27 May 2024
by Shunsuke Mabuchi, Head of Resilient and Sustainable Systems for Health and Pandemic Preparedness at the Global Fund

“Pandemic preparedness and response” wasn’t part of my job when I started working at the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2022.

I was hired to lead the organization’s work on health systems strengthening in the 120 countries where the Global Fund invests. (Strong health care capacity contributes to ending HIV, TB and malaria as public health threats, produces better health outcomes and delivers health services sustainably over the long-term.) The Global Fund has been investing in strengthening health and community systems for over 20 years.

At the time, “preparing for the next pandemic threat” wasn’t linked to “building a strong and resilient health system.”

And yet it was.

With the understanding that health systems strengthening is, in fact, the basis for preventing, preparing for and responding to future pandemics – we integrated the two. Over the next three years, the Global Fund is investing over US$6 billion – no other multilateral funder invests more in grants for health and community systems than we do – in health systems strengthening and pandemic preparedness and response in low- and middle-income countries.

Because strong health systems in every country – not just the wealthy ones – are absolutely essential to confront the next pandemic threat.

Whatever the next pandemic may be – an emerging zoonotic disease, existing epidemics like malaria that are surging in new places, antimicrobial resistance – it will not respect country borders. As we saw with COVID-19, we are all at risk.

I grew up in Japan – a country that has proven that fighting an infectious disease delivers much more than the benefit of halting that particular threat. It also creates resilient health systems that are truly universal.

In the early 1950s, Japan launched a massive nationwide effort to combat TB – at that time the biggest cause of death in the country – that combined the latest scientific tools, community mobilization, private sector engagement and determined efforts to reach the most marginalized communities. Many of the approaches that are deemed innovative in health systems today, such as grassroots experience informing high-level policy, local groups leading case-finding, and compulsory workplace testing, were pioneered in Japan decades ago.

Not only did Japan achieve dramatic reductions in TB infections and deaths, but it used this effort as the platform on which to create universal health coverage – a comprehensive health system available to all, with a strong public health component. Japan’s health system intervenes early, monitors patients thoroughly and, critically, aims to leave no one behind. Although no system is perfect, the country’s success against COVID-19 demonstrated the strength of this approach. By going all in to fight one disease, the health system as a whole becomes more powerful – and agile enough to confront a new threat.

We know that this approach works.

In the countries where the Global Fund invests, the same tools countries built to fight TB were used to fight COVID-19. When a patient fell ill with COVID-19 in Indonesia for example, a health worker tested them for the SARS-CoV-2 virus using equipment that was initially designed for TB testing. The results of the test were analyzed in a laboratory that was built with investments to fight TB. Integrated testing – screening for more than one disease at the same time – is becoming a primary tenet of many countries’ pandemic preparedness and response plans and is also key for making TB screening and testing more widespread. When we focus on the person, and not the individual disease, we build true pandemic preparedness.

And thanks to a robust health management information system built to support TB surveillance, the country was able to gather data to really understand the COVID-19 case distribution and respond accordingly with informed prevention and treatment strategies.

As global health partners gather at the World Health Assembly this week to consider a Pandemic Agreement, let’s keep one thing in mind: Going forward, pandemic prevention, preparedness and response financing must be integrated into existing health systems and disease control interventions to maximize efficiency, sustainability and equity.

This is the only way forward to build a healthier and safer world for all.


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