From HIV to Ebola to Zika, Dr. Jim Kim of World Bank makes a case for pandemic insurance

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World Bank President Dr. Jim Kim

“Legislatures are not set up to effectively and scientifically and in an evidence-based way respond to pandemics . . .”

WASHINGTON, DC – At the Center for Strategic and International Studies where he had come today to discuss how to prevent the next pandemic, Dr. Jim Kim, now President of the World Bank, recalled earlier visits, when the topics were HIV and tuberculosis. He remembers often, he said, the times before President Bush’s January 2003 announcement of the President’s Emergency Plan for AIDS Relief, when policy makers argued about the wisdom of treating HIV in Africa, in spite of the clear alternative then: “The 25 million people living with HIV in Africa would all just have to die.”

The subsequent success of HIV treatment globally, leading to 17 million people on antiretroviral treatment today, offered lessons that seemed unforgettable, he said.

Then, Kim noted, Ebola broke out in West Africa, starting in one small village in late 2013, sweeping into the capitals of three countries by the spring of 2014, and, with no large scale response until the autumn, going largely unchecked until close to the end of that year.

“How did we let it happen again?” he asked.

Today nearly as much economist as physician, Dr. Kim has a theory and it is that preconceptions are sometimes stronger than actual data. “We’re still working with mental models that hamper our ability to have higher aspirations,” he said.

It is one of the reasons, he noted, that policy makers can’t be counted on to act quickly in the face of dire and apparent health threats. “Legislatures are not set up to effectively, and scientifically and in an evidence-based way respond to pandemics,” he said.

Consider the reluctance evidenced even now, as policy makers argue how and how much to spend on responses to Zika. Then consider figures Kim presented of estimated annual costs of a “moderate to severe” global pandemic: at $570 billion, about 0.7 percent of global income. A more severe one, on the scale of the 1918 influenza pandemic, he said, would cost about 5 percent of global income, or about $4 trillion.

But Dr. Kim also has an alternative, announced last week at the G-7 Summit in Japan, a quick-release source of funding for pandemic responses, in the form of an insurance plan, and he was making the case for supporting it.

“People say is the insurance too expensive?” he said. “Expensive compared to what?”

The Pandemic Emergency Financing Facility got its first $500 million commitment from Japan last week. He knows the work ahead will be complicated.

But he believes that the plan also will promote concrete discussion of the work that a world better protected against pandemics will require. He contrasts that with the current situation, in which, he says, “we alternate between periods of total panic and complete neglect.”

Without the fundamental change to pandemic responses he hopes the new plan will promote, he says, he presents another alternative, in the form of a warning he attributes to U.S. Centers for Disease Control and Prevention leader Dr. Tom Frieden:

“There really is such a thing as being too late.”

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