This chapter provides an overview of the cost of investing in pandemic preparedness and response across 51 OECD, European Union/European Economic Area and Group of 20 countries, using the OECD Strategic Public Health Planning Costing Tool.
The Economic Case for Pandemic Preparedness and Response
Beyond Lockdowns
Abstract
Key messages
Investments in pandemic preparedness and response (PPR) pay twice: By reducing the cost of health emergencies and by strengthening the foundations of routine health systems
When pandemics strike, countries with stronger PPR systems are better able to respond. While investments in PPR can appear costly, failing to make them simply shifts, and often amplifies, expenses during health emergencies.
Many PPR investments also deliver “dual-use” benefits: the infrastructure, surveillance systems and co‑ordination mechanisms built for emergencies strengthen routine care, improve detection of everyday health threats and bolster public trust.
The OECD Strategic Public Health Planning (SPHeP) Costing Tool was used to estimate the cost of scaling up a comprehensive PPR package across 51 OECD, EU/EEA and G20 countries:
The OECD analysis included investments that can help safeguard population health and the economy when reliable medicines and vaccines are unavailable at scale:
building a national stockpile for personal protective equipment (PPE) and hygiene supplies,
physical contact-reducing non-pharmaceutical interventions (NPIs) including those that aim at ensuring greater compliance with physical distancing measures, ensuring educational continuity, facilitating innovative workplace arrangements and ensuring safe international and domestic travel and
improving wastewater surveillance capacity.
The OECD estimates suggest that:
In the OECD, the average annual cost of PPR is estimated at almost USD PPP 7.1 billion (USD PPP 5.9 per capita). The annual cost averages around USD 2.6 billion across the EU/EEA countries (USD PPP 6.3 per capita) and it exceeds USD PPP 18 billion (USD PPP 4.7 per capita) per year in G20 countries.
Of the estimated USD PPP 5.9 per capita needed each year to strengthen PPR capacity across OECD countries, around USD PPP 2.1 per person reflects start-up investments to establish core systems, institutions and infrastructure. An additional USD PPP 2.1 per capita would be required on an ongoing basis to cover operational costs once these foundational elements are in place. The remaining investment, about USD PPP 1.7 per capita, would only be required in the event of an outbreak to scale up activities and support the response.
Building and maintaining national PPE and hygiene stockpiles is the most expensive component of the PPR package, with an average annual cost of USD PPP 4.4 billion (USD PPP 3.2 per capita) in the OECD to almost USD PPP 1.5 billion (USD PPP 3.2 per capita) in the EU/EEA and nearly USD PPP 14 billion (USD PPP 3.1 per capita) across G20 countries. The average yearly cost of implementing NPIs that aim to reduce physical contact is slightly lower, ranging from USD PPP 1.6 per capita in the G20 to USD PPP 2.5 per capita in the OECD and USD PPP 2.8 per capita in the EU/EEA. The scaling up of wastewater surveillance remains below USD PPP 1 per year in nearly all countries.
The cost estimates presented in this chapter assume that countries start with relatively limited PPR capacities. Countries that already have some core PPR systems, institutions and infrastructure in place would need lower overall investments due to lower initial investment needs, although recurrent spending would still be required to sustain preparedness and ensure timely and effective responses to future outbreaks.
The COVID‑19 pandemic showed how outbreaks can disrupt healthcare systems and economies. As highlighted in Chapter 2, the health and economic shocks of potential outbreaks can be vast and as shown in Chapter 6, a number of non-pharmaceutical interventions (NPIs) remain a vital first line of defence when reliable medical treatments or vaccines are not yet available. As OECD, EU/EEA and G20 countries continue to work towards enhancing their resilience against future pandemics, a growing body of evidence shows that disease outbreaks are becoming more frequent and severe (Jones et al., 2008[1]; Meadows et al., 2023[2]), with projections suggesting substantially higher death tolls than previous outbreaks without stronger action (Meadows et al., 2023[2]; Madhav et al., 2023[3]).
When pandemics strike, countries with stronger PPR systems are better positioned to respond quickly and avoid the steep health and economic toll of uncontrolled outbreaks. Although PPR spending may appear costly upfront, neglecting it simply shifts, and ultimately magnifies, the expenses incurred during the response phase. Importantly, PPR investments generate important “dual-use” benefits that extend well beyond crisis moments. The same infrastructure, surveillance systems and co‑ordination mechanisms that safeguard populations during outbreaks also strengthen routine care, accelerate detection of other health threats and reinforce public trust in institutions. Wastewater surveillance, for instance, can track seasonal influenza and other endemic diseases, while robust stockpiles can be mobilised for a range of health emergencies. In this sense, preparedness is not simply an insurance policy, but a long-term investment in the resilience of health systems.
The COVID‑19 pandemic spurred a comprehensive re‑evaluation of financing needs to strengthen PPR capacity at the country and global levels (Box 8.1). Two landmark reviews were particularly influential. The first review, which was done by the Independent Panel for Pandemic Preparedness and Response (2021[4]), showed that prior to COVID‑19, efforts to bolster national PPR capacities were vastly underfunded and only two‑thirds of countries reported having in place mechanisms that would fully enable legislation and financing to support PPR capacities. The second review, by the G20 High Level Independent Panel (2021[5]), similarly concluded that countries must substantially increase domestic investment in core PPR capacities to prevent and contain future outbreaks. In 2025, the COVID‑19 Global Evaluation Coalition, led by the OECD, brought together evaluation units from countries, multilateral institutions and United Nations organisations to generate evidence‑based lessons and good practices for future global crises, including those pertaining to financing efforts to strengthen PPR capacities (OECD, 2025[6]).
The COVID‑19 pandemic spurred a comprehensive re‑evaluation of global PPR financing
At the international level, the Independent Panel for Pandemic Preparedness and Response (2021[4]) review showed that the pre‑COVID‑19 global health financing mechanisms were not able to facilitate rapid access to financial resources. The G20 High Level Independent Panel review underlined that countries should commit to scaling up international financing for PPR to support global PPR capacity across the globe (G20 High Level Independent Panel, 2021[5]). It highlighted that the additional international PPR funding must add to, and not substitute for, existing financial resources to advance other global public health and development goals.
Both reviews called for a massive scale‑up in multilateral financing to prevent and respond to future disease outbreaks (OECD, 2020[7]). They spurred the global health community to shift the paradigm on pandemic financing, with a transition towards proactive and sustainable long-term investments in PPR capacities.
