On May 17, 2026, the World Health Organization declared a public health emergency of international concern for an Ebola outbreak in the Democratic Republic of the Congo and Uganda. The causative virus was Bundibugyo, first identified in a Ugandan district in 2007 and since then characterized in the scientific literature, discussed at international conferences and listed on priority pathogen watchlists: nearly two decades of institutional concern. Doctors treating patients in 2026 had no approved vaccine and no approved treatment for a virus that had killed roughly 30 to 50 percent of patients in its two previous outbreaks.
Scientists had known about Bundibugyo for years, and the biology was not intractable. The rVSV vector platform behind Ervebo, the Zaire ebolavirus vaccine the FDA approved in 2019, is adaptable technology, and the biological knowledge needed to apply it to Bundibugyo had long been accumulating. After WHO declared the emergency, CEPI moved quickly. On June 1, 2026 it fast-tracked three investigational candidates, from IAVI, Moderna and the University of Oxford with the Serum Institute of India, committing up to $62 million, including an initial $3.2 million to IAVI for an rVSV-based Bundibugyo candidate.
Within eleven weeks, two candidates were in Phase 1 trials. That is fast by any historical standard, yet human testing still started from zero: Phase 1 trials beginning months into a declared emergency, for a virus known since 2007.
The eighteen-year gap between discovery and that emergency funding comes from a calculation that pharmaceutical companies make before beginning any development program.
The calculation
If you were a pharmaceutical company in 2009, two years after Bundibugyo was first characterized, looking at the outbreak data across your conference table, the question on the table was “will the expected return on developing this vaccine be positive?” Whether a vaccine could be made at all was a separate question, and confusing the two is how this problem gets misread as a scientific one.
Vaccine development is expensive enough to keep most companies out. Bringing a vaccine to market costs, on average, an estimated $886.8 million, and development takes about 15 years on average from research program to approval. Average out-of-pocket costs per trial phase are far smaller, from about $6.5 million for Phase 1 to about $104 million for Phase 3. The $886.8 million is an expected capitalized cost: it incorporates the cost of capital across the fifteen-year development timeline and adjusts for the high probability of failure at each stage, since most vaccine candidates never reach approval. It is the figure a pharmaceutical company uses when deciding whether to begin.
So a company making a development decision is looking at an expected bill of roughly a billion dollars, once failures and the cost of capital are counted, spread over fifteen years and weighed against the probability of technical success, against projected market size and per-dose price, against competitors, reimbursement dynamics, and the time value of money. The exercise has a name in pharmaceutical finance: expected net present value analysis. A positive NPV says development is commercially rational; a negative one says it is not.
Expected NPV applies a discount rate to project cash flows, which means a dollar earned fifteen years from now is worth less today than a dollar earned in five years. For a vaccine requiring a decade and a half of investment before any revenue appears, discounting shrinks the present value of sales that arrive only at the end, while money spent early compounds at the cost of capital until launch. Then add the probability weighting. The expected NPV must account for the likelihood that this specific program will fail, and for the money sunk in candidates that fail along the way, and that makes the market return required to justify an NPV-positive decision large enough that most pharmaceutical executives, presented with Bundibugyo’s profile in 2009, would not have needed a spreadsheet to reach a conclusion.
Statins, cancer therapies and diabetes medications treat diseases that affect hundreds of millions of people in countries with deep insurance systems and high willingness to pay, and for them the expected NPV is reliably positive. Markets are large and prices high, the probability of regulatory success is well characterized by historical data, and returns, while uncertain, are predictable within ranges that justify the risk.
For a hemorrhagic fever virus concentrated in Central Africa whose known outbreaks had never exceeded about 130 cases, the calculation looks different in every variable simultaneously.
In 2009, the Bundibugyo data showed a disease that had produced 131 cases, 56 of them laboratory-confirmed, in its single known outbreak, in Uganda’s Bundibugyo District in 2007. The next outbreak, in DRC’s Province Orientale in 2012, would produce 59 cases (38 confirmed, 21 probable) and be declared over within about three months. The effective market for any resulting vaccine, meaning the buyers who would purchase doses, consisted of government health ministries in DRC and Uganda. They buy most vaccines through donor-backed procurement at low per-dose prices, in countries where annual GDP per person is counted in hundreds of dollars or barely above a thousand (under $700 in DRC and about $1,080 in Uganda in 2024), and their health budgets cannot support large advance purchase commitments. International emergency stockpiles and donor-funded outbreak response exist, but they are structured to buy at humanitarian prices, not at prices that recover hundreds of millions in development costs. The time-to-revenue problem compounds the discount-rate problem: a vaccine for an epidemic that erupts every decade cannot be monetized steadily over time the way a chronic-disease drug can.
