BACKGROUND:
Pandemic prevention, preparation and response (PPPR) is dominating international public health discourse. The World Health Organization (WHO) and World Bank are proposing unprecedented public funding, over US$31 billion annually and over $US10 billion additional for One Health,1.2 to address pandemic risk. This diversion of resources in a funding-restricted environment, based on claims of rapidly increasing pandemic threat, has major implications for public health outcomes.

METHODS:
The University of Leeds REPPARE project reviewed the evidence base of major claims in official reports of the WHO,1,3,4 World Bank,1,2 G20 High Level Independent Panel (HLIP),5 including their primary citations, that underpin assumptions of pandemic risk and projected return on investment (ROI). We further examined the major citations on zoonotic spillover, considered the primary driver of outbreak risk.

RESULTS:
Major evidence gaps and uncertainties underlie the WHO, World Bank’s and G20 HLIP’s assumptions on risk, with significant discrepancies between their claims and the evidence base and citations on which these are based.6,7 Evidence on spillover risk is complex, and an increase in outbreak reporting is strongly associated with the development and roll-out of technology advances in diagnostics and communications. Most outbreaks proposed as evidence of risk are of very low mortality. The ROI projections of the WHO and World Bank are dependent on this unclear risk, and highly problematic in methodology. Comparisons with costs of endemic diseases are based on highly questionable data. Conclusion. There is an urgent need to thoroughly review the evidence base and financial justification for the PPPR agenda. Failure to do so puts efforts towards health equity as increasing risk. A concentration on demonstrably low burden and rare diseases of concern to high income countries will divert resources from major disease burdens in poorly resourced health systems, with a likelihood of an overall negative net impact.