The Pandemic Fund is the first multilateral financing mechanism dedicated to ensuring sustainable PPR funding
Launched in November 2022, the Pandemic Fund was developed under Italy and Indonesia’s respective G20 presidencies, with broad support from other G20 members and beyond, to address the lack of a global funding body aiming to strengthen global capacity to prevent, detect and respond to future pandemics (The Pandemic Fund, 2024[8]). It is the first multilateral financing mechanism dedicated to ensuring sustainable funding for strengthening PPR capacities in low- and middle‑income countries, with three core objectives: 1) strengthening national health systems, 2) supporting regional and global surveillance mechanisms and 3) ensuring rapid response capabilities.
The Pandemic Fund is structured as a financial intermediary fund, pooling contributions from governments, philanthropic organisations and private entities. Its governance framework includes representatives from donor and recipient countries, as well as technical experts and civil society organisations. Hosted by the World Bank, the Pandemic Fund completed two funding rounds by October 2024, which amounted to USD 885 million to finance 47 projects across 75 countries in all geographic regions (The Pandemic Fund, 2024[8]; World Bank, 2024[9]).
Source: G20 High Level Independent Panel (2021[5]), “A Global Deal for Our Pandemic Age: Financing the Global Commons for Pandemic Preparedness and Response”, https://pandemic-financing.org/report/foreword/; OECD (2020[7]), “Multilateral Development Finance 2020”, http://doi.org/10.1787/e61fdf00-en; The Pandemic Fund (2024[8]), “Building Pandemic Resilience: The Time is Now”, https://www.thepandemicfund.org/sites/default/files/2024-08/UK01_0005700_03_ThePandemicFund_InvestmentCase_Singles.pdf; World Bank (2024[9]), “Pandemic Fund Allocates Second Round of Grants to Boost Pandemic Preparedness in 50 Countries”, https://www.worldbank.org/en/news/press-release/2024/10/19/pandemic-fund-allocates-second-round-of-grants-to-boost-pandemic-preparedness-in-50-countries.
This chapter seeks to estimate the cost of investing in a comprehensive policy package for strengthening PPR capacity which involves: 1) building a national stockpile for personal protective equipment (PPE) and hygiene supplies, 2) strengthening the implementation of physical contact-reducing NPIs including ensuring greater compliance with physical distancing measures, ensuring educational continuity, facilitating innovative workplace solutions and ensuring safe domestic and international travel and 3) enhancing wastewater surveillance capacity. The estimates focus on country-level resource needs, although regional initiatives remain essential to complement and reinforce national efforts (Box 8.2). The results presented in this chapter were generated using the OECD Strategic Public Health Planning (SPHeP) Costing Tool in 51 OECD, EU/EEA and G20 countries. The chapter begins with a concise overview of the OECD SPHeP Costing Tool, followed by the presentation of results and concludes by synthesising the key findings and discussing their implications for resource allocation and policy design.
The COVID‑19 pandemic underscored the importance of building resilience not only at the national level but also across regions. In response, the EU/EEA countries have intensified efforts to strengthen regional co‑operation, launching several major initiatives in recent years. A key example is the launch of the European Health Emergency Preparedness and Response Authority (HERA) in 2021. HERA is responsible for implementing the European Commission’s policies on health preparedness, crisis response and strengthening the resilience of healthcare systems (HERA, 2024[10]). During health emergencies, it oversees the development, production and distribution of medicines, vaccines and other medical countermeasures. To date, HERA channelled funding through multiple instruments:
EU4Health Programme: Established by Regulation (EU) 2021/522, the EU4Health Programme aims to improve health system resilience across EU member states by 1) strengthening national health systems to cope with future public health crises, 2) enhancing access to medicines and medical devices, 3) promoting digital health solutions to improve efficiency and cross-border co‑operation and 4) supporting disease prevention and addressing inequities (European Commission, 2024[11]).
Horizon Europe: Horizon Europe is the EU’s key funding programme to promote research and innovation. To support the EU-level effort to strengthen PPR and health security, Horizon Europe aims to advance 1) research projects focussing on better assessing pathogen characteristics and behaviours, 2) the development of novel vaccines, therapeutics and diagnostics and 3) research on climate change‑related health threats and antimicrobial resistance (European Commission, 2024[12]).
rescEU: RescEU was created in 2019 as part of the EU Civil Protection Mechanism to safeguard EU citizens from disasters and to manage emerging risks. Today, RescEU capacity includes field hospitals and a stockpile of medical items (e.g. ventilators) for health emergency response, as well as shelters, transport and logistics assets and energy supply items.
HERA invest: With a budget of EUR 100 million, HERA invest is the first European health investment instrument that specialises in promoting advanced research and development (R&D) for medical countermeasures and relevant technologies for tackling priority cross-border health threats including pathogens of epidemic/pandemic potential, antimicrobial resistance and chemical, biological, radiological and nuclear threats (European Commission, 2024[12]).
In addition to HERA, there have been other developments at the EU-level as follows:
Introduction of Regulation (EU) 2022/2371: At the regional level, the EU has established a structured framework for assessing and strengthening PPR capacity. Under Article 7 of Regulation (EU) 2022/2371 on serious cross-border threats to health, EU Member States report to the European Commission every three years on their national prevention, preparedness and response planning, using a common template set out in Commission Implementing Regulation (EU) 2023/1808 (European Commission, 2023[13]). The template is organised around 16 capacities in two groups. The first 11 correspond to the core capacities of the International Health Regulations (2005), spanning, among others, surveillance, laboratory capacity, the health workforce, health emergency management and logistics, health-service provision, risk communication, points of entry and border health, and zoonotic and environmental threats. The remaining capacities reflect additional EU-specific elements, including antimicrobial resistance and healthcare‑associated infections, and Union-level co‑ordination. These self-assessments are subsequently reviewed by the European Centre for Disease Prevention and Control (ECDC), which conducts country assessments and issues tailored recommendations, creating a recurring cycle of reporting, assessment and improvement designed to identify and close preparedness gaps. The first cycle was run between 2024 and 2026 (ECDC, 2026[14]).
Expansion of the ECDC mandate: In 2022, Regulation (EU) 2022/2370 reinforced the ECDC mandate, granting the institution a much stronger role in EU-wide disease surveillance and prevention. Among many new capacities, the ECDC is now tasked with co‑ordinating the EU Health Task Force, which is responsible for outbreak investigation and crisis support.