A rational investor looking at all of this in 2009 concludes the expected return is negative, and the arithmetic backs the investor. Greed would be a more comfortable explanation, and an easier one to dismiss. Here every company that runs the same numbers reaches the same decision, and those decisions add up to a structural market failure that leaves the people most at risk with no vaccine.
A generous projection for a Bundibugyo vaccine might count 10–15 million high-risk people in DRC and Uganda, reached over a decade at $3 per dose: $30–45 million in total revenue across that decade, at one dose each. That revenue would be earned mostly in outbreak years and heavily discounted over the fifteen-year development horizon, against an expected development bill near a billion dollars. The company spends its capital elsewhere. The same pattern repeats across Nipah, Crimean-Congo haemorrhagic fever and Rift Valley fever. The market fails any pathogen whose outbreak population cannot afford to pay development-sustaining prices and whose government cannot commit to pay them on its behalf, and Bundibugyo is one of many.
Three ways to fail the test
Bundibugyo fails the pharmaceutical investment calculation on three separate counts at once, and each failure compounds the others.
The first failure is purchasing power. DRC’s GDP per capita was under $700 in 2024. The global procurement architecture for vaccines in low-income settings, run through GAVI and UNICEF, has driven prices for routine vaccines to roughly $2–$3 per dose, sometimes lower. That pricing exists to extend vaccine access into the countries that most need it, but it leaves a manufacturer no realistic way to recover $886.8 million in development costs from this market. At $2 per dose, recovering the development cost alone requires selling roughly 450 million doses, before production costs, distribution or any return on invested capital. The entire population of DRC is roughly 110 million people. Outbreak vaccines can command more: UNICEF pays Merck about $99 a dose for Ervebo, a price that includes keeping the global Ebola stockpile stocked. But that stockpile is held at 500,000 doses, and even at Ervebo’s price, recovering the development cost would take about nine million.
The obvious objection is that other buyers exist: wealthy-country outbreak response stockpiles, emergency procurement at higher prices, humanitarian donor purchases. These exist, but they are not large enough to change the calculation. WHO outbreak response funds and donor emergency stockpiles operate at humanitarian prices, not development-recovery prices. And they are mostly structured for reactive purchasing, buying doses of something that already exists rather than funding the decade-long process of creating something that doesn’t. Gavi’s 2016 deal with Merck, $5 million toward an Ebola vaccine still awaiting licensure, came only after that vaccine had already protected people in the ring trial. Even optimistically sized, their aggregate purchasing capacity for any single neglected pathogen represents a fraction of what would be required to flip a negative expected NPV to positive for an investor deciding in Year 1 whether to start Phase 1.
The post-PHEIC response itself demonstrates the failure. CEPI’s emergency portfolio is reactive funding for candidates that weren’t in clinical development before the outbreak began: up to $62 million committed on June 1, 2026, two weeks after the emergency was declared, followed by further awards. That money, however fast it moved, is not part of the expected-return calculation a pharmaceutical company makes in 2009. It is a donation that materializes only after the catastrophe, after deaths that a vaccine already on the shelf might have prevented. Emergency humanitarian funding, however welcome, does not retroactively rewrite the investment logic that left the stockpile empty.
The second failure is government procurement leverage. What made COVID-19 vaccines commercially viable went beyond market size: the US government was willing to act as a large, creditworthy buyer committed to paying development-sustaining prices before any regulatory approval existed. The initial US government contract for Pfizer/BioNTech’s COVID-19 vaccine was $19.50 per dose, an early and substantial signal that a buyer with an enormous balance sheet was committed to purchase at scale. That signal changed the expected-NPV calculation for manufacturers. It meant that even before Phase 3 results existed, the revenue side of the ledger had a floor. DRC has no comparable lever. Its government cannot commit to buy a future Bundibugyo vaccine at development-sustaining prices, because it doesn’t have the budget or the institutional infrastructure to make such a commitment credible. What it has, when an outbreak arrives, is a request for international emergency assistance.
The third failure concerns the evidence a regulator needs before a vaccine can be approved.
