It’s not too Late to Stem the Third Wave of the Coronavirus Pandemic: Bottom-up Approaches to Pandemic Response
Maryam Zarnegar Deloffre
It’s a matter of time before the Corona virus (COVID-19) pandemic engulfs the developing world in its third wave. Crisis-affected and developing countries in the Middle East, Africa and South America with weak health care systems and capacity; low levels of basic water and sanitation facilities; crowded urban centers, slums, and refugee camps; poor disease surveillance; and weak government capacity will struggle to contain the pandemic. Social distancing is not possible in a refugee camp, and it is ineffective without adequate testing and contact tracing; hand-washing is not feasible without soap and running water. These underlying conditions, existing vulnerabilities, and low levels of resilience make fertile ground for disease spread. The medical emergency will devastate the fragile economies, food security, and development outcomes in these already vulnerable countries. Yet the cataclysmic potential of this third wave has garnered very little global attention and even less global action. It is painfully obvious that global cooperation to fight the pandemic is necessary, but also, unlikely. The COVID-19 pandemic has revealed long-standing weaknesses in global humanitarian and health cooperation, however, decades-long reforms in both sectors provide three bottom-up solutions states can support to mitigate the effects of the third wave: build on existing coordination structures, flexible funding and localization.
Challenges to Global Cooperation
In 2014 the United Nations Security Council (UNSC) adopted Resolution 2177 stating, “the unprecedented extent of the Ebola outbreak in Africa constitutes a threat to international peace and security,” which led to the creation of the UN Mission for Ebola Emergency Response (UNMEER) the first-ever UN system-wide emergency health mission (Deloffre 2016). Today, a similar type of global response is unlikely for three reasons. First, world leaders have repeatedly invoked the analogy of war when addressing their nations about the COVID-19 outbreak. By framing the pandemic as a threat to national security, states communicate a zero-sum view of the crisis, one that accentuates the role of the state in protecting its population, emphasizes unilateral and self-interested action, and subsequently produces competition for resources rather than striving for the absolute gains that come from cooperation, such as sharing medical research, technology and best practices. We saw this zero-sum logic on display as European Union countries reinstated borders and the American government tried to secure exclusive rights to a COVID-19 vaccine being produced in Germany. Whereas securitizing the 2014 Ebola outbreak mobilized collective action, securitization of infectious diseases such as H1N1 has typically backfired, incentivizing non-cooperative behavior based on narrow calculations of national interest over international collaboration on health (Elbe 2010).
Second, ongoing tensions between China and the U.S., both permanent members with veto powers, have stalemated action in the UNSC, dashing hopes for a similar type of decisive global action in reponse to COVID-19. Last week the U.S. blocked a joint statement of G7 foreign ministers because there was no support for its unilateral demand to replace the virus’ scientific name with the controversial phrase Wuhan virus.
Third, the dynamics of the COVID-19 pandemic are different from previous humanitarian and health emergencies; donor countries are overwhelmed with domestic responses; the headquarters of aid bureaucracies, located in New York City, Geneva and Washington D.C., are operating with limited capacity amidst confinement policies; global supply chains are disrupted as a result of closed borders, halted air travel, and increased demand of essential goods; and international non-governmental organizations (NGOs) cannot easily deploy medical experts or field staff. Since the World Humanitarian Summit in 2016, the mantra of humanitarian reforms has been “as local as possible, as international as necessary;” localization efforts might now be the only way to meet the growing challenges and increased humanitarian needs of crisis-affected areas during the pandemic.
Build on Existing Leadership and Coordination Structures: We can draw two important lessons for global cooperation from the Ebola outbreak in West Africa: new coordination mechanisms built in reaction to crisis are suboptimal, and pandemics should be viewed as a broad-based humanitarian emergency from the outset (Deloffre 2016). The UNSC resolution labeled the Ebola outbreak a security threat, however it was variably referred to as a ‘health event’ or a ‘humanitarian disaster.’ The Office for the Coordination of Humanitarian Affairs (UNOCHA), the UN’s designated agency for emergency coordination, viewed the Ebola crisis as a “systemic medical issue,” while the World Health Organization (WHO)—the global health arm of the UN charged with coordinating global health emergencies—argued the crisis demanded a response beyond its technical expertise (Deloffre 2016). Humanitarian affairs and health are interrelated policy areas, however each sector has its own funding mechanisms, practices, working groups, and coordination bodies, which create policy siloes and inhibit cross-sectoral collaboration. UNMEER was an unprecedented innovation designed to bridge these sectors and provide a whole-of-system response, but institutional and structural factors impeded true integration. UNMEER was ultimately organized around a health mandate, focused on the technical and medical aspects of disease containment, and employed a top-down approach that centered the UN bureaucracy and donors in decision-making (Moon et. al 2015; ICG 2015; DuBois et. al 2015).
Framing the outbreak as a health crisis had significant implications for the overarching response strategy; for one, UNMEER objectives primarily focused on implementing and funding health programs designed to end the Ebola outbreak, at the expense of investing in health infrastructure or treatment for non-communicable or other infectious diseases. In addition, UNMEER did not fully address a number of the wider social and economic consequences arising from the outbreak including the impact on food security and emergency shelter (Kamradt-Scott et. al 2015; Kahn 2015).