Expansion of the European Medicines Agency (EMA) mandate: The expansion of the EMA’s mandate in 2022 reaffirmed the institution’s critical role in the EU’s crisis preparedness and management of medicinal products and medical devices. Most importantly, the new mandate gave rise to the Executive Steering Group on Shortages and Safety of Medicinal Products, which is the leading body tasked with responding to and preventing medicine supply issues caused by public health emergencies such as pandemics (European Medicines Agency, 2023[15]).
In addition, the EU has recently strengthened its crisis preparedness framework through a set of strategies and policy initiatives that emphasise surveillance, prevention and effective response to major threats across both civilian and military domains as follows:
The EU Preparedness Union Strategy, the EU Stockpiling Strategy and the Niinistö report collectively highlight the need to build robust protection capabilities, improve resilience and ensure the availability of critical resources in times of crisis (Niinistö, 2024[16]; European Commission, 2025[17]; European Commission, 2025[18]).
These efforts align with the EU priorities for 2024‑2029, which identifies a “strong and secure Europe” as a core priority, including enhanced preparedness, prevention and response capacities (European Union, 2024[19]).
The 2025 EU Medical Countermeasures Strategy reinforces these objectives by accelerating innovation and securing the supply of medical countermeasures, further contributing to the EU’s overall resilience architecture (European Commission, 2025[20]).
Source: HERA (2024[10]), “Health Emergency Preparedness and Response Authority”, https://commission.europa.eu/about/departments-and-executive-agencies/health-emergency-preparedness-and-response-authority_en; European Commission (2024[11]), “EU4Health programme 2021-2027 – a vision for a healthier European Union”, https://health.ec.europa.eu/funding/eu4health-programme-2021-2027-vision-healthier-european-union_en; European Commission (2024[12]); “Funding and opportunities”, https://health.ec.europa.eu/health-emergency-preparedness-and-response-hera/funding-and-opportunities_en; European Commission (2023[13]), “Commission Implementing Regulation (EU) 2023/1808”, https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32023R1808; ECDC (2026[14]), “Public Health Emergency Preparedness Assessments”, https://www.ecdc.europa.eu/en/about-us/what-we-do/public-health-emergency-preparedness-assessments; European Medicines Agency (2023[15]), “EMA's extended mandate”, https://www.ema.europa.eu/assets/en/annual-report/2022/emas-extended-mandate.html; Niinistö (2024[16]), “Safer Together – Strengthening Europe’s Civilian and Military Preparedness and Readiness”, https://commission.europa.eu/document/download/5bb2881f-9e29-42f2-8b77-8739b19d047c_en?filename=2024_Niinisto-report_Book_VF.pdf; European Commission (2025[17]), “EU stockpiling strategy: Boosting the EU's material preparedness for crises”, https://civil-protection-humanitarian-aid.ec.europa.eu/document/download/c57d4067-1900-4616-9239-ca4598b55d69_en?filename=COM_2025_528_1_EN_ACT_combined.pdf; European Commission (2025[18]), “EU preparedness union strategy”, https://commission.europa.eu/topics/preparedness_en; European Union (2024[19]), “European Union priorities 2024-2029”, https://european-union.europa.eu/priorities-and-actions/eu-priorities/european-union-priorities-2024-2029_en; European Commission (2025[20]), “Medical Countermeasures Strategy”, https://health.ec.europa.eu/health-emergency-preparedness-and-response-hera/preparedness/medical-countermeasures-strategy_en.
The OECD SPHeP Costing Tool aims to provide accurate estimates for a wide range of interventions that can help safeguard population health (Box 8.3). The tool balances the need for a consistent methodology to estimate the country-level cost of interventions with flexibility required to consider the diversity in country context by:
adopting an ingredients-based approach (i.e. a systematic methodology for estimating the total costs of implementing an intervention) which entails exhaustively specifying all inputs required to implement an intervention regardless of how they are financed.
offering flexibility to modify parameters such as demographic characteristics, time horizon of analysis, target population and intervention coverage to reflect a country’s circumstances.
The OECD SPHeP Costing Tool was used to estimate the investment requirements to bolster PPR capacity across 51 OECD, EU/EEA and G20 countries. Similar to the WHO Choosing Interventions that are Cost-Effective Tool (Bertram et al., 2021[21]),the OECD SPHeP Costing Tool uses a standardised ingredient-based approach, whereby quantities of all inputs were multiplied by their corresponding unit prices. Total intervention costs were calculated as the sum of two components:
Programme‑level costs, covering resources needed for implementation including personnel, administration, training, co‑ordination and materials; and
Individual-level expenditures, capturing personal use of goods and services such as PPE.
Costs were estimated for two phases of a pandemic: 1) preparedness and 2) response. The preparedness phase, spanning ten years, is assumed to comprise a two‑year start-up period followed by eight years of steady-state operations. Costs incurred in the preparedness phase reflect the set of activities required to establish and maintain each intervention:
Start-up costs which include one‑off investments needed to establish the interventions, including developing standard operating procedures (SOPs) and guidelines, building co‑ordination mechanisms across sectors, putting in place digital infrastructure (e.g. public health hotlines, wastewater surveillance dashboards etc.), initial recruitment and training of staff, as well as the procurement of capital goods such as laboratory equipment.
Operational costs represent recurrent expenditures required to sustain the implementation of the interventions beyond the start-up period, including replenishment of stockpiles, maintenance of warehouses and subscriptions to digital learning platforms, ongoing guideline revisions, routine training and staff salaries.
Given that consistent cross-country data on current capacity is difficult to obtain, analyses for the preparedness phase assume that countries do not have any pre‑existing capacity for these interventions. This approach allows estimation of the full investment required and can be considered as an upper-bound indicator of the resources required. Additional analysis is also provided for scenarios where 30% and 50% initial capacity is assumed to be available at the start-up period.
The response phase covers the first nine months of an outbreak caused by a respiratory pathogen, similar to those discussed in Chapters 3 and 7, during which the capacities established during the preparedness phase are assumed to expand to meet emergency needs. Costs incurred in the response phase capture surge requirements during an outbreak such as temporary workforce expansion, increased sampling and testing for more frequent wastewater surveillance and enhanced communication campaigns.
Inputs and data sources
The analysis incorporated all commodities, supplies and human resources required to implement each intervention across preparedness and response phases. Commodities included, for example, PPE (e.g. N95 respirators), hand hygiene supplies (e.g. hand sanitisers, liquid soap), wastewater testing kits and other laboratory consumables, laptops, barcode readers for warehouse staff, subscriptions to learning management systems and communication materials (e.g. posters). Full-time equivalent (FTE) estimates were mapped to salary levels from the International Labour Organization (ILO) wage database.
