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have called on national governments to break the cycle of “panic and neglect”—a term meant to describe the episodic way in which national budgets are often used to fund preparedness. There are similar funding shortfalls for advancing preparedness on the global level. While multiple existing mechanisms provide emergency funds for global response operations, such as WHO’s Contingency Fund for Emergencies, the UN Central Emergency Response Fund, and the Pandemic Emergency Financing Facility, these funds generally are not available to support preparedness activities. While national governments should continue to be encouraged to increase and sustain their investments in preparedness, there is also a need to explore the availability of financing from nongovernment sources. New models and sources of financing are needed to increase the availability of resources for preparedness. Private Sector Beyond the financial sector, there has been acknowledgment in recent years of the need to engage the broader private sector in disease outbreak preparedness activities. A severe respiratory pandemic is likely to devastate economic growth, either directly via trade and travel restrictions or indirectly via high morbidity and mortality and the loss to jobs and industry, such as tourism. Therefore, both out of self-preservation and for reasons of corporate social responsibility, the private sector will need to play a greater role in planning for and responding to such events. Increasingly, public-private partnerships are being proposed as a model to expand the availability of financial resources for preparedness. The Coalition for Epidemic Preparedness Innovations (CEPI) receives financial contributions from governments and private philanthropists to promote vaccine development for priority pathogens identified in the WHO R&D Blueprint. To date, CEPI intends to invest upwards of $500 million in candidate vaccines for MERS-CoV, Lassa, Nipah, Rift Valley fever, and chikungunya. CEPI is also making investments in platform technologies with the goal of accelerating development of vaccines for previously unrecognized diseases, such as Disease X. Overall, CEPI has set a $1 billion fund-raising target.79 Another example of public-private partnership, the PIP framework, requires industry stakeholders to pay an annual contribution, of which 70% is used by WHO solely on influenza preparedness activities.80 Still more initiatives are required to mobilize financial support to enhance preparedness systems. Identifying new sources of funding for both national preparedness strengthening and research and development of vaccines, diagnostics, and treatments for high-priority diseases is greatly needed. 39 Governments have historically viewed the private sector as a potential source of support for public sector–led operations, including in-kind donations and purchases of equipment, supplies, or medical countermeasures. But the private sector has additional capabilities and expertise that can be tapped to support preparedness efforts.50 The unique expertise and services of several industries deserve special attention. The first is the pharmaceutical industry, which plays a key role in the research, development, and manufacture of medical countermeasures. The second is the airlines, transportation, and logistics/ shipping industries, which can ensure the transfer of medical personnel and equipment for scaling up operations. The third is the medical supply industry, which would also be of high global importance in a pandemic and contribute to R&D and manufacturing of MCMs. And fourth is the global communications sector—both those who provide the hardware and software around communications, as well as those who are global leaders in delivering content and helping to serve public information needs. Despite its potential, private sector involvement to date has been haphazard and mostly limited to the response phase of a disease outbreak. A key challenge is the lack of advance communication and coordination between public and private actors, which is needed to clarify the appropriate roles, responsibilities, and expectations of each during an epidemic or pandemic. The Private Sector Roundtable and a variety of efforts at the World Economic Forum around private-sector engagement in preparedness and response are notable exceptions in which global business has been leading or participating in the development of new partnerships and potential solutions with WHO and governments.50, 81 The partnership between government and the private sector will be most effective if defined and agreed on well in advance of an event. The ad hoc inclusion of private sector services into a health response could conceivably hinder a response in that it could risk public suspicion of private sector involvement for monetary or financial gain. Prenegotiated partnerships and/or memoranda of understanding that transparently define the nature and extent of private-sector involvement are needed. Private-sector organizations can also meaningfully contribute to preparedness by preparing continuity plans to ensure their continued operations in the event of a potential pandemic.82 Many communities rely on such organizations to provide essential services. Therefore, these organizations can also serve as extensions of government health response by educating their employees, families, and surrounding communities about recommended protective actions and planning to provide support for employees who become ill. 40 Security The potential for deliberate release of a high-impact respiratory pathogen provides a clear case of an instance when engagement with the security sector is required. However, the need to involve security in disease outbreak preparedness is not limited to deliberate events. The ongoing outbreak of Ebola in the Democratic Republic of Congo has also underscored the importance of having robust partnerships between health and security. Generally, a national or international security sector will include military, law enforcement, and intelligence agencies. Militaries may have a mandate and well-defined protocols for disaster relief operations, but their experience in disease preparedness and
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