Two New Outbreaks, One Familiar Lesson: We Are Still Underfunding Early Warning Systems

On May 17, 2026, the World Health Organization (WHO) declared the Bundibugyo Ebola outbreak in the Democratic Republic of the Congo and Uganda a public health emergency of international concern (PHEIC). This strain has no approved vaccine or treatment, and community transmission was likely underway for weeks before recognition because the strain cannot be easily diagnosed with standard test kits.

Two weeks earlier, the Andes hantavirus surfaced aboard the Dutch cruise ship MV Hondius. Passengers from 23 nationalities had already disembarked in Antarctica, South Georgia Island, Tristan da Cunha, Saint Helena, and Ascension Island, with the ship eventually intercepted by Centers for Disease Control and Prevention personnel in the Canary Islands. The case-fatality rate for severe hantavirus pulmonary syndrome is roughly 38 percent.

A Familiar Pattern

Neither event is, at present, a pandemic. However, together, they expose two recurring failures: Pathogen data and analysis do not move quickly enough across borders and sectors, and countries lack sustained financing for surveillance infrastructure. A novel pathogen can reach six continents in just 36 hours.

The Milken Institute's Catalytic Capital and FasterCures teams—through a series of Financial Innovations Labs®—have argued that a global Early Warning System, integrating traditional surveillance with nontraditional data to flag pathogen spillover before outbreaks scale, is among the most consequential investments the world can make against the next pandemic. The 2015 Zika outbreak in Brazil could have been predicted a month earlier by tracking El Niño temperature conditions. The current Ebola outbreak shows a different challenge: Detection is delayed because current tools were not designed for the pathogen. 

The Financing Problem

The public health case is clear. The financing case remains unresolved. A joint World Bank–WHO report at the 2022 G20 Summit estimated that $13.3 billion a year is needed for robust surveillance, collaborative intelligence, and early warning—of which roughly $4.1 billion is an outright gap. The Pandemic Fund, the financial intermediary fund hosted by the World Bank and launched in 2022, has awarded roughly $1.4 billion in grants that have catalyzed an additional $10 billion in domestic and international cofinancing— meaningful, but well short of the gap and concentrated on country-level capacity rather than the early-stage technology and cross-border data infrastructure the surveillance layer requires.

The economic case for closing the gap is compelling. COVID-19 killed 6.9 million people, infected 764 million, and may have cost the global economy $13.8 trillion in cumulative output by 2024. The probability of another COVID-scale pandemic in the next decade is 27.5 percent—subsequent modeling suggests rapid vaccine rollout could reduce that to 8.1 percent. A World Bank analysis of six major outbreaks from 1997 to 2009 concluded prevention could save $6.7 billion a year.

The barrier is not the math. Public and philanthropic funding alone cannot close the gap, and private capital has stayed on the sidelines because risk-return is uncertain, the business model is unproven, and the regulatory environment is fragmented.

Two Financing Vehicles to Unlock Private Capital 

In April 2023, the Milken Institute convened a Financial Innovations Lab bringing together government, investors, philanthropies, multilateral organizations, and academia to map the financing architecture. Two vehicles emerged as the most promising paths to scale because they address different parts of the market failure.

The first is a venture philanthropy fund for high-risk, long-horizon investments in new data sources, diagnostics, and analytic tools. This vehicle would pay for the innovation layer that traditional public funding has often underwritten too late. The second is a blended finance vehicle—a tiered equity or debt fund using concessional capital in the first-loss tranche to crowd in impact and commercial investors. This vehicle would pay for country-level deployment: interoperable surveillance infrastructure, laboratory networks, data-sharing incentives, and implementation support. 

Blended structures have mobilized private capital in climate and global health; applied to early warning, they can make parts of a public good financeable. Both would sit alongside a new Health Information Insight Exchange that sets data standards, supports secure exchange among national nodes, and helps governments, health systems, researchers, and private partners share surveillance signals. Without this operating layer, even well-funded national systems remain islands.

How This Looks on the Ground

The global architecture only matters if it lands in national systems. The Milken Institute wrote case studies of Brazil, Kenya, and Indonesia that illustrate different financing needs: digital infrastructure, local reporting incentives, and interoperability across fragmented systems. Brazil, where a 2024 dengue outbreak forced Rio de Janeiro and São Paulo to declare emergencies, is a test case for public-private partnerships and blended finance directed at digital health-care infrastructure, paired with a domestic Health Information Insight Exchange.

Kenya, where 93 percent of Western Kenya households keep livestock, sits at the human-animal interface where zoonotic spillovers begin. A blended fund using donor capital as a risk cushion—plus incentives such as low-interest loans and mobile-data packages for clinics and smallholder farms to share data—addresses the conditions in which the next outbreak is most likely to emerge.

Indonesia, fragmented across 6,000 islands and weakened by two decades of decentralized health data, needs government–technology partnerships to digitalize and interoperate. These are the in-country counterparts of the global vehicles—the same $4.1 billion gap translated into infrastructure, incentives, and interoperability.

Time Bought Is Value Created

Early warning systems are valuable in proportion to the time they buy. Two months between the onset of the Ebola outbreak and the PHEIC declaration is two months in which a more capable surveillance layer could have changed the trajectory. WHO’s warning that responders are now “playing catch-up” underscores the same lesson: delayed detection leaves public health systems reacting after an outbreak has gained speed. The current outbreaks of Ebola and hantavirus are not, on current trajectories, the next pandemic—but they are reminders that the next one will not announce itself, and the financing architecture to see it coming has been designed but not yet built. 

The Institute's report, Innovative Finance Models for a Global Early Warning System for Pandemics, sets out the structures, governance, and incentives required to operationalize these vehicles.

This year, three actions are needed:

• G20 finance and health ministers should adopt a time-bound financing commitment to close the $4.1 billion gap with transparent country-level burden sharing. 
• Multilateral development banks and major philanthropies should anchor a $500 million first-loss tranche for a blended finance vehicle that private investors can underwrite. 
• Governments, foundations, and the private sector should commit to launching the Health Information Insight Exchange. 

The Milken Institute will continue to convene the capital, policymakers, and scientific expertise needed to build that system. We invite partners ready to move from blueprint to implementation to join us.