reporting is hampered only by the avail-
ability of financial and technical resources, these programs are likely to
improve disease surveillance information. However, in countries that could
afford their own programs if desired, these resources would either displace
national resources for disease surveillance or be misspent if incentives for
the country to detect and report an outbreak are not changed.
In addition, the global approach to finance widespread prevention or
control of HPAI H5N1 needs to consist of multisectoral coordination and
integrated response at the national, subnational, and global levels as de-
tailed in recommendations from the FAO, OIE, WHO, UNSIC, UNICEF,
and World Bank Strategic Framework (2008), prepared for the Sharm
el-Sheikh Inter-ministerial Conference on Avian and Pandemic Influenza.
Consequently, some of the policy issues that can emerge correspond to the
fact that most resource-poor nations lack the resources for the development
of training and capacity-building programs of this nature (World Bank,
2006a).
Completing HPAI H5N1 Control Activities
The recent joint Strategic Framework (FAO et al., 2008) reports that
of the $2.7 billion pledged in the subsequent international Inter-ministerial
Meetings, a total of $2 billion has been firmly committed or already ex-
pended for the human and animal control cost of HPAI H5N1. The break-
down of the expenditure provides that about 41 percent ($853 million)
was directed to national programs, about 25 percent ($510 million) to in-
ternational organizations, 15 percent ($301 million) to regional programs,
and the remaining 19 percent ($386 million) to other programs, including
research. This expenditure pattern seems to deviate somewhat from the
earlier declaration of the Beijing conference, the first inter-ministerial meet-
ing on control of HPAI H5N1, which declared that “individual countries
are central to a coordinated response.” The novelty of the threat, which
caught the international community and international organizations by
surprise, is probably the reason for the bias toward international programs.
Future funds could, most likely, be more directed toward national govern-
ments. The Strategic Framework also reports a shortfall in the current
programs of $836 million, mainly because of unmet pledges. Most ($440
million, or more than 50 percent) of this shortfall concerns the sub-Saharan
subcontinent.
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SUSTAINABLE FINANCING
Developing Global Capacity
The Strategic Framework (FAO et al., 2008) makes a very approximate
assessment of the costs of a permanent global disease surveillance system,
acknowledging that in preparing these estimates, provided in Table 6-2,
this was “an art, not a science” (FAO et al., 2008, p. 44). These tentative
cost estimates are provided for 49 low-income countries and for all 139
low- and middle-income countries. The table reflects the much higher need
per country for the low-income countries and includes a basic infrastructure
establishment and operation, and special investment in 40 “hotspot” coun-
tries, as described in Table 6-3 under global responsibility. The estimates
also account for previous investments already carried out under the ongo-
ing AHI Facility. It also includes the approximate estimate of the needs to
complete the current campaign, which is based on the considerable number
of already prepared Integrated National Action Plans (140 by September
2008). They were based on an assessment by joint human and animal
health specialists. They were based on early detection and response to HPAI
H5N1. The study committee conducted rough estimates regarding the cost
to scale up these HPAI H5N1 needs to survey and control of multiple spe-
cies. This will come close to International Health Regulations 2005 (IHR
2005) surveillance requirements. The annual additional financing needed
over the next 3 years would range from $542 million to $735 million. Based
on the working paper for this assessment (FAO et al., 2008), more than
50 percent (nearly $6 billion) would be operating costs, and the remain-
ing $5 billion would be investments in hardware (laboratories, equipment)
and human skills (training, etc.). The rather high share of operating costs
reflects the major infrastructure investments already made under the current
HPAI H5N1 campaign and is based on 2008 prices without inflation.
TABLE 6-2 Estimated Cost of Funding the One World One Health
Framework to 2020 (millions of US$)
Category of Expenditure 49 Low-Income Countries 139 Eligible Countries
Prevention:
Human and animal health services 1,264 3,083
Veterinary services 3,286 5,476
Wildlife monitoring 1,495 2,495
Communication 583 1,167
International organizations 3,180 3,475
Research 420 420
Total 10,228 16,116
Average per year 852 1,343
SOURCE: FAO et al. (2008).
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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
FUNDING A GLOBAL PUBLIC GOOD
Policymakers generally agree that the responsibility for funding has
to be divided among international, national, and local public and private
sources. The most common key criteria being applied to decide which of
these sources is responsible for a particular service are (1) the degree of
externalities involved in the consumption of those goods (i.e., the extent to
which they are a public good); (2) whether these goods are mostly global,
national, local, or private; and (3) the capacity to pay. Conceptually, it fol-
lows logically that the global community funds the global public goods; the
national and local public sectors, respectively, fund the national and local
public goods; and the private sector funds private goods. Because of their
transboundary nature, protection from highly infectious zoonotic diseases
is generally considered a global public good.