Whenever possible, quantities were parameterised using international guidelines and evidence gathered from comprehensive literature reviews that aimed to identify the operational aspects of real-world programmes and best practice examples for each intervention. To adapt inputs across the 51 countries, the quantities identified were scaled to population size. Internationally traded goods (e.g. computers) were assigned harmonised PPP-adjusted prices. The costing analysis was conducted from a governmental perspective. All costs are expressed in 2022 PPP-adjusted USD.
All inputs were parameterised using publicly available data sources. Population estimates were taken from the United Nations World Population Prospects. Macroeconomic indicators, including PPP conversion factors, market exchange rates, consumer price indices and level price indices, were extracted from the World Bank World Development Indicators, OECD and Eurostat. Unit costs for PPE and medical consumables were obtained from Eurostat’s medical supplies dataset and salary estimates for relevant personnel were sourced from the ILO wage database reflecting the level of educational attainment.
Source: Bertram et al. (2021[21]), “Methods for the Economic Evaluation of Health Care Interventions for Priority Setting in the Health System: An Update from WHO CHOICE”, http://doi.org/10.34172/ijhpm.2020.244.
Table 8.1 summarises the key design features of each intervention that was costed as part of the PPR package and the remainder of the section provides more details. The designs of the costed interventions were informed by reviews of the scientific and grey literature, government reports and documents on real-world programmes and international guidelines. The interventions presented in the rest of the chapter should be interpreted as illustrative benchmarks that provide a consistent and comparable basis for estimating investment needs. While they reflect evidence‑based approaches to implementing interventions to prepare for and respond to pandemic outbreaks, they are not intended to imply that countries should implement identical activities or organisational arrangements.
Note: LMS = learning management systems; M&E = monitoring and evaluation; PPE = personal protective equipment, RT-qPCR = reverse transcription-quantitative polymerase chain reaction; SOP = standard operating procedures.
Source: Based on OECD review of the available literature.
8.2.1. Building a national stockpile for PPE and hygiene supplies
Investing in a national PPE stockpile is an essential strategy that can rapidly safeguard population health during disease outbreaks while ensuring preparedness for future health emergencies. A well-maintained stockpile guarantees the availability of critical PPE for rapid distribution, benefiting not only healthcare workers but also the general population. Adequate PPE reserves also enable essential workers to return to their jobs more quickly, mitigating the economic distress caused by outbreaks. Building a national stockpile can also stimulate domestic production of medical supplies, reducing reliance on global supply chains in the event of a disease outbreak.
Maintaining a national stockpile also offers significant cost advantages. Procuring PPE in advance at standard market prices can help avoid the inflated costs observed during disease outbreaks. For example, one earlier study showed that in Israel, pre‑pandemic stockpiling to protect against a future influenza pandemic remained a cost-saving option as long as the estimated risk of a pandemic remained greater than 1 every 80 years (Balicer et al., 2005[23]). Another study from the United States found that establishing an adequate PPE stockpile beforehand would cost only 17% of the amount required to purchase the same supplies during a crisis (Dow, Lee and Lucia, 2020[24]).
This intervention was conceptualised as a national stockpile for PPE and hygiene supplies (Table 8.1), with the aim of supporting the needs of the public during a health emergency. (See Chapter 9 for a deeper discussion of various types of stockpiling arrangements). During the preparedness phase, the stockpile is assumed to be built through the procurement of goods such as respiratory masks and essential hygiene and protective supplies in quantities sufficient to cover 20% of the population aged over 12 years for a three‑month period (WHO, 2020[22]). Other activities include managing the stockpile (e.g. staff for procurement and warehouse management), warehouse management (e.g. putting in place inventory management IT systems and basic operational equipment) and annual external audits to verify stock levels and compliance with guidelines. Assumptions used to parameterise warehousing requirements (e.g. physical space and staffing levels) are based on the stockpiling experiences from Australia (Premier of Victoria, 2020[25]) and scaled by population size for each country. During the response phase, it is assumed that a temporary scale‑up of operations would be necessary to meet increased demand, with additional procurement of goods equivalent to 10% of the preparedness-phase stock; a 30% increase in staffing capacity in the warehouses to support higher distribution volumes and a 10% increase in transport activity to reflect intensified logistics and delivery requirements.
8.2.2. Strengthening the implementation of physical contact-reducing NPIs
Physical contact-reducing NPIs refer to interventions aimed at reducing close interpersonal contacts across various settings (i.e. ensuring greater compliance with physical distancing measures, ensuring educational continuity, facilitating innovative workplace solutions and ensuring safe domestic and international travel). During the preparedness phase, all these interventions are assumed to rely on similar foundational activities to support operational readiness in case of outbreaks (Table 8.1). These include developing and implementing SOPs and best practice guidelines, reviewing and updating them every five years and assigning dedicated staff to co‑ordinate implementation. During the response phase, implementation is assumed to be temporarily scaled up, which would involve a 30% expansion in staff capacity to manage the additional operational demand due to the outbreak.
Each physical contact-reducing NPI also includes setting-specific activities as discussed below.
Ensuring greater compliance with physical distancing measures
Physical distancing is a highly effective strategy to limit disease transmission by reducing the number of close contacts between individuals, but its effectiveness depends on the level of compliance in the general population. Previous studies suggest that physical distancing measures are most effective when clear and well-designed guidelines that consider social, cultural and economic contexts are in place (Bausch, 2020[26]). This is particularly important during rapidly evolving disease outbreaks when timely communication of key public health messaging is key.
This intervention is modelled as a novel programme that aims to increase compliance with physical distancing during an outbreak (Table 8.1). During the preparedness phase, the main activities are assumed to centre around building operational capacity and improving the public’s access to accurate public health information (e.g. building a public health hotline to increase awareness of best public health practices, for example, in peak influenza seasons.) The parameters used to cost the public health hotline are scaled by population size, referencing an emergency programme from the United Kingdom (NHS, 2023[27]). It is also assumed that public compliance with public health best practices would be monitored and evaluated to identify bottlenecks in implementation (see Chapter 5 for more detailed discussion.) During the response phase, a temporary intensification of implementation activities is assumed, including the launch of large‑scale public communication campaign (e.g. weekly television and radio announcements, widespread use of posters and signage in public spaces), as well as a 30% increase in public health hotline staff. It is also assumed that civil security personnel would assist with enforcement of physical distancing requirements, using the staffing levels consistent with the assumptions in the WHO-CHOICE mode (Bertram et al., 2021[21])l.