States should therefore resist calls to build new national or global coordination mechanisms. Instead, they should support the recently launched UN COVID-19 Global Humanitarian Response Plan (HRP). A massive undertaking, it requests US$2 billion to prevent and mitigate the effects of the pandemic on the most vulnerable and least resilient countries. The Global HRP outlines measures to contain the virus; to support wider public health efforts; to provide clean water and sanitation for handwashing; and to limit the impacts on economic and food security, as well as education, gender-based violence, and migration.
The COVID-19 Global HRP is being led by the UN OCHA, along with the WHO, and the Inter-Agency Standing Committee. With UN OCHA in charge, we should expect more coordination between the humanitarian, development and health sectors, as well as increased attention to food, economic, and personal security such as the protection of women and children. UN OCHA also has an established presence in these countries through its regional and country offices; this local presence and community connections facilitate localization, particularly when country offices are given flexible funding and authority to implement programming.
Localization: Localization strengthens the capacity of local and national community groups and NGOs to respond to crises. Hiring and training local staff to plan and implement humanitarian projects is one mechanism for improved localization. The total estimated number of humanitarian workers in the field continues to grow and most of this increase is accounted for by national aid workers (ALNAP 2018). These investments in local capacity will pay off in this crisis. Local and national responders enable a timely, appropriate, and quality response because of their proximity to and presence in crisis-affected communities; shared language and contextual knowledge; relationships with local religious leaders, government officials, ethnic groups and clans; and their use of participatory planning processes (Howe et. al 2019; Deloffre 2020). During the UNMEER response, Oxfam trained individuals in Sierra Leone to form Community Health Committees that analyzed barriers to disease prevention, case management and safe burials, and then designed programs to overcome these factors (Meredith 2015). UNMEER claims that the areas where the community was educated and actively engaged in the intervention exhibited the most success in reducing and eliminating the incidence of Ebola. Local NGOs working in conflict-affected contexts identify lack of direct funding and inflexible, short-term funding as two major impediments to scaling up their activities (Howe et. al 2019). Flexible funding and pooled funds are one mechanism to foster localization by directly donating to local and national responders.
Flexible Funding: Humanitarian need has increased consistently in the last decade as a result of violent conflicts, the protracted nature of humanitarian crises, and the exacerbation of vulnerabilities due to climate change (OCHA 2020). Even prior to the COVID-19 pandemic, UNOCHA estimated that nearly 168 million people would need humanitarian assistance and protection in 2020, their highest ever estimate (OCHA 2020). Yet, the unfortunate reality is that humanitarian programs are consistently underfunded. Between 2008-2017, 63% of consolidated funding requirements of UN appeals were met on average (ALNAP 2018). As of this writing, the current Global HRP for COVID-19 has been funded at 18%.
OCED-DAC countries, and in particular Germany, the U.S., and the United Kingdom, are typically the top donors of official development assistance which includes humanitarian aid. These countries are presently struggling to address the pandemic and its economic fallout in their own countries. Many donor states are considering reallocating pledged humanitarian funding for other programs to the COVID-19 response or restricting official development funding altogether. Diverting money from existing humanitarian programs to the pandemic response will further weaken healthcare, education, and food security systems and exacerbate underlying vulnerabilities (New Humanitarian 2020). The aid bureaucracies and legislatures of these donor countries are likely overwhelmed, which will slow down program and funding approvals for bi-lateral or multi-lateral aid.
To quickly and adequately finance the Global HRP, states should prioritize flexible funding mechanisms that improve local actor capacity, and are sensitive to community needs, context-specific, and responsive to crisis dynamics. Global mechanisms such as the Central Emergency Response Fund (CERF), pool funding before a disaster happens, positioning resources for quick allocation when necessary. CERF decentralizes decision-making by authorizing local actors and humanitarian country teams to allocate funding as needs arise rather than waiting on approval from bureaucracies in Geneva or New York (Deloffre 2020). Country-based Pooled Funds (CBPF) allow donors to pool their contributions into single, unearmarked funds to support local humanitarian partners in delivering timely, coordinated, and relevant assistance. During the 2014 Ebola outbreak, the Ebola Response Multi-Partner Trust Fund (MPTF) and Quick Impact Projects (QIPs), enabled coordination, facilitated rapid disbursement of funds, and to some extent empowered affected countries in the decision-making process for funding allocation (Deloffre 2016; UN 2015). Flexible funding mechanisms decrease funding uncertainty, increase responsiveness to local needs, and incentivize cross-sectoral planning to improve aid quality and effectiveness (Burkart, Besiou, and Wakolbinger 2016). Moreover, flexible funds are cost-effective; uncertainty about funding and delayed funds increase operating costs, whereas smaller amounts of funding received in a timely manner produce better outcomes (Burkart, Besiou, and Wakolbinger 2016). CERF is currently the second highest donor, behind the Japanese government, to the COVID-19 Global HRP.
To stem a surge of the virus in less developed and conflict affected countries in Africa, South America and the Middle East a system-wide response is necessary but given current realities, a top-down approach led, funded, and staffed by states, inter-governmental organizations and international NGOs is not feasible. But all is not lost. States should support the UNOCHA-led Global HRP, which views the COVID-19 response as a broad-based humanitarian emergency, by prioritizing localization and flexible funding. Major donor governments are overwhelmed by the pandemic in their own countries, yet they should recognize their borders do not protect them from disease spread. As UN Secretary General Antonio Guterres said during the COVID-19 response launch "The world is only as strong as our weakest health system." Acting swiftly will save lives.