Preventing the emergence and cross-border spread of human and ani-
mal highly infectious diseases conforms to this definition and is generally
considered to be a global public good. Less infectious and hence more local
disease risks—such as rabies or bovine tuberculosis—are by their nature
national or local public goods, often also with private goods characteris-
tics. Their control benefits the local population, and in the case of animal
diseases, the individual private owner.
One important issue in this context, however, is whether to include
equity and poverty alleviation as criteria for deciding whether a disease is
a global public good. From a global social perspective, this would be ap-
propriate. Poverty alleviation is a key Millennium Development Goal and
explicitly defined as a global responsibility. This discussion has specific
relevance in the case of zoonotic diseases because they are typically the
“diseases of the poor,” affecting their health and that of their animal stock
proportionally more than other types of diseases. However, this would have
major repercussions on the funding requirements, and hence in this report,
the zoonotic diseases of a lesser transboundary nature are classified as a
national public or private good.
Most public goods, including those of global characteristics, are im-
pure; they have components with various degrees of exclusion or rivalry
and thus present a mixture of public and private goods. Disease surveillance
systems have such characteristics. They cannot be disease specific, but un-
derpin the prevention of emergence and spread of highly infectious diseases,
which is recognized as a global public good. Surveillance for all diseases is
therefore considered a global public good. Control is much more disease
specific, and hence becomes a national, local, or private good in the case of
disease of low human epidemic nature. These considerations are reflected
in Table 6-3.
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SUSTAINABLE FINANCING
TABLE 6-3 Disease Prevention and Control Activities at the Human–
Animal–Ecosystems Interface and Their Status Level as a Public Good
Disease of Moderate
Disease of Low Human to High Human
Activity Epidemic Potential Epidemic Potential
1. Preparedness
Risk analysis Global Global
Preparedness plan National/regional Global
Privatea
Animal vaccine development Global
2. Disease surveillance
Human and animal health, veterinary Global Global
and wildlife
Diagnostic capacity Global Global
Managerial and policy arrangements National Global
3. Outbreak control
Rapid response teams National/regional National/global
Vaccination National/regional/private Regional/global
Cooperation among human, veterinary, National Global
and wildlife services
Compensation schemes National/private Global
4. Eradication plans National/regional/private Global
5. Research National/regional/private Global
aThis may also be a global public good depending on diseases and circumstances
(context).
SOURCE: Adapted from FAO et al. (2008).
FUNDING MECHANISMS
All industrialized and middle-income nations need to have responsi-
bility for funding their own disease surveillance systems, a sentiment also
reflected in the Sharm el-Sheikh Framework Document. Industrialized coun-
tries also have the responsibility to fund research to develop surveillance
and control technology. Low-income countries, however, have multiple and
immediate needs competing for limited resources. Quite understandably,
a long-term investment in the operation of a disease surveillance system
cannot be feasibly prioritized above other needs for low-income countries.
International funding is therefore necessary and fully justified in view of
the global public good involved, as well as the human and animal health
and economic benefit that the international community derives from early
detection of a potential health or economic (trade) risk.
For the international funding of a disease surveillance and early re-
sponse system in low-income countries, the classical and still current way
such investments are funded consists of a time-bound (mostly 3–5 years),
project-based investment, with the external investor (mostly bilateral or
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GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
international donor or financing agencies) funding most of the infrastruc-
ture costs (laboratory, transport, etc.) and some initial operating costs. In
this model, the recipient country funds part of the operating costs and is
expected to continue to fund the activity after the time-bound project ends.
Long-term financing by these international agencies is often not possible
because of internal budgetary procedures, parliamentary approval cycles,
policy changes, and geopolitical considerations. This model has major
constraints funding the national part of the operating costs, with even
greater problems in low-income countries to maintain the operation after
the international financing stops. Pre-project commitments of governments
are difficult to enforce in the post-project period, and the general scenario is
one of a high activity level when external financing is available. This is fol-
lowed by a low activity level when the external funding stops. For a system
that is expected to provide a continuing service to the global community,
such a “boom and bust” model is not recommended.
The constraints of many poor countries may prohibit their provision
of the necessary funding and consequently their participation in any glob-
ally sustained efforts of disease surveillance for preventing and control-
ling emerging zoonotic diseases. This situation would result in the typical
“weakest link” problem, whereby a country with poor capacity and no
resources would jeopardize the efforts of all others. The committee con-
cludes that the global tasks as described in Table - clearly require new,
more innovative ways of fully or partially funding their costs to replace the
current boom and bust model. The committee reviewed several options for
funding this global public good:
• Long-term twinning arrangements between human and animal
health institutes of high-income and resource-poor countries, funded by
specific budget lines in those high-income countries;
• Long-term commitments of governments to fund WHO/IHR 2005
and FAO/OIE in supporting global disease surveillance systems;
• Establishment of special endowments through nonconventional
donors;
• Imposition of a levy on internationally traded meat; and
• Other public–private partnerships.
