From Crisis to Confidence: Building a Pandemic-Ready Asia and the Pacific

Pandemic preparedness has historically followed a cycle of panic and neglect. From the 1918 influenza pandemic to SARS (2003), H1N1 (2009), and Ebola (2014–2016), each outbreak triggered institutional responses that quickly faded once immediate threats passed. The 2019 Global Preparedness Monitoring Board report warned that the world remained dangerously unprepared for a fast-moving respiratory pathogen, estimating annual underfinancing at roughly $30 billion. By 2019, fewer than 40% of countries had achieved basic compliance with International Health Regulations requirements for surveillance, laboratory diagnostics, and risk communication.

The financing gap compounded governance weaknesses. Between 2016 and 2018, contributions to the World Health Organization Contingency Fund for Emergencies fell by over 30%. Most low- and middle-income countries lacked fiscal space to maintain surveillance and emergency-response functions between crises, relying on fragmented donor projects rather than stable domestic allocations. This left Asia and the Pacific particularly vulnerable despite early lessons from SARS and avian influenza.

The COVID-19 pandemic produced simultaneous health and economic shocks. Health systems faced acute overload—over 90% of countries reported disruptions to essential services, including maternal care, childhood immunization, and chronic disease management. Routine immunization coverage in Southeast Asia fell from 91% in 2019 to 83% in 2022, erasing nearly a decade of progress.

Economic fallout was equally severe. Developing Asian economies collectively contracted by 0.7% in 2020, their first recession in 6 decades. Between 108 and 166 million jobs were lost across the region in 2020 alone. Governments deployed fiscal stimulus packages of 5%–10% of gross domestic product (GDP), financed largely through deficit spending. By 2023, over 40% of low-income economies in the region were at high risk of debt distress. School closures averaging 41 weeks resulted in an estimated 0.8 learning-adjusted years of schooling lost per child.

Conservative estimates indicate that each dollar invested in preparedness globally can yield over $10 in avoided economic losses. A cost-benefit analysis estimates that COVID-like pandemic scenarios yield $1,703 in health gains and $1,102 in economic gains for every dollar invested in preparedness, while averting 49 to 124 deaths per 100,000 population. Annual global preparedness needs are estimated between $24.8 billion and $43 billion, with benefit-cost ratios exceeding 10:1.

Under-preparedness forces countries to pay twice: first through output loss, then through higher borrowing costs and reduced policy space. For Asia and the Pacific, where high population densities and trade openness increase exposure to cross-border pathogen spillovers, the costs of prevention and detection are estimated at least six times lower than response costs, with economic benefits exceeding costs by several multiples.

A pandemic-ready Asia and the Pacific rests on four interconnected pillars:

1. Globally networked surveillance and research. By 2023, fewer than one-third of low-income countries had achieved real-time linking of genomic data with clinical surveillance. Association of Southeast Asian Nations (ASEAN) Health Cluster 2, Asian Development Bank's (ADB) One Health Framework, and regional laboratory networks represent critical building blocks. Global modeling indicates that an additional $3 billion–$4 billion annually in surveillance capacity could avert $350 billion in GDP losses in a moderate-severity pandemic.
2. Resilient national systems. Countries with pre-existing emergency operations centers and surge-finance protocols contained outbreaks faster. Closing basic capacity gaps in 20 priority economies in Asia and the Pacific would require $6 billion–$8 billion annually, but yield avoided losses of over $100 billion in severe outbreak scenarios.
3. Equitable supply of medical countermeasures. Ten economies control over 80% of global vaccine production. Regional manufacturing ecosystems through initiatives like ASEAN's Vaccine Security and Self-Reliance initiative and the Quad Vaccine Partnership can shift the region from dependency to self-sufficiency. Reducing time from pathogen identification to vaccine availability from 9 months to 3 months could save $2 trillion–$3 trillion in global output losses.
4. Global governance and financing. The Pandemic Fund currently disburses less than $1 billion annually, a tenth of the required amount. Multilateral development banks must embed preparedness within sovereign lending frameworks through instruments such as the World Bank's Crisis Preparedness and Response Toolkit, which enables prearranged crisis financing and debt-service flexibility.

The pandemic revealed that health is not a self-contained social sector but a macro-critical domain that underpins economic stability, fiscal sustainability, and climate resilience. International financial institutions are transitioning from vertical disease interventions to integrated, systems-based financing linking health security, digital transformation, and climate resilience. The World Bank's Health Emergency Preparedness & Response platform and some of ADB's recent investments embed preparedness indicators directly into sovereign lending, treating health as fiscal planning rather than emergency aid.

The lessons from COVID-19 demand a fundamental transformation in how pandemic preparedness is financed and governed. For policymakers in Asia and the Pacific, three actions are critical.

1. Embed preparedness within national fiscal frameworks rather than treating it as emergency spending. Countries should integrate pandemic readiness into medium-term expenditure plans, debt sustainability analyses, and climate adaptation strategies—ensuring investments are protected from budget cuts during downturns.
2. Strengthen regional coordination mechanisms. ASEAN health networks and vaccine partnerships in Asia and the Pacific must evolve from forums into operational platforms capable of pooled procurement, real-time data sharing, and joint emergency response. Regional regulatory harmonization through mutual recognition agreements can accelerate access to vaccines and therapeutics.
3. Leverage multilateral development bank innovations. Instruments such as contingent credit lines, climate-resilient debt clauses, and blended finance mechanisms can expand fiscal space for preparedness without adding unsustainable debt. Governments should actively engage with multilateral development bank preparedness diagnostics and integrate health security metrics into sovereign risk assessments.

The coming decade presents a narrow but decisive window. Climate change and urbanization are intensifying zoonotic spillover risks. Meeting this challenge requires continuous readiness—treating health resilience as a global public good and transforming crisis experience into a sustained, inclusive security architecture for the region and world.

Asian Development Bank. 2020. Asian Development Outlook 2020 Update: Wellness in Worrying Times. September.

GPMB (Global Preparedness Monitoring Board). 2019. A World at Risk: Annual Report on Global Preparedness for Health Emergencies. World Health Organization. September.

R. Glennerster, C. M. Snyder, and B. J. Tan. 2022. Calculating the Costs and Benefits of Advance Preparations for Future Pandemics. NBER Working Paper No. 30565. National Bureau of Economic Research.

World Health Organization (WHO). 2022. 14.9 Million Excess Deaths Associated with the COVID-19 Pandemic in 2020 and 2021. News release. 5 May.

WHO and World Bank. 2022. Analysis of Pandemic Preparedness and Response (PPR) Architecture, Financing Needs, Gaps and Mechanisms. Prepared for the G20 Joint Finance & Health Task Force. March 22.