Thread by @felixundstein

The @WorldBank's controversial suggestion for a new Pandemic Preparedness & Response (PPR) Fund shows what's at stake in global health financing. A 🧵...

1. The Bank asks for $10.5bn on the weak basis that a. PPR is important & b. "sustained focus" on PPR needs yet another trust fund. projects.worldbank.org/en/projects-op…

2. The Bank does not address the usual shortcomings of trust funds in health (e.g. donor dependency, complexity & obfuscation, lack of health systems work, crowding out other actors etc. - see bmj.com/content/358/bm…)

3. The suggested fund has four spheres of governance (financing, governing board, secretariat, implementation) & the Bank puts itself on all four of them. @WHO is relegated to mere "technical advisory"

4. Big donors will definitely have executive roles on the fund's governing board; recipient countries maybe (the Bank fears their "real or perceived conflicts of interest"...), @WHO likely not.

5. The money of this trust fund would come from big donors via regular replenishment rounds & mostly pay the Bank itself, WHO & other UN institutions, other MDBs & the IMF;

6. Money would be paid out via quarterly or semi-annual calls for proposals (this seems audit-heavy as the Bank already announces "regular reports based on individual progress reports")

7. Written responses from the public to the suggested fund (same URL above) are interesting to read: Norway's Gov. does not know whether it will pay into the fund, and wants to see WHO strengthened

8. Germany's @BMZ_Bund wants more power for WHO and for recipient countries. @AfricaCDC highlights the need for more #healthsystems work in LMICs (see also @olga_02138's comment on the Bank's history in health)

9. @WHO's @Economy4Health by @MazzucatoM and others is "deeply concerned" that LMICs, civil society and WHO itself are not more powerful on the governance board. It calls this fund a "business as usual" approach to global health financing.

10.@Economy4Health also point out that the Bank's fund does not learn from #COVAX's failure & weak response to #corporatepower (see pubmed.ncbi.nlm.nih.gov/34686103/); that it mostly circulates money within the UN; & that it is weak for relying on #pledges.

11. The @CGDev sees things differently, arguing that as an institutional arrangement this trust fund is "appropriate" as it helps lower income policymakers "to think beyond the short term".

12. @CGDev also argues that this fund can remain limited, as most countries are growing their way out of poverty anyways and must pay for "basic preparedness" such as pre-purchasing vaccines themselves.

13. Interestingly, even the #G20 wants to see @WHO at the heart of this fund. It also asks for more than just this fund, including conditional debt cancelling by the Bank & IMF, as well as LMIC tobacco taxes for example.

@WHO 14. Overall, the proposal and the responses indicate that the World Bank has not yet drawn major lessons from the @ACTAccelerator & #COVAX experiments.