Enabling quick action to save lives – the Contingency Fund for Emergencies

March 2018

Vaccination campaign in Kutupalong camp, Cox's Bazar, Bangladesh
Vaccination campaign in Kutupalong camp, Cox's Bazar, Bangladesh

In October 2016, Haiti was hit by its strongest hurricane for more than half a century. Hurricane Matthew caused enormous damage, killing more than 470 people, leaving more than 175 000 homeless and decimating what little infrastructure the country had.

Despite the devastation, within five days of receiving a request for help, WHO medical supplies – including cholera and malaria diagnosis and treatment kits – were being delivered to affected areas.

Health workers who respond to a medical emergency or accident speak about a 'golden hour'', shorthand for the minutes straight after traumatic injury when the right intervention can make the greatest difference to survival prospects.

With health emergencies there is a similar principle. During disease outbreaks and humanitarian crises, a quick response can make a huge difference.

"We know that a dollar spent in the first few days may save US$ 10 a few weeks later," says Dr. Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response. "But it is hard to get the resources to kick-start responses to emergencies that may arise without warning. This funding gap often means the ultimate cost – and death toll – is higher."

When the Zika virus – which can create neurological damage in newborns – was identified as an international public health emergency in February 2016, it took six weeks for the promised donor funds to be available to spend.

But in Haiti, WHO was able to move fast thanks to a particular funding mechanism, the Contingency Fund for Emergencies (CFE).

The unique structure of the CFE allows up to US$ 500 000 to be made available within 24 hours. This can plug the dangerous gap before other sources of funding – including donor pledges – kick in.

In May 2017, the Democratic Republic of the Congo experienced a cluster of unexplained deaths in a remote part of the country. WHO deployed a team within 24 hours thanks to CFE funding. By July, the Ebola outbreak was over, resulting in four deaths. This rapid release of US$ 2 million quite possibly saved thousands of lives and billions of dollars. In contrast, the Ebola outbreak in West Africa in 2014 resulted in more than 11 000 deaths and cost more than US$ 3.6 billion to contain.

Later in the year, Madagascar was hit by its worst outbreak of pneumonic plague on record, killing more than 200 people. WHO released US$ 1.5 million to boost the response, which included sending 135 experts and more than 1 million doses of antibiotics. Within a few months, the outbreak was contained. No cases spread beyond the island.

In Cox’s Bazar, Bangladesh, WHO has used US$ 5 million in CFE funds to respond to the Rohingya crisis – providing medicines, improving water safety and disease surveillance, and helping to vaccinate hundreds of thousands refugees against measles, polio, diphtheria and cholera.

So far the Contingency Fund for Emergencies has enabled WHO to get quick starts on more than 50 disease outbreaks, humanitarian crises and natural disasters, allocating more than US$ 46 million. In 2017, the CFE provided nearly US$ 20 million for operations in 23 countries, with most allocations released within 24 hours.

“Without the CFE, recent outbreaks of Ebola in DRC, Marburg virus Disease in Uganda and pneumonic plague in Madagascar could have gotten out of control. The CFE is a reliable flexible funding source that allows us to act quickly, making the world safer,” added Dr Salama.

The CFE’s simple, fund pool structure also lowers transaction costs. It allows countries that do not traditionally contribute to emergency relief – perhaps because they lack the systems or financial resources – to help. One example is Estonia, which has so far contributed more than US$ 145 000.

“We have seen how [the CFE] helped WHO immediately respond to a range of challenges including yellow fever [in several contexts] and the devastating Hurricane in Haiti,” said Taavo Lumiste of the Estonian Ministry of Foreign Affairs. “Funds provided in the early stages of an emergency save lives and money. We encourage other donors to contribute.”

Germany is currently the CFE’s largest donor, having already given more than US$ 14 million. “An emergency can happen any day,” said Ambassador Ulrich Seidenberger, Deputy Permanent Representative at the German mission in Geneva. “WHO needs to have the capacity and resources to immediately mount an adequate response.”