Ensuring educational continuity
As discussed in more detail in Chapter 7, temporary school closures can reduce the adverse health impacts of disease outbreaks, but they also have significant negative consequences such as disruptions to learning and mental health challenges for students. One effective strategy to mitigate the negative effects of school closures is scaling up the use of alternative education systems such as virtual learning platforms. These measures can help counter the adverse impacts of school closures by lowering the need for physical interactions while helping to maintain educational continuity. They can also facilitate social interactions with peers and teachers, which, in turn, may help support the mental health of students. They can be particularly valuable for vulnerable students who may lack access to adequate learning materials and resources at home. Beyond students, alternative education systems can enable parents to continue working during outbreaks (Sadique, M.Z., Adams and Edmunds, 2008[28]), while helping to avoid large scale job losses among teachers and support staff.
This intervention is costed as a nationwide programme to support virtual learning during disease outbreaks (Table 8.1). During the preparedness phase, this intervention is assumed to involve developing and implementing operational guidance to ensure a smooth transition from face‑to-face teaching to remote learning and strengthening readiness for online education (e.g. obtaining and maintaining subscriptions to online teaching platforms and providing training opportunities at regular intervals for teaching staff to promote best practices in remote learning). During the response phase, a temporary intensification of implementation is assumed to support large‑scale remote education such as procurement of laptops for primary and secondary school students from lower-income families to reduce digital access gaps; monthly teacher training sessions, as well as the continued use and subscription of LMS platforms throughout the response period.
Facilitating innovative workplace solutions
Facilitating innovative workplace solutions can be crucial in case of outbreaks to ensure business continuity and operational resilience. Well-designed guidelines, for example, can address occupational health and safety concerns arising from teleworking such as work-life balance and mental health (OECD, 2022[29]). They can help mitigate risks associated with prolonged teleworking such as social isolation and detachment from colleagues.
This intervention is conceptualised as a nationwide programme to support businesses in their efforts to transition to teleworking-based work in an emergency context (Table 8.1). During the preparedness phase, activities would focus on establishing the institutional and operational foundations that would support higher use of teleworking arrangements during health emergencies, whereas during the response phase, a 30% expansion is assumed in the staff capacity to provide technology support and guidance for businesses on the skillset and organisational changes that would help facilitate timely implementation of innovative workplace solutions. The design of this intervention reflects examples from many initiatives undertaken by the OECD countries prior to and during the COVID‑19 pandemic (OECD, 2021[30]). For example, it has been reported that Germany supported small and medium enterprises by facilitating their access to consultancy firms that assist them in the digitisation of business processes, whereas Australia was shown to offer advisory and mentoring services, involving an initial review of business needs and granting access to webinars, workshops and one‑to‑one mentoring (OECD, 2021[30]).
Ensuring safe domestic and international travel
Ensuring safe travel during a pandemic is essential for preserving global connectivity, facilitating trade and promoting economic recovery while safeguarding public health. During the COVID‑19 pandemic, countries scaled up the implementation of various types of safe travel protocols such as testing requirements at entry and exit points, establishing “travel bubbles” between countries with similar levels of SARS‑CoV‑2 incidence rates etc. to help prevent the cross-border importation of the virus and subsequent infection waves, protecting both travellers and local populations.
This intervention is conceptualised as a nationwide programme implemented in major travel hubs such as domestic and international airports (Table 8.1). During the preparedness phase, efforts are assumed to focus on developing and implementing SOPs and best practice guidelines. During the response phase, this intervention would be further supported by launching a communication campaign to disseminate timely and accurate information on the most up-to-date travel requirements through broadcast and digital platforms (e.g. weekly travel advisories in radio, television and real-time online updates of public advisory on travel guidelines). Resources would also be allocated to validate the compliance of travellers with the travel-related health regulations in major travel hubs based on experiences from France where approximately 6 000 civil security service members were deployed each week to support travel-related validations (Ministre de l'Intérieur, nd[31]), adjusting for population size.
8.2.3. Enhancing wastewater surveillance
As discussed in more detail in Chapter 7, improving disease surveillance through enhanced wastewater surveillance is key to strengthen PPR capacity. Wastewater surveillance does not depend on individual testing or healthcare access, making it a highly desirable approach to population-based monitoring. It captures the presence of pathogens shed by both symptomatic and asymptomatic individuals, offering a more comprehensive view of population health. Multi-pathogen detection capabilities further enhance the utility of wastewater surveillance.
This intervention is conceptualised as a national programme to enhance wastewater surveillance as an early warning system for disease outbreaks (Table 8.1). During the preparedness phase, activities are assumed to include developing and implementing operational guidance (e.g. updating and implementing SOPs and best practice guidelines), strengthening laboratory capacity (e.g. procuring wastewater sampling kits, laboratory equipment and consumables such as RT-qPCR kits) and strengthening research and data sharing capacities to enable timely data sharing and analysis (e.g. developing and maintaining of an online data dashboard). In line with the French experience during the COVID‑19 pandemic, wastewater surveillance is assumed to cover 40% of the population (Maréchal et al., 2023[32]). During the response phase, it is assumed that a temporary scale‑up activities will take place, including an increase in sampling frequency from twice per week in line with international guidelines during “normal times” (European Commission, 2021[33]) to three times a week to reflect the rise in the circulation of pathogens in the community (Jourdain et al., 2025[34]) and expanded technical support for the data sharing.
8.3.1. Strengthening PPR capacity in the OECD will cost nearly USD PPP 6 per capita each year
The annual cost of strengthening pandemic preparedness and response capacity is estimated to average around USD PPP 20.2 billion across the 51 countries included in the analysis, corresponding to USD PPP 5.6 per capita (Figure 8.1). In the OECD, the cost of PPR is estimated to average at almost USD PPP 7.2 billion. This is around USD PPP 5.9 per capita whereas the estimated cost per year is estimated to reach around USD 2.6 billion across the EU/EEA countries, which is around USD PPP 6.3 per capita. The same cost is estimated to be around USD PPP 18.2 billion (USD PPP 4.7 per capita) per year in G20 countries.
Annual average cost of investing in PPR, USD PPP
Note: PPP = purchasing power parity; B = billions; M = millions.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
The OECD analysis reveals significant cross-country variation in the investments required to strengthen PPR capacity, with the per capita annual cost of PPR ranging from USD PPP 3.3 in Indonesia to USD PPP 11 in Luxembourg (Figure 8.1). More populous countries incur the highest costs in absolute terms, even when their per capita annual cost remains relatively low. For example, the annual cost of PPR averages around USD PPP 5 billion in China and India, more than double the cost in the United States at less than USD PPP 1.9 billion, even though the per capita cost in China and India is roughly 40% lower (about USD PPP 3.5 per capita in both countries compared to USD PPP 5.6 per capita in the United States). This finding partly reflects that the PPR systems (e.g. the quantities of PPE purchased) need to be scaled to the population size.
