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Excerpted From:  Nita Madhav, Ben Oppenheim, Mark Gallivan, Prime Mulembakani, Edward Rubin, and Nathan Wolfe, Chapter 17 Pandemics: Risks, Impacts, and Mitigation, Jamison DT, Gelband H, Horton S, et al., editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27. doi: 10.1596/978-1-4648-0527-1/pt5.ch17 (References Omitted) (Full Document)


Few data are available regarding costs and cost-effectiveness of pandemic preparedness and response measures, and they focus almost exclusively on HICs. The available data suggest that the greatest cost-related benefits in pandemic preparedness and response are realized from early recognition and mitigation of disease—that is, catching and stopping sparks before they spread. Costs can be reduced if action is taken before an outbreak becomes a pandemic. Similarly, once a pandemic has begun, preventing illness generally is more cost-effective than treating illness, especially because hospitalizations typically have the highest direct cost per person. High costs also may occur as a result of interventions (such as quarantines and school closures) that lead to economic disruption. These interventions may be more cost-effective during a severe pandemic.


No systematic time-series data exist on global spending on pandemic preparedness, and arriving at an exact figure is complicated by the fact that many investments in building basic health system capacity also support core dimensions of pandemic preparedness. An analysis of global health spending found that roughly 1 percent of global ODA spending on health in 2013 (approximately US$204 million) focused specifically on pandemic preparedness. Other, non-ODA spending on pandemic preparedness is similarly difficult to measure but likely to be significant; in 2013, the U.S. Department of Defense spent roughly US$256 million on efforts to build global biosurveillance and response capacities.

Globally, the current funding for pandemic preparedness and response falls short of what is needed. In 2016, the international Commission on a Global Health Risk Framework for the Future recommended an additional US$4.5 billion annual global investment for upgrading pandemic preparedness at the country level, for funding infectious disease research and development efforts, and for establishing or replenishing rapid-response financing mechanisms such as the World Bank’s PEF .

Costs for efforts associated with pre-pandemic preparedness activities also are not well quantified, although investment in One Health activities is likely to be cost-effective. The USAID PREDICT project has estimated that discovery and detection of the majority of zoonotic viruses would cost US$1.6 billion. The Global Virome Project, a more comprehensive study aiming to characterize more than 99 percent of the world’s viruses, is estimated to cost US$3.4 billion over 10 years. Building on efforts to identify and describe the ecology of potential pandemic viruses, the Coalition for Epidemic Preparedness Innovations (CEPI) estimated a cost of US$1 billion over five years to develop vaccine candidates against known emerging infectious diseases (for example, Ebola virus) and to build technology platforms and production facilities to accelerate vaccine response to outbreaks of known or unknown pathogens.

Instituting response measures after a pandemic has begun can be expensive, with most of the direct cost borne by the health care sector, although response costs typically are not reported in a cohesive manner. As noted, the response to the 2014 West Africa Ebola epidemic cost more than US$3.8 billion, including donations from several countries. Additionally, the World Bank Group mobilized US$1.6 billion from the International Development Association and the International Finance Corporation to stimulate economic recovery in the three worst-affected countries of Guinea, Liberia, and Sierra Leone. Taken together, at US$5.4 billion, these values amount to a cost of US$235 per capita for these three countries.


Vernellia R. Randall
Founder and Editor
Professor Emerita of Law
The University of Dayton School of Law