The health emergency precipitated by the Zika virus is a salutary reminder: global preparedness for emerging pathogens with endemic or pandemic potential is crucial and needs an overhaul. These crises are not rare — Lassa fever, Ebola virus, Middle East respiratory syndrome, H1N1 influenza and severe acute respiratory syndrome (SARS) have surfaced in head-spinning succession over the past 10–15 years. Each emergence proves how woefully unprepared the global community is to deal with worldwide health emergencies that have deep societal and economic impact.

The slow global response to the Ebola crisis in west Africa suggests that important gaps exist in donor financing for key global functions, such as support for health research and development for diseases of poverty and strengthening of outbreak preparedness. In this Health Policy, we use the International Development Statistics databases to quantify donor support for such functions.

The current drug discovery paradigm in the West is constrained in what it can do, primarily due to the funding model. Here we envisage a hypothetical non-governmental, non-profit organization called the Centre for Affordable Medicine. By sourcing innovation from a network of academic and corporate partners, and working primarily in India, it could lower the cost of innovation. Funding could be from a variety of players that expect a social, not financial, return.

Performance-based financing is generating a heated debate. Some suggest that it may be a donor fad with limited potential to improve service delivery. Most of its critics view it solely as a provider payment mechanism.

Aid agencies are well resourced and quick to act, but not enough of them appear to be using their power to tackle the long term problems posed by climate change. Aid agencies are first on the scene of many of the world's trouble spots, and often play a huge role in helping communities get back on their feet.

The PATH Malaria Vaccine Initiative (MVI), the main public