8.3.2. Investments made during the preparedness phase can help reduce costs incurred during the response phase
It is critical to adopt a proactive approach to investing in PPR. Without prior investments in strengthening PPR capacity, countries would still incur the estimated preparedness costs during an outbreak as part of the response expenses but likely at a higher price. Proactive investments can yield significant benefits. For instance, establishing wastewater surveillance systems can enable early detection of emerging threats, potentially curbing widespread transmission and reducing the need for costly large‑scale interventions. Similarly, building and maintaining a national stockpile of PPE and hygiene supplies can eliminate the need for emergency procurements during a crisis, thereby lowering costs associated with urgent capacity expansion and resource mobilisation. Furthermore, pre‑established emergency response plans and protocols developed as part of preparedness initiatives can facilitate a more co‑ordinated and efficient response by streamlining decision-making processes and resource allocation, reducing potential delays in the response phase and inefficiencies that could otherwise inflate response costs.
Figure 8.2 represents the annual average cost of PPR across different phases of the outbreak. The OECD analysis shows that of the USD PPP 5.9 per person required each year to bolster PPR capacity in the OECD countries, around USD PPP 2.1 per person per year would be spent on start-up costs incurred for building the core PPR systems, institutions and infrastructure (e.g. national PPE and hygiene stockpile, strengthening operational readiness for implementing physical contact-reducing NPIs and disease surveillance capacity) needed, whereas USD PPP 2.1 per capita would be needed annually to cover the cost of operations following the start-up years. In comparison, the cost that would be incurred in the response phase would average at around USD PPP 1.7 per capita per year, which would entail expanding the PPR capacity established during the preparedness phase rather than building these systems from scratch in an emergency context.
It is crucial to note that the costs associated with the preparedness phase represent expenses that countries would have incurred during the response phase if they had not made any prior investments in preparation for a pandemic. In this light, the preparedness estimates (i.e. a combination of start-up and operational costs) presented in Figure 8.2 should be viewed as conservative, as actual costs incurred during an outbreak would likely be higher, especially for activities such as expanding the national stockpiles, considering that the expected peak in demand is likely to drive up costs.
Annual average cost of PPR by the phase of outbreak
Note: Preparedness phase involves a 10‑year period when investments in NPIs are made before a disease outbreak occurs. The first 2 years of the preparedness phase are considered to be the start-up period, whereas the remainder is considered as the operational period. Response phase focusses on the scale‑up of NPIs during the initial 9 months of an ongoing outbreak. EU/EEA = European Union/European Economic Area; G20 = Group of 20; NPIs = non-pharmaceutical interventions; PPP = purchasing power parity.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
8.3.3. Building a national stockpile is the costliest component of the PPR package
The OECD analysis suggests that building and maintaining a national PPE and hygiene stockpile is consistently the costliest component of the PPR package (Figure 8.3). It is estimated that the annual average cost of this intervention ranges from almost USD PPP 1.5 billion (USD PPP 3.2 per capita) in the EU/EEA, almost USD PPP 4.4 billion (USD PPP 3.2 per capita) in the OECD and nearly USD PPP 14 billion (USD PPP 3.1 per capita) across G20 countries (Figure 8.3). Across countries, Iceland would bear the lowest annual cost of building and maintaining a national stockpile (USD PPP 2.1 per capita) whereas Latvia would face the highest annual cost at almost USD PPP 3.8 per capita.
Annual average cost of PPR by component
Notes: Physical contact-reducing NPIs include 1) promoting higher compliance with physical distancing measures, 2) ensuring innovative workplace solutions, 3) ensuring educational continuity and 4) encouraging safe international and domestic travel. EU/EEA = European Union/European Economic Area, G20 = Group of 20; B = billions; M = millions; NPIs = non-pharmaceutical interventions; PPE = personal protective equipment; PPP = purchasing power parity.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
The average yearly cost of activities to strengthen the implementation of NPIs that aim to reduce physical contact is slightly lower than supporting national stockpiling efforts (Figure 8.3), ranging from around USD PPP 1.1 billion (USD PPP 2.8 per capita) in the EU/EEA to almost USD PPP 2.8 billion (USD PPP 2.5 per capita) in the OECD and nearly USD PPP 4.2 billion (USD PPP 1.6 per capita) across the G20 countries. Efforts to scale up wastewater surveillance are cheaper, with the estimated per capita cost of facilitating enhanced wastewater surveillance remaining below USD PPP 1 per year in all countries included in the analysis except in Luxembourg where the average cost is estimated to be around USD PPP 1.3 per year.
8.3.4. How do OECD estimates change depending on the PPR capacity at the start-up period?
The cost estimates provided in this chapter reflect an upper bound, under the assumption that countries start from relatively limited PPR capacity for the interventions assessed. Countries that already have some of these systems in place would require lower overall investments. As illustrated in Figure 8.4, if countries begin with even 30% of the necessary PPR capacity at the start-up period, average annual cost would fall markedly to USD PPP 6.4 billion (USD PPP 5.3 per capita) for the OECD, to USD PPP 2.4 billion (USD PPP 5.7 per capita) for the EU/EEA and to USD PPP 17.7 billion (USD PPP 4.2 per capita) across the G20 (See Annex Figure 8.A.1 and Annex Figure 8.A.2). These results reinforce that early and sustained investments in PPR capacities can reduce long-term investment needs.
Annual average PPR cost per capita
Note: Start-up period refers to the first two years of the preparedness phase in which countries establish mechanisms to bolster PPR capacity.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
The relatively modest decline in long-term costs at higher initial levels of PPR capacity reflects the structure of the cost components. Countries with pre‑existing PPR capacity can expect to reduce certain programme‑level expenditures (e.g. developing SOPs and best practice guidelines, costs associated with the initial recruitment and training of staff, procurement of certain goods such as PPE and wastewater sampling kits etc.). However, even in countries with higher start-up PPR capacity, there is limited scope for reducing the operational costs, because many recurrent expenditures (e.g. staff salaries, routine staff training, warehouse costs etc.) are largely driven by the overall scale of the PPR systems in the country, which depends heavily on the population size rather than the initial level of preparedness. In other words, while early investments would reduce the need for accelerated building of PPR capacities during health emergencies, they do not eliminate the recurring costs of sustaining readiness for future outbreaks and for effective response.