The fund, regardless of its sources, could provide the full costs of
global disease surveillance (infrastructure and recurrent costs) or only the
recurrent costs because international funding generally is available for the
hardware investments.
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SUSTAINABLE FINANCING
Long-Term Twinning Arrangements
Under this option, governments from high-income countries, through
their human and animal health institutions, would commit to permanent
support for their counterpart institutions in resource-poor countries. This
would require a long-term engagement of the high-income country, and,
in line with its budgetary procedures, be an integral part of the budget of
those agencies in the high-income country, and not be seen as a time-bound
contract. For the high-income country, this would have the advantage that
it could select the group of countries it likes to sponsor, for example, based
on the risk that an outbreak of a zoonotic disease poses to its own human
or animal health. Another positive aspect would be the long-term capacity-
building opportunities for the recipient country. This model has already
been used, for example, by Australia in several Sanitary and Phytosanitary
Measures Agreement-related aspects in Southeast Asia. Drawbacks of such
an approach would be a certain fragmentation of approaches because
the agencies of the high-income countries would tend to establish their
own standards and procedures. Another disadvantage would be that the
dependence on a national budget, even of a high-income country, would
still introduce a degree of fickleness. An additional issue to address in the
aspect of twinning support is ensuring that reagents and samples can be
exchanged easily. Documentation required for shipment and receipt of
biological materials has increased dramatically since 9/11 and can prolong
diagnosis time.
Long-Term Commitments of Governments to
Fund WHO/IHR and FAO/OIE
This would imply that high- and middle-income countries directly
commit to permanently support a funding mechanism established by inter-
national agencies. This would enable a full implementation of IHR 2005,
which is now underfunded, and would enable FAO and OIE to continue
their current support to developing countries, when their funding for HPAI
H5N1 concludes, which will be 2010 for most funds. Contributions could
be channeled in specific funds, such the OIE World Animal Health and
Welfare Fund, and the FAO Special Fund for Emergency and Rehabilita-
tion Activities. A key requirement would be that the three international
agencies (WHO, FAO, and OIE) and other donor agencies establish close
cooperation mechanisms on priority countries and hotspots, on minimum
requirements to be funded and other funding criteria, and fully support the
principle of an integrated human–animal (and ecosystem) health system. If
not, this option could lead to fragmentation, duplication, and an overall
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inefficient use of resources. As in the case of the twinning arrangements, this
option would also depend on the long-term commitment of high-income
countries, and whether that commitment is likely to waver.
Establishment of Endowment Funds Through Nonconventional Donors
Nonconventional donors and foundations and a few conventional do-
nors generally have a longer investment and support span than most other
conventional donors, and funding could be on a regular basis or toward
the establishment of an endowment. The establishment of an adequately
resourced endowment would be the most appropriate solution, but, if es-
tablished, is unlikely to be able to fund the amounts necessary in the near
future, and other sources would need to be identified. This would still have
some of the disadvantages of the earlier options.
A Levy on Internationally Traded Meat
Although several levy sources would be possible, one option to be con-
sidered in more detail would the imposition of a levy on meat trade from
middle- and high-income countries. Developed countries are the major ex-
porters of meat (see Table 6-4). A meat levy to control emerging pandemics
would be directly related to the global public good of control of zoonotic
diseases. As in the twinning arrangement, it would provide an incentive
to the middle- and high-income countries because a strong global disease
surveillance and early alert system would help to protect their food-animal
production sector against the introduction of other contagious animal
diseases, such as foot-and-mouth disease. Under the same argument of
enlightened self-interest, the levy would have to be collected by the export-
ing country, and it would be relatively easy to collect by customs offices.
Importing countries have more limited incentives to protect their own
food-animal population. The meat levy would not apply to the low-income
TABLE 6-4 Value of Meat Export by Country Income Category Group
Bovine Meat Other Meat and Edible Offal
Live
Country Group (in billions of US$, 2005 data) Animals
Middle- to high-income countries 20.1 36.5 11.6
Resource-poor countries 0.8 1 0.5
Total 20.9 37.5 12.1
SOURCE: Adapted from ITC (2009).
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SUSTAINABLE FINANCING
countries it is raising funds to assist. By exonerating resource-poor3 coun-
tries from this levy, this would allow their emerging food-animal production
sectors to grow and develop rather than be penalized.
