Governance Challenges in International Health Financing and Implications for the New Pandemic Fund

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> The failures of the international COVID-19 response highlighted key gaps in pandemic preparedness and response (PPR). The G20 and WHO have called for additional funding of $10.5 billion per year to adequately strengthen the global PPR architecture. In response to these calls, in 2022 the World Bank announced the launch of a new Financial Intermediary Fund (The Pandemic Fund) to catalyse this additional funding. However, there is considerable unclarity regarding the governance makeup and financial modalities of the Pandemic Fund, and divergence of opinion about whether the Fund has been successfully designed to respond to key challenges in global health financing. <jats:bold>Methods/ results:</jats:bold> To better situate the Pandemic Fund within discussions about existing challenges in global health financing, this article presents the results of a scoping review identifying key challenges associated with international health financing instruments. A total of 73 documents were collected from which 51 were reviewed for analysis. Thematic analysis identified eight thematic groupings that emerged from the literature which were then used as policy criteria to assess the current governance and financing design of the Pandemic Fund using available information on the Fund. The eight themes in hierarchical order of frequency were: misaligned aid allocation; accountability; multistakeholder representation and participation; country ownership; donor coherency and fragmentation; transparency; power dynamics, and; anti-corruption. Assessment of the Pandemic Fund against these criteria found that although some mechanisms have been adopted to recognise and address challenges, overall, the Pandemic Fund has unclear policies in response to most of the challenges while leaving many unaddressed. <jats:bold>Conclusion:</jats:bold> It remains unclear how the Pandemic Fund is explicitly addressing the eight challenges identified. Moreover, there is evidence that the Pandemic Fund might be exacerbating these global financing challenges, thus raising questions about its potential efficacy, suitability, and chances of success. In response, this article offers three sets of policy recommendations for how the Pandemic Fund and PPR financing architecture might respond more effectively to the identified challenges.</jats:p>