Figure 8.5 shows the total PPR investment by the phase of outbreak. Nearly 80% of the total cost of the PPR package is estimated to be incurred in the preparedness phase. Investments in building and maintaining national PPE and hygiene stockpiles and in strengthening wastewater surveillance are highly concentrated on this phase, with close to 95% and 90% respectively of their total costs allocated to preparedness activities. This reflects the need for upfront investments, such as for the procurement of goods (e.g. purchase of PPE, sampling kits etc.). By contrast, spending during the response phase would mainly involve scaling up capacities that have already been put in place. Physical contact-reducing NPIs follow a different pattern. Most of these measures are response‑driven, largely reflecting their reliance on activities that would only be introduced in case of an active outbreak (e.g. enforcement of public health guidelines). For example, investments made in the preparedness phase account for approximately 20% of total cost associated with efforts to encourage safe international and domestic travel, which reflects the greater resource requirements due to enforcement related activities carried out during the response phase. Similarly, the majority of costs incurred due to the NPIs for ensuring innovative workplace solutions and for ensuring educational continuity would take place during the response phase. In comparison, costs incurred during the response phase represent only around 20% of the total cost of efforts to ensure innovative workplace solutions, as the core investments associated with this intervention are made upfront during the preparedness phase.
Percentage of total PPR investment by the phase of outbreak
Notes: Preparedness phase involves a 10‑year period when investments in NPIs are made before a disease outbreak occurs. Response phase focusses on the scale‑up of NPIs during the initial 9 months of an ongoing outbreak. Physical contact-reducing NPIs include 1) promoting higher compliance with physical distancing measures, 2) ensuring innovative workplace solutions, 3) ensuring educational continuity and 4) encouraging safe international and domestic travel.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
Costing the investment requirements for strengthening PPR capacity is a complex endeavour. The existing estimates for the magnitude of PPR investment requirements vary considerably, reflecting the variation in terms of their assumption related to what activities should be costed as part of efforts to strengthen PPR capacity, diversity in the data sources and costing methods used. This high level of variation in methodological approaches makes direct comparison of cost estimates challenging. Despite these challenges, the cost estimates presented in this chapter are well aligned with estimates generated by previous works on global PPR investment requirements (Box 8.4).
The OECD analysis suggested that the annual per capita cost of PPR ranges from USD PPP 4.7 in G20 countries to USD PPP 5.9 in the OECD and USD PPP 6.3 across the EU/EEA. These estimates are aligned with the range of per capita annual global cost estimates generated by previous works, varying from USD 1.4 to USD 5.4 per capita (Craven et al., 2021[35]; World Bank, 2022[36]). The (G20 High Level Independent Panel[5]) and the (WHO and World Bank[37]) estimates, at USD 4.3 and USD 3.9 respectively, sit near the midpoint of this range. More recently, the WHO, OECD and the World Bank (2025[38]) also estimated that the cost of improving PPR within the health sector alone to full capacity in low- and lower-middle‑income countries. The OECD estimates presented in this chapter are slightly higher than previous estimates, reflecting the more comprehensive coverage of cross-sectoral investments spanning health, education and transportation sectors and labour markets and higher costs for non-tradable goods (e.g. wages) in many OECD countries compared to many low- and middle‑income countries included in the global analyses. Unlike previous estimates, the OECD analysis goes beyond quantifying the cost of preparedness alone by including the cost of responding to a COVID‑19‑like pandemic as explored in Chapters 3 and 7.
The OECD analysis estimated that strengthening disease monitoring through wastewater surveillance would cost, on average, USD PPP 0.2 per capita each year across OECD countries. As discussed below in this box, this figure is broadly aligned with France’s investment to develop its wastewater surveillance system, which served as a model for this analysis, but remains below earlier estimates (Sorbonne Universite, 2024[39]), which range from the global estimates of USD 0.9 to 1.4 (Craven et al., 2021[35]) and to USD 1.9 (G20 High Level Independent Panel, 2021[5]). The difference largely reflects the scope of the investment. Enhancing wastewater surveillance capacity primarily requires building on existing surveillance systems, whereas (Craven et al.[35]) estimated the cost of closing gaps in pathogen surveillance and sequencing, building notifiable disease surveillance systems globally and developing population-representative surveillance foundations in countries. In comparison, the G20 High Level Independent Panel (2021[5]) calculated the cost of expanding the global surveillance capacity more broadly, often from ground up in many countries, including upgrading laboratory infrastructure and investing in research and development capabilities on future and emerging communicable diseases.
The OECD estimates of the annual investment needed to build national stockpiles of PPE and hygiene supplies are higher than those from earlier analyses, averaging USD PPP 3.1 per person per year across OECD countries, versus the global estimates of USD 0.6‑0.9 in Craven et al. (2021[35]) and USD 1.6 in the G20 High Level Independent Panel (2021[5]). The differences likely reflect methodological approaches. For example, estimates generated by Craven et al. (2021[35]) focus on the cost of maintaining stockpiles of medical supplies and emergency supply-chain mechanisms at different administrative levels (i.e. subnational, national or regional).
The estimates presented in this chapter are also consistent with emerging evidence from OECD countries and recent regional efforts:
The United States allocated about USD 905 million to its national stockpile in 2022 through the Public Health and Social Services Emergency Fund (HHS, 2022[40]). This investment helped secure critical medical supplies, expand storage and distribution capacity and reinforce the broader PPR infrastructure, closely aligning with the OECD’s estimate of roughly USD 1 billion annually to maintain a robust national stockpiling system.
In France, the OBEPINE network, a consortium of 22 public, private and academic partners, received approximately EUR 10 million over five years to scale up wastewater surveillance and integrate it into the national health monitoring system (Sorbonne Universite, 2024[39]). This translates to about EUR 2 million per year, broadly in line with the OECD’s estimate of EUR 2.3 million annually for building and sustaining wastewater surveillance capacity in France.
In the EU/EEA, HERA allocated EUR 2.8 billion (USD 3.2 billion) under the EU4Health programme to reinforce PPR capacities and additional EUR 1.2 billion (USD 1.24 billion) to expand rescEU’s shared EU-level reserves for 2022‑2027 (HERA, 2023[41]; DG Sante, 2023[42]). This corresponds to roughly USD 900 million per year, lower than the OECD estimate of nearly USD 1.5 billion. The differences in the HERA resource allocation and the OECD estimates reflect both methodological assumptions and HERA’s policy focus. The OECD analysis found that if national stockpiles across the EU/EEA countries already cover around half of the capacity needed, the OECD estimate would fall to around USD PPP 1.1 billion annually. Whereas HERA’s funding is designed to supplement existing national stockpiles, providing a strategic shared reserve to be deployed in times of crises. Taken together, these figures indicate an alignment, showing that EU-level and national efforts are mutually reinforcing part of a broader strategy to bolster PPR capacity.