The standard route to approval runs through a large randomized efficacy trial with enough incident cases to measure the protective effect statistically. The WHO-led ring vaccination trial of Merck’s rVSV-ZEBOV, the vaccine later licensed as Ervebo, enumerated 11,841 contacts and contacts-of-contacts in Guinea and Sierra Leone in 2015 and vaccinated 5,837 of them. That trial was possible because the 2014–2016 West Africa Ebola epidemic generated approximately 28,000 cases across Guinea, Liberia and Sierra Leone over two years, a sustained outbreak with the geographic concentration and duration to make a large, well-powered trial logistically achievable. Regulators can accept less. In 2020 Europe authorized Johnson & Johnson’s two-dose Ebola regimen under exceptional circumstances, on immune-response data from human studies and efficacy extrapolated from animals, because a randomized efficacy trial could not be run. Even that route needs a candidate that has already been through human trials.
Until 2026, Bundibugyo’s outbreak pattern was the opposite: sporadic, brief and geographically scattered. The 2007 Uganda outbreak ran from August to December, and the 2012 DRC outbreak was declared over within about three months, before research infrastructure could be mobilized at scale. The 2026 epidemic broke that pattern. By late August, CEPI was calling it the second-largest Ebola outbreak on record, but no developer could have built a business case on that possibility in 2009. For most of the virus’s known history, its epidemiology made the large human efficacy trial that standard approval relies on essentially impossible to run.
The Phase 3 problem
A protective efficacy trial for an outbreak pathogen like Bundibugyo requires thousands of participants at active risk of exposure, with enough incident cases in the trial population to distinguish vaccine-induced protection from baseline low transmission. Ring vaccination designs, which enroll contacts and contacts-of-contacts of confirmed cases, need sustained outbreak chains to function at all. The rVSV-ZEBOV ring trial recorded zero cases among those vaccinated immediately from ten days after randomization, a result made possible by an epidemic that had already sustained transmission for more than a year when the trial began.
Running such a trial in Bundibugyo-affected territory requires vaccine cold-chain capacity in remote DRC, certified sample collection and transport to reference laboratories, ethical oversight from both national and international review bodies, active regulatory engagement with DRC authorities and, above all, enough cases in a tight enough geographic area for long enough to reach statistical significance. Bundibugyo’s two outbreaks before 2026 were over before most of these prerequisites could be assembled. Adaptive trial designs and platform approaches can reduce some of these barriers, but before 2026 none of them had been funded or tested for Bundibugyo, because the market offered no return to pay for them and public funders had other priorities. They are being assembled now, in the middle of an epidemic, with public and philanthropic money.The result is a catch-22: the disease’s outbreak pattern blocks the evidence-generation process that standard approval requires. Without that evidence there is no standard approval, and without approval there is no licensed stockpile to deploy when the next outbreak arrives.
The rVSV platform that could produce a Bundibugyo vaccine, the same platform behind the IAVI candidate CEPI is now funding, was validated and sitting in laboratories before the 2026 outbreak. What didn’t exist was anyone willing to pay for clinical development, because it costs far more than any plausible market could return. Influenza and hepatitis B, by contrast, have licensed vaccines and enormous paying markets that keep manufacturers in the business; influenza vaccines are remade every season because buyers pay for each season’s shots.
The fixes
The market failure has been understood since at least the mid-1990s. Every mechanism designed to address it responds to a specific theory of what’s wrong, and most of them are technically sophisticated. None of them has solved it at the scale it requires, partly for lack of money and partly because no financial instrument can change the diseases themselves.
The first advance market commitment, for pneumococcal vaccine, addressed a specific version of the problem: the situation where a vaccine exists but manufacturers have no viable market signal to produce it at scale for low-income populations. It is the canonical success. A $1.5 billion donor fund, assembled from the Bill & Melinda Gates Foundation and five governments, guaranteed manufacturers a viable purchase price for pneumococcal vaccines delivered to low-income countries. When donors launched it in 2007, two qualifying vaccines were already in advanced development: GSK’s Synflorix and Pfizer’s Prevenar 13, both licensed in Europe in 2009. Their makers needed a credible demand signal to invest in low-income-market supply capacity and bring prices down, and the AMC provided it. Within its first decade, more than 150 million children had been immunized and an estimated 700,000 lives saved.
The conditions under which it worked explain why it hasn’t generalized. The pneumococcal AMC solved a distribution problem: there were existing products and willing manufacturers, and what was missing was a viable buyer, which the AMC created. Gavi’s COVAX AMC, launched in June 2020, went further, guaranteeing purchase volumes for some COVID-19 candidates before they were licensed, but it rode on a disease that wealthy governments were already spending billions to defeat.
