Evolution of the World Bank Response to Infectious Disease Outbreaks:From a Reactive to a Proactive Approach

Six major infectious disease outbreaks have occurred in rapid succession in the twenty first century causing an estimated $80 billion in economic losses and many lives lost. The World Bank Group (WBG) was not prepared to respond quickly and effectively to contain the spread of these outbreaks. It reacted too late to the earlier outbreaks but slowly improved its response time and its coordination with major stakeholders. The response time of its financing contribution decreased across the six infectious disease outbreaks ranging from two years (Avian Influenza) to two months (Zika). The organizational structure of the WBG partly accounts for slow decision making with functions of the Board of Directors intertwining managerial decisions with its governance role in contrast with more agile decision making by management in comparable large private companies. The delays in part caused by the WBG sui generis organizational structure have been corrected with the Board’s pre-approval of pandemic emergency funds especially following the lessons learned from the still late response to the Ebola crisis. The strategic shift from a reactive to a proactive strategy to finance a potential outbreak has now put in place tools and resources prior to the occurrence of an outbreak applying the triple goals of preventing, detecting and responding. A key proactive decision has been the creation of the US$375 Pandemic Emergency Financing Facility (PEF) approved by the Board in May 2016 to enable management to respond quickly in the event of an infectious disease outbreak before it becomes a regional epidemic or a worldwide pandemic. Additional proactive measures initiated, under execution or already concluded include a Crisis Response Window as part of the International Development Association 2018 (IDA 18) agreements that could allocate US$3 billion for natural disasters, economic crises, and health emergencies; IDA 18 financial support to at least 25 countries in developing pandemic multi-sector preparedness plans; simulation exercises; simulation exercises; a regional network of public health laboratories in East Africa; the West Africa Regional Disease Surveillance Systems Enhancement Program; financial and technical support to the Africa Center for Disease Control (CDC), and an operational framework for investing in One Health.