to ensure that money does not hold back effective pandemic response” (WGB Press Release, 22 May
2018).
The PEF shares similarities with several other funding mechanisms, but has important distinctions. The
WHO’s Contingency Fund for Emergencies (CFE), for example, can be used for early response to a variety
of health and humanitarian emergencies, including natural disasters. There are also some insurance plans
in play for natural disaster risks, such as the Caribbean Catastrophe Risk Insurance Facility
(CCRIF). Unlike these efforts, the PEF is unique in that it is activated at a level of higher severity than the
CFE and only applies to pandemics, not all types of catastrophe.
The PEF is composed of both a cash window and an insurance window. The activation criteria for the
PEF insurance window of $425 million includes thresholds of outbreak size, growth, and spread, covering
six specific viruses (including the pathogens which cause SARS, MERS, Ebola, Marburg, Crimean Congo
hemorrhagic fever, Rift Valley fever, Lass fever, and new influenza). All 77 poorest countries in the world
which are eligible for the World Bank’s International Development Assistance (IDA) grants are also eligible
for the PEF. The premiums, $37 million annually for potential payout of $500 million, are paid by
Germany and Japan. Private investors earn interest on the bonds but could lose capital in a massive
outbreak.
While PEF’s insurance window requires set criteria, the cash window is more flexible. The purpose of the
cash window is to provide coverage for new or unknown pathogens not specifically listed in insurance,
enable a mechanism for partners to donate to nations in crisis, fund severe outbreaks in a single country,
and finance situations for pathogens covered by the insurance which have not yet met the activation criteria
in terms of outbreak size and growth. The cash window consists of a $61 million commitment from
Germany and could be resupplied by another national donor.
An eligible country affected by a disease outbreak must apply for funds and have its response plan reviewed
by WHO for the PEF to proceed. A steering group of donor countries, experts, and WHO advisors makes
final funding decisions. The PEF funding can also be applied to international responders addressing the
outbreak. The PEF has been officially operational since July 2017, with its cash window in effect summer
2018… just in time for its first historic use.
On 8 May 2018, the Democratic Republic of the Congo declared an outbreak of Ebola. The outbreak first
occurred in Bikoro (northwestern Equateur Province) but spread to Mbandaka, a large city with
transportation links to the capital. This location increased concerns of the disease spreading rapidly.
The government of the DRC released a 3-month response plan which would require $56.8 million. On 22
May 2018, after an emergency meeting, the PEF made its first historic financial commitment of a $12
million grant from the PEF cash window. The funding was split between financing DRC government
health response activities and international responders working in the affected areas. In addition to the
PEF funding, the WBG reallocated $15 million for another project to the Ebola response, and $25 million
was committed to the response by other donors. As such, within two days, the response plan was entirely
funded by partners and the government.
The day after the outbreak was declared, a response team from WHO arrived. Within a week and in record
response time, vaccinations were available from Geneva, and within two weeks of the outbreak, a ring
vaccination campaign began of people who had been in contact with those who had contracted the
disease. Teams surveilled the virus and engaged with communities where it may have spread, raising
awareness, promoting safe burials, and improving capabilities for response readiness in bordering
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