The Bundibugyo problem is different: there is no product. A hypothetical Bundibugyo AMC would need to function as a “pull” mechanism, committing today to purchase a vaccine that doesn’t yet exist, at a price high enough to make development commercially rational, contingent on successful development. This theoretical construct exists in policy literature under various names: advance market commitments for development, pull financing, innovation inducement prizes. What it has not done is materialize as a funded mechanism for any neglected outbreak pathogen at the scale that would change the expected-NPV calculation from negative to positive. The guarantee would need to promise purchase at prices substantially above GAVI humanitarian levels, for a product that may never clear regulatory approval, from manufacturers that haven’t started the development process. The nearest thing so far came after the emergency began: in May 2026 Gavi set aside up to $40 million to help Bundibugyo vaccine makers build manufacturing capacity before any candidate is proven, alongside CEPI’s development money, but without any commitment to buy doses at a price that would recover development costs. What that guarantee looks like, in practice, is a government contract with AMC language layered on top of it.
CEPI was designed for exactly this gap. Founded at Davos in January 2017, directly after the 2014–2016 West Africa Ebola epidemic made vivid what the absence of preemptive development infrastructure costs, CEPI began with a mandate to accelerate vaccine development for high-risk outbreak pathogens with no viable commercial market. CEPI-funded programs have advanced Lassa candidates, Nipah candidates, and a chikungunya vaccine, Valneva’s Ixchiq, that won approval in several jurisdictions (the US suspended its license in August 2025 over safety concerns). During Uganda’s 2022 Sudan ebolavirus outbreak, candidate vaccine doses arrived only after the last patient had tested negative; when Sudan virus returned in 2025, a CEPI-supported ring vaccination trial of IAVI’s rVSV candidate launched four days after the outbreak was confirmed. For several pathogens, CEPI has shortened development timelines well below the uncoordinated baseline.
CEPI 2.0, covering 2022–2026, had a fundraising target of $3.5 billion. By March 2024 it had secured about $2 billion in contributions and pledges, $1.65 billion of it from governments and the EU, which left it some $1.5 billion short of its own stated goal. The shortfall came during a period in which the COVID-19 pandemic had made the case for epidemic preparedness as forcefully as anything in modern public health history. Every government that faced the COVID emergency had, by 2021, experienced in real time what happens when novel pathogens spread through a world without pre-positioned vaccine development infrastructure. Asked to fund CEPI at $3.5 billion, donors including those governments came up short. CEPI 3.0 is now seeking $2.5 billion in additional investment for 2027–2031.
When WHO declared a PHEIC for Bundibugyo in 2026, no Bundibugyo vaccine candidate was in clinical development. CEPI, which exists specifically to prevent this situation, had no Bundibugyo vaccine in human trials; the most advanced candidate had been tested only in monkeys. Money explains much of it: with a budget that funds roughly two complete development programs at the industry’s average capitalized cost, and eight WHO emergency-priority disease groups to cover, CEPI has to prioritize. Prioritization means betting on which pathogens are most likely to drive the next emergency: Lassa over Bundibugyo, Sudan ebolavirus over Crimean-Congo haemorrhagic fever. Bundibugyo, with its sporadic outbreak history and small confirmed case counts, didn’t make the cut before 2026. The emergency portfolio CEPI assembled after the PHEIC was declared (up to $62 million across three candidates in its first round, followed by further awards) is reactive vaccine development, exactly the pattern CEPI was built to replace. Starting from zero clinical development, even the fastest possible effort is measured in years rather than weeks.
Priority review vouchers are the third mechanism, and a clever one. The PRV program, created by Congress in 2007, awards FDA vouchers to pharmaceutical companies that gain regulatory approval for drugs or vaccines targeting qualifying neglected tropical diseases. A voucher converts a standard FDA review of about ten months into a priority review of about six, saving roughly four months of time-to-market for whatever product the holder applies it to. Vouchers are transferable: by 2019, 17 of the 31 vouchers FDA had awarded across its tropical-disease, rare-pediatric and countermeasure programs had been sold, for between about $67 million and $350 million.
The idea is to turn FDA review capacity into a tradable asset. A small company develops a neglected-disease drug, earns a voucher, sells it to a large company racing to launch a new product and uses the cash to fund its next neglected-disease program, all through private incentives and without direct public expenditure.
