During the COVID-19 pandemic, middle-income countries struggled to invest in vaccines and other medical countermeasures. To avoid repeating the same mistake, policymakers from these countries must demand that multilateral development banks make at-risk financing available as soon as the next outbreak occurs.

JAKARTA/WASHINGTON, DC – Six years after the outbreak of COVID-19, the world is in danger of forgetting the lessons learned and repeating the same mistakes. The pandemic threat has not disappeared: studies suggest that the annual probability of another COVID-level event is 2-3%. Experts estimate that future pandemics will cost the world more than $700 billion, on average, every year.

We were both in government when COVID-19 struck and had front-row seats to Operation Warp Speed, America’s fast-track program for developing vaccines. By investing billions of dollars in early-stage candidates before regulatory approval, the United States and the United Kingdom enabled firms to expand factories while trials were underway. As a result, within a year of the pandemic’s start, the US was vaccinating vulnerable populations against COVID-19. According to some estimates, Operation Warp Speed would have paid for itself in averted mortality, morbidity, and output losses had it reduced the length of the pandemic in the US by even less than one day.

We also saw the challenges that middle-income countries faced in their attempts to follow the same strategy. No middle-income country bought COVID-19 vaccines when Operation Warp Speed launched in May 2020. In fact, many of these countries were unable to submit orders until the following year, owing largely to multilateral development banks’ (MDBs’) criteria for financing.

The World Bank, which launched its $12 billion vaccine pledge in October 2020, initially required in-country regulatory authorization, coupled with either World Health Organization prequalification and approval by one WHO-recognized “stringent regulatory authority,” or approval by three SRAs in three different regions. No vaccines met these criteria until January 2021, which significantly slowed uptake. Indonesia had the fiscal flexibility to invest in vaccines in October 2020, but only because the pandemic hit early in the year.

We must do better next time. MDBs should offer at-risk financing that allows countries to borrow for investments in candidate medical countermeasures before regulatory approval. With commercial borrowing liable to be expensive during a pandemic, MDBs are the only institutions with financial resources that can match the scale of the challenge.

Policymakers from middle-income countries must demand that MDBs make at-risk financing available as soon as the next pandemic strikes. A recent report by the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response calls on MDBs to issue guidance notes confirming their crisis-response facilities within the next six months. This would prevent foot-dragging during the crucial early days of an outbreak and ensure that MDBs meet the needs of middle-income countries.

The report also recognizes that middle-income countries require access to independent, non-political technical expertise when making such risky bets. Credible expert recommendations would help policymakers in these countries overcome any domestic regulatory and legal barriers. To facilitate this process when lives are on the line and urgent action is needed, the World Bank should take the time now to recognize a panel of economists and health experts who are well-positioned to judge which medical countermeasures are worth betting on.

But at-risk financing would be the real game changer, because it would ensure that middle-income countries could make early bets, too, and were not left waiting for vaccines and other medical countermeasures. Up to 75% of the delay in vaccine deliveries to low- and middle-income countries during COVID-19 can be attributed to the fact that they signed deals later than high-income countries.

As we saw with COVID-19 vaccines, when these bets succeed, businesses can reopen, kids can return to school, and social-welfare spending can return to more normal levels. But the sooner these effects kick in, the better. Middle-income countries should not have to wait for grant-funded vaccine donations that are too little, too late, especially when donor countries are scaling back foreign aid.

The huge economic and educational benefits of gaining early access to lifesaving vaccines and therapeutics make them high-return investments, despite the risk that they may not work. It was worth investing in such interventions during the COVID-19 pandemic, even if the probability that a vaccine would succeed was as low as around 20%. Well-designed investments also boost production capacity, to the advantage of everyone.

Taking these steps now would allow people in middle-income countries to gain faster access to the vaccines and therapeutics they need when the next pandemic arrives. But implementing these proposals will require countries to demand action from MDBs and hold them accountable for following through.