“I don’t think it’s one thing or the other,” said Harley Feldbaum, head of strategy and policy at the Global Fund to Fight AIDS, Tuberculosis and Malaria. “I’m sure you could suggest elements of the global health community that are more or less focused on, you know, getting back on track towards the original sustainable development goals versus fighting Covid versus thinking about future pandemics. But when you bring it back to people and health systems, there are overlapping capabilities, and they’re not antithetical to each other.

The push to strategize around pandemic preparedness is partly rooted in the signals governments around the world are sending, global health officials have said. For example, as cases wind down in the United States, hospitals are beginning to deactivate official Covid units that have operated for the past two years. The Centers for Disease Control and Prevention has recalculated the current risks posed by Covid-19 in the country, allowing more state and local officials to reduce public health mandates such as masking in schools.

In order to emerge from the emergency phase of Covid-19, governments and multilateral organizations are beginning to issue massive budget requests for pandemic preparedness.

In the past few weeks alone, the Biden administration has presented a new preparedness plan. Capitol Hill lawmakers have launched a new bill outlining funding priorities for domestic and international preparedness. And the G20 is calling for $75 billion in international public funding to close the gaps in pandemic prevention and preparedness.

Health advocates and officials leading the race to vaccinate the world have long feared that the money they got could disappear as soon as rich countries have vaccinated the majority of their people. Now they see those dollars potentially earmarked for preparedness rather than efforts to end the Covid-19 pandemic.

That may be true, a senior European official told me.

“There’s not an unlimited amount of money out there,” the senior EU official told me. “There have to be priorities. We can try to do both at the same time. But the money has to come from somewhere.

This rhetoric worries representatives of the global health community – worried that not only is funding for Covid-19 dwindling, but that general interest in global health is starting to wane. On that February night at dinner in Munich, attendees noted, albeit indirectly, that the intensity with which governments and multilateral organizations had attacked the Covid-19 issue in 2020 and 2021 was beginning to fade.

“The concern of many who worry about low-income countries is that in the West, while the pandemic is perceived to have subsided or become manageable…that [countries] will turn to other pressing issues and crises,” said Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations, who attended the dinner. “I mean, we’re talking about it here at a Ukraine-dominated conference.”

Just two years ago, the same world health leaders who attended the Munich dinner in 2022 buzzed in a hotel cafe bar about rising SARS-Co-V cases. -2 and sought to avoid the worst-case scenario of governments failing. to contain the virus, allowing it to spread across the world, killing millions. Representatives from regions across Europe, Southeast Asia and Africa all rushed to meet with these leading global health institutions to learn and prepare for what was to come. Officials knew these global health officials were going to be the ones to lead the way in finding ways to stop Covid-19 wreaking havoc around the world. Their organizations have collectively gobbled up billions of dollars in funding.

But by the time conference attendees reached the Bayerischer Hof in 2022, Covid-19 seemed like an afterthought. The conference had turned into a real-time crisis planning session on Russia’s likely invasion of Ukraine. Officials met to solidify NATO plans, sanctions and arms transfers to Kyiv. There were a few signs about global health and the pandemic, but for the most part conference badge holders rushed into the hotel to find out if and when Ukrainian President Volodymyr Zelenskyy would arrive.

Okonjo-Iweala said there has been a similar decline in interest in finding funds for pandemic preparedness.

“We’ve spent $26 trillion to fight the pandemic… but aren’t we ready to spend $75 billion to start prevention now? This is wrong,” she said, referring to a recommendation a panel of experts made to the G20 earlier this year. “I’m a former finance minister, I know budgets are tight and it’s very difficult. But leaders must unite. Where is the political will?

Over dinner in Munich, Hatchett said he had offered an alternative approach — one the US government and others in Europe have encouraged in previous years.

“One of the challenges is that a pandemic is often treated as a health crisis and, when it comes to low- and middle-income countries, as a development issue,” Hatchett said. “We need to understand pandemics [as] a security threat. If you see it as a security threat, then many trade-offs – are we focusing on health system strengthening or pandemic preparedness? – fall because you take pandemic preparedness out of a fixed health budget or a development budget.

The budget discussion — how to keep putting money in for Covid efforts while providing funds for preparedness — is one that has consumed Capitol Hill lawmakers and Biden administration officials.

Last week, the administration asked Congress for a small fraction — less than $5 billion — of what USAID needs in 2022 to help put the shots in developing countries. In its official request, the administration stressed that it would reassess the funding situation later in the year and find other ways to step up its support for the global fight against Covid if needed.

Meanwhile, organizations like COVAX and the WHO are reassessing their approach to Covid-19 vaccination efforts now that case numbers are falling.

Representatives of both have acknowledged in interviews that officials and scientists in developing countries around the world are beginning to factor in past infection rates when calculating immunity levels. By doing so, countries could decide not to order as many doses in 2022, said Seth Berkley, CEO of Gavi, the vaccine alliance and leader of COVAX.

“Each country has to decide what it wants,” he said in an interview last month. “We don’t know how much these [prior infection] coverage rates are. The second thing we don’t know, of course, is the future. My own view is that we should definitely try to cover the high-risk population with vaccination. »

Berkley said COVAX is working with countries to identify specific vaccination needs, including how many doses governments want to order in advance, what type of vaccine they prefer to get and where they want it. distribute. The tailored response will help COVAX help governments administer effectively.

Much more needs to be done to ensure low- and middle-income countries have the doses they need and have the resources on the ground to distribute them, said Kate O’Brien, director of immunization at the WHO.

“We have to remember that for the countries that have the lowest coverage, their supply flexibility has only really been open since November. It really wasn’t before that that they had a predictable supply,” she said in an interview last month. “We are in the early days. It’s kind of like comparing the contemporary era we’re in now for low-income countries to what it was for high-income countries in April 2021.”

Part of the problem with gunfire in developing countries is that too few resources have been devoted to helping countries get the infrastructure and medical personnel they need to run large-scale vaccination campaigns.

“There are a lot of people who want to get vaccinated, but you have to make it easy for them,” said Orin Levine, director of vaccine distribution at the Bill & Melinda Gates Foundation.

USAID, in coordination with COVAX, is making it a priority to help countries with weaker health systems develop plans to increase immunization rates in 2022. There are still 30 countries that have levels below 10%.

As global health organizations try to keep their Covid-19 funding and continue to help protect vulnerable populations and simultaneously prepare for the next pandemic, they are also trying to revamp their existing programming. Intense attention to Covid-19 over the past two years has reversed progress in campaigns against HIV, tuberculosis, malaria and vaccination, according to global health experts.

The Global Fund recently announced that the world needs $18 billion to get back on track with this programming while fighting Covid-19 and preparing for the next pandemic.

“It’s like we’re all trying to walk and chew gum at the same time,” a global health advocate working in Washington told me. It’s a slogan that many have used to describe the dichotomy between continuing to focus on scaling up vaccinations against Covid-19 and also preparing for the next pandemic.

“We use this term because it is really true,” laughed the lawyer. “We have to do everything. But in reality, there are issues that concern us more than others.

For the Biden administration, walking and chewing gum is the goal. It must meet its international covenants on Covid-19, but it must also find ways to protect Americans from the next large-scale outbreak, which top health officials say could occur within the next few years.

“We need to do both,” said Loyce Pace, assistant secretary for global affairs at the Department of Health and Human Services, during a recent briefing with reporters in Geneva. “What I think we can and should do is say, ‘OK, well, how can we improve our Covid response so that it helps Covid and also prepares us? I don’t think it’s about stopping one and starting another because… some of the actions we’re taking now or seeing them as dual purpose.