In practice, PRVs are awarded at regulatory approval, so the entire development investment, from Phase 1 through regulatory submission, must be committed before any voucher benefit materializes. A company deciding before Phase 1 can count the voucher in its expected NPV, but only after discounting it for the years until approval and for the odds of never getting there, and companies describe vouchers as one factor among several in those decisions. A voucher worth $67 million to $350 million is small against an expected development bill of $886.8 million for a product whose end market cannot support commercial price recovery. Most PRVs have been earned for drugs, not vaccines; vaccines cost more to develop, require more extensive clinical trials for a narrower population of eligible diseases, and have a lower probability of earning a voucher per development dollar spent. And the secondary market for vouchers only functions because the voucher value is modest relative to what large companies earn from faster launches: the mechanism creates value by selling something cheap. The program may tip some neglected-disease decisions at the margin, but there is little evidence that it has added approvals that would not otherwise have happened. It has not changed the structural dynamics of vaccine development for outbreak pathogens with negative expected NPV.
Any mechanism that still routes through private expected return has to pay for the whole shortfall the market leaves, because a cleverer instrument leaves untouched the disease characteristics that make the market fail: the poverty of the affected population, the government procurement constraints, and the epidemiology that makes Phase 3 trials logistically near-impossible.
Consider what each mechanism would look like scaled to the point where it closes the gap. A pull AMC large enough to make Bundibugyo vaccine development commercially rational is structurally indistinguishable from a government procurement contract, since it is a government commitment to buy a future product at a guaranteed price. CEPI funded to cover all eight WHO emergency-priority disease groups simultaneously is a public vaccine-development agency, accountable to state funders, making allocation decisions on public health grounds rather than expected commercial return, producing vaccines as public goods.
A PRV sized to offset an $886 million negative-market development program would need to sell at roughly $900 million or more. That is more than two and a half times the highest price any voucher had fetched by 2019, for the same four months of review time.
Scaled that far, each of these mechanisms turns into public finance, because the structural characteristics of these diseases (the outbreak populations, their purchasing power, the trial logistics) cannot be altered by instrument design.
The arithmetic of a real solution
The WHO’s “priority diseases for R&D in emergency contexts” was the R&D Blueprint list that steered emergency preparedness from 2018 until WHO broadened it in July 2024 into a framework spanning 28 viral families. In its final, COVID-era version it names eight disease groups requiring urgent vaccine and treatment development: COVID-19; Crimean-Congo haemorrhagic fever; Ebola and Marburg viruses; Lassa fever; MERS-CoV and SARS; Nipah and henipaviral diseases; Rift Valley fever; and Zika. It adds Disease X, a placeholder for the next novel pathogen. Each disease group needs at least one complete development program: preclinical research, clinical trials through Phase 3, regulatory approval, manufacturing scale-up, stockpile.
CEPI 2.0 secured roughly $2 billion of its $3.5 billion five-year target. At the industry’s average capitalized cost of $886.8 million per program, that budget covers the expected cost of roughly two complete programs from preclinical research to regulatory approval. The comparison is rough, since a public funder does not pay the 11 percent private cost of capital built into that average, so its money stretches further. The average already prices in the candidates that fail along the way, and it leaves out building manufacturing plants and supply chains, as well as administrative overhead and the organizational infrastructure required to run an international public health institution. There are eight disease groups on the WHO emergency list, and at its actual funding level CEPI’s budget matches the full development bill for roughly two of them.
Global pharmaceutical R&D spending in 2024 was approximately $288 billion. CEPI’s annual budget, roughly $400–500 million, is less than two-tenths of one percent of what the pharmaceutical industry spends each year, almost entirely on diseases affecting wealthy or middle-income populations.
Two mechanisms can close this gap, and both are explicitly non-market. The first is regulatory mandate: governments requiring pharmaceutical companies, in exchange for the patent protections and market exclusivities that underpin the entire pharmaceutical business model, to invest some defined share of R&D in neglected disease development. The structural logic is coherent. Companies receive an enormous public subsidy in the form of patents, exclusive rights that run 20 years from filing and are enforced by state power, and attaching public interest conditions to that subsidy is reasonable.