Source: Craven et al. (2021[35]); “Not the last pandemic: Investing now to reimagine public health systems”, https://www.mckinsey.com/industries/public-sector/our-insights/not-the-last-pandemic-investing-now-to-reimagine-public-health-systems#/; World Bank (2022[36]), “Putting Pandemics Behind Us: Investing in One Health to Reduce Risks of Emerging Infectious Diseases”, https://openknowledge.worldbank.org/server/api/core/bitstreams/956a58be-ddd8-572f-8aac-df5ab453d7b2/content; G20 High Level Independent Panel (2021[5]), “A Global Deal for Our Pandemic Age: Financing the Global Commons for Pandemic Preparedness and Response”, https://pandemic-financing.org/report/foreword/; WHO and World Bank (2022[37]), “Analysis of Pandemic Preparedness and Response (PPR) architecture, financing needs, gaps and mechanisms: Prepared for the G20 Joint Finance & Health Task Force”, https://thedocs.worldbank.org/en/doc/5760109c4db174ff90a8dfa7d025644a-0290032022/original/G20-Gaps-in-PPR-Financing-Mechanisms-WHO-and-WB-pdf.pdf; WHO, OECD, World Bank (2025[38]), “Report on Financing Pandemic Preparedness: Ensuring Sustainable and Efficient Financing. Report for G20 South Africa Presidency”, https://www.g20.utoronto.ca/2025/G20-JFHTF_Report-on-financing-for-pandemic-preparedness-1.pdf; HHS (2022[40]), “Department of Health and Human Services Public Health and Social Services Emergency Fund Fiscal Year 2022: Justification of Estimates for Appropriations Committee”, https://www.hhs.gov/sites/default/files/fy-2022-phssef-cj.pdf; Sorbonne Universite (2024[39]), “Anticipating future epidemics with OBEPINE+”, https://www.sorbonne-universite.fr/dossiers/sante-globale/anticiper-les-futures-epidemies-grace-obepine; HERA (2023[41]), “HERA 2024 Work Plan”, https://health.ec.europa.eu/publications/hera-2024-work-plan_en; DG Sante (2023[42]), “State of Health Preparedness Report 2023”, https://health.ec.europa.eu/publications/state-health-preparedness-report-2023_en.
The OECD analysis has some limitations. The interventions included in this chapter were selected to capture non-pharmaceutical measures that protect health and the economy in the early phase of an outbreak, consistent with the scenarios modelled in Chapter 7 and other measures that have been shown to bolster PPR foundations including strategic stockpiling arrangements (Chapter 9) and wastewater surveillance. They do not, however, encompass every measure that strengthens PPR capacity. Others such as improving ventilation and air hygiene, as well as targeted initiatives in healthcare and other high-risk settings can also play an important role in reducing transmission. Countries undertaking their own costing analyses could weigh these alongside the interventions assessed here, drawing on the factors most relevant to their context.
The OECD analysis focusses exclusively on the investments required to strengthen PPR capacity at the country level. But because pandemics can emerge anywhere and spread rapidly, a global-goods perspective is critical. Investments in cross-border priorities (e.g. R&D for new therapeutics, diagnostics and vaccines) are indispensable for a resilient global health architecture. The analysis does not account for country-specific institutional arrangements that may substantially affect investment needs. Decentralised systems, for instance, may face higher costs due to additional co‑ordination demands and potential duplication across administrative levels. Differences in regulatory environments, procurement practices and public-private partnership models may further shape investment requirements. Countries with streamlined emergency approval pathways may be able to implement certain PPR measures more quickly and at lower cost.
Despite these limitations, the OECD cost estimates should be considered conservative. Many of the investments examined in this chapter have the potential to yield benefits beyond PPR, contributing to other health system priorities. For instance, improving disease surveillance capacity through enhanced wastewater monitoring can effectively address the rising threat of antimicrobial resistance. Expanding stockpiles of PPE and hygiene supplies increases resilience against seasonal surges, natural disasters and other health emergencies. Together, these dual-use benefits underscore that spending on PPR capacities is not only a safeguard against future pandemics but also a strategic investment in the resilience of health systems.
Findings from this chapter showed that the annual cost of bolstering PPR capacity involving multisectoral action averages almost USD PPP 7.2 billion across the OECD, with substantial cross-country variation in investment needs. Crucially, findings from the chapter showed that failing to invest in the preparedness efforts before a disease outbreak occurs does not eliminate the need for these expenses. Instead, it shifts them to the response phase where they are likely to be more costly. In the response phase, it will be crucial to provide funding quickly to support the rapid scale up of the implementation of physical contact-reducing NPIs and other measures that can help limit the adverse health and economic impacts of the outbreak.
The economic rationale for prioritising PPR is compelling. It not only saves lives but shields economies from the devastating economic consequences of inadequate pandemic responses. As discussed earlier, the cumulative probability of experiencing another pandemic on the scale of COVID‑19 within the next 25 years is estimated at roughly 50% (Madhav et al., 2023[3]). Set against the potential health and economic toll documented in Chapters 3 and 7, the investment required to strengthen PPR capacity is modest. In the absence of timely non-pharmaceutical interventions, an uncontrolled outbreak could reduce GDP by between 11.7% and 28.9% in its first nine months and, in the most severe scenarios, could claim the lives of up to one in five people. Against losses of this magnitude and an increasing risk of facing them within a generation, investing in bolstering PPR capacity emerges as a sound economic proposition.
As OECD countries weigh their options for strengthening PPR capacity, it will be essential to emphasise international co‑operation, establish sustainable funding models and adopt integrated approaches that account for the complex interplay between human, animal and environmental health.
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Total and per capita cost of investing in PPR, USD PPP
Note: Start-up period refers to the first two years of the preparedness phase in which countries establish mechanisms to bolster PPR capacity. PPP = purchasing power parity; B = billions; M = millions.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
Total and per capita cost of investing in PPR, USD PPP
Note: Start-up period refers to the first two years of the preparedness phase in which countries establish mechanisms to bolster PPR capacity. PPP = purchasing power parity; B = billions; M = millions.
Source: OECD analysis based on the OECD SPHeP Costing Tool.