The meat levy would not include live animals because of the difficulty
in collecting such a fee and the potential unintended consequence of sending
the live-animal trade “underground,” leading to more illegal trade. Disad-
vantages of such a levy would be the political sensitivity to the imposition
of fees (although small as shown below) in an era of globalization and
promotion of free trade, its legality under current World Trade Organiza-
tion rules, and other impacts, such as the potential for increased illegal
importation of bushmeat. Strengthened disease surveillance systems, which
would be the intended result of such a funding mechanism, would also help
to reduce such illegal trade of bushmeat. However, more study and consul-
tation with policymakers and other stakeholders is required to fully assess
the political and technical implications of such a financing mechanism.
This proposed funding mechanism would have the advantage of well-
established systems of levy collection, as many commodity groups or gov-
ernments funding national public goods have used such dedicated levies
(Nugent and Knaul, 2006). Examples are the imposition of transaction
levies on food-animal sales by producers to fund marketing and research
on meat in Australia (MLA, 2009); slaughter levies to fund food-animal
production insurance against major disease outbreaks in the Netherlands
(World Bank, 2006b); and an export levy to fund agricultural research in
coffee in sub-Saharan Africa (UNU/INTECH, 1995). These levies directly
benefit the producers. The same would apply to the meat levy—this would
reduce the risk of infection of notifiable disease and the resulting ban of an
exporting country, and therefore be in direct interest of the exporting coun-
try. “Check-off” dollars are used in the United States to fund marketing
programs for food-animal products. The UK government also just proposed
a new arrangement to fund an independent body for animal health, which
can raise a levy from food-animal keepers in England through mandatory
insurance to recover the costs of dealing with exotic disease outbreaks
(Defra, 2009).
While these dedicated levies are generally considered an effective way
of securing sustainable funding for a public good, less is known about a
levy for a global public good. The proposed levy on air traffic to be man-
aged by the Global Environment Facility (GEF, 2009) to finance climate
change adaptation is one example. A similar levy is another possible source
of funding for global disease surveillance, but there are no ongoing opera-
3 Defined as the countries meeting the International Development Association eligibility
criteria of $1,095 USD (World Bank, 2009b).
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0 GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES
tions in the fields of human and animal health. One example, which ap-
proaches a global fund similar to the type the committee has advocated, is
proposed in a recent feasibility study on the creation of a Global Emergency
Response Fund for Animal Epizootics and Zoonoses prepared for the OIE
and World Bank conference, Global animal health initiative: The way for-
ward. This fund would provide developing and transition countries with
immediate funding to cover the cost of control measures and food-animal
owners’ compensation costs (Alleweldt et al., 2007). It is still in its initial
phase, but has had, until now, limited success in attracting funds.
With an estimated 24 million tons of meat exported from developed
countries (OECD, 2009), the incremental costs for the meat levy could vary
between $0.03 per kilograms (kg) if all costs were covered (of the US $836
million shortfall) and $0.015 per kg for operating costs only. The funds
needed to be generated by these permanent streams would thus be reduced
by about 50 percent, from $800 million to $400 million.
Public–Private Partnerships
Opportunities should always be left open to also involve the private
sector directly in the funding of global surveillance and response teams.
Global food supermarket and restaurant chains have a direct interest in
preserving animal and human health, as emerging zoonotic diseases have
serious economic repercussions. Typically, until now, they have protected
their own herd/flock health, but with past experiences, for example in East
Asia, where HPAI H5N1 outbreaks have seriously affected demand for
poultry products, they have become more interested in contributing to a
wider national or regional surveillance and response system.
THE INSTITUTIONAL ARCHITECTURE
The institutional architecture would have to be in line with the fund-
ing option selected. Under the twinning arrangement, the main issue is the
harmonization of standards and areas to be covered to achieve compatible
data and complete coverage. Ensuring a coordinating role of the technical
agencies for these tasks is important. To directly support funding the inter-
national agency, coordination among international agencies is even more
important. In this case, an overall coordinating body might be needed to
ensure an appropriate distribution of funds. A similar framework would
be required for the endowment and levy option. In these cases, the man-
agement could be entrusted to a global entity, such as a United Nations
agency (e.g., the United Nations Central Emergency Response Fund or
UNSIC) or a fund managed by an international funding agency. Activities
could be implemented through the technical agencies WHO, FAO, and
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SUSTAINABLE FINANCING
OIE and any additional agency, such as in the areas of communication
and wildlife management. However, to avoid conflicts of interest, these
technical agencies should not be charged with the overall management of
such a funding mechanism. Alternatively, not necessarily all funds have to
be channeled through a global-level institution or institutions; individual
developed countries can decide based on their own geographical and insti-
tutional preferences and maintain their own sustainable funds. Coordina-
tion could be provided through annual inter-ministerial meetings (Bamako,
Beijing, Delhi, Sharm el-Sheikh). This was the model for the HPAI H5N1
campaign after the Beijing conference, and it has worked well. More study
is clearly indicated.
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