The politics have not followed. The TRIPS Agreement, the WTO treaty framework governing pharmaceutical intellectual property, was negotiated under sustained pharmaceutical industry lobbying pressure. It protects patent rights aggressively and leaves its public-health flexibilities, such as the compulsory licensing reaffirmed in the 2001 Doha Declaration, as case-by-case national exceptions rather than standing obligations on industry. The COVID-19 pandemic did produce a TRIPS waiver for vaccine production, adopted at the WTO’s 12th Ministerial Conference in June 2022, but only as a partial, hard-won concession after two years of opposition. India and South Africa first proposed a broad COVID-related IP waiver in October 2020. The United States, the European Union, the United Kingdom and Switzerland opposed it. The US reversed its position in May 2021; the EU held out for another year. The final text covered vaccine production only, excluded diagnostics and therapeutics, and was substantially narrower than originally proposed, yet the pharmaceutical industry still condemned it: its global federation, IFPMA, expressed “deep disappointment” and dismissed the decision as an “empty shell”. A mandatory neglected-disease R&D requirement faces the same opposition, more organized and better resourced, and without even a COVID-scale emergency as political cover.
The second mechanism is public subsidy at scale: governments funding vaccine development directly through public agencies, owning the resulting intellectual property, and producing vaccines as public goods priced for access rather than return on private investment.
Only one program has come close, and it ran through private companies rather than public agencies, under conditions that generated the political will to pay for it. Operation Warp Speed committed approximately $18 billion of US government funding to COVID-19 vaccine and treatment development.
The government absorbed much of the clinical-trial risk, funding development and late-stage trials for most of its partners directly. It contracted with Moderna, Pfizer/BioNTech, Johnson & Johnson, AstraZeneca, Novavax, and others for hundreds of millions of doses before any of those vaccines had demonstrated efficacy in humans. For most of them it was essentially pre-paying for products that might never work, so that manufacturing capacity could be built in parallel with clinical development; Pfizer/BioNTech took no development money and would be paid only on delivery, after authorization. It paid for disappointments: AstraZeneca’s vaccine never won US authorization, Novavax’s timeline slipped, others were never deployed. Two vaccines were authorized for emergency use in December 2020, less than a year after the virus was identified, which made Operation Warp Speed the fastest vaccine development program in history by a substantial margin.
Public money on that scale has been deployed for exactly one disease. Smaller versions exist: Ervebo itself began in a Canadian government laboratory and was carried to licensure with US Defense Department and BARDA support alongside Merck’s own spending. COVID-19 killed people in the United States, the United Kingdom, Germany, France, and Japan at a rate that put politicians facing re-election in those countries under direct electoral pressure. It threatened populations whose governments had both the budget and the political motivation to respond, governments that faced accountability at the ballot box for deaths at home. The same regulatory infrastructure, emergency procurement authorities, fast-track pathways and public health agencies exist now and could be pointed at Bundibugyo, Lassa, Nipah, Crimean-Congo haemorrhagic fever and Rift Valley fever. The WHO’s priority list has been published, updated, and cited in global health policy discussions for years. Both the risk information and the development model were available.
What has been missing is political motivation, and it tracks whether the threatened population has governments with both the budget and the electoral incentive to treat the outbreak as an emergency.
DRC does not have that lever. Uganda has it only partially. The governments of the countries where Bundibugyo kills 30–50% of its patients do not have the fiscal capacity to mount an Operation Warp Speed for a disease that threatens primarily their own populations. And the governments that do have that capacity (the G7, the major bilateral donors, the multilateral institutions) have no electoral constituency pressing them to act with anything like the urgency they displayed for COVID-19.
The gap between what was spent on COVID-19 and what has been spent on the WHO’s other seven named emergency-priority disease groups follows a consistent pattern: the same institutions that moved at unprecedented speed to fund COVID vaccines have been serially asked to fund CEPI at its stated goal and have serially come up short. Political systems can respond to pandemic risk, as COVID demonstrated. In practice, though, “pandemic risk” means risk to populations whose governments have the resources and the political incentive to treat them as worth an emergency response. Bundibugyo, Lassa and Nipah strike populations whose governments mostly lack that combination.
On June 1, 2026, two weeks into the emergency, CEPI committed up to $62 million to three Bundibugyo vaccine candidates, for a virus known since 2007. That entire first round is about 7 percent of the expected cost of a single full development program, at the industry’s capitalized average.
The United States assembled $18 billion for Operation Warp Speed. Nothing comparable has been assembled, by Washington or anyone else, for Bundibugyo, Lassa, Nipah or the other pathogens on the WHO’s own priority list.
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