TY - JOUR
T1 - Global investments in pandemic preparedness and COVID-19
T2 - development assistance and domestic spending on health between 1990 and 2026
AU - Global Burden of Disease 2021 Health Financing Collaborator Network
AU - Micah, Angela E.
AU - Bhangdia, Kayleigh
AU - Cogswell, Ian E.
AU - Lasher, Dylan
AU - Lidral-Porter, Brendan
AU - Maddison, Emilie R.
AU - Nguyen, Trang Nhu Ngoc
AU - Patel, Nishali
AU - Pedroza, Paola
AU - Solorio, Juan
AU - Stutzman, Hayley
AU - Tsakalos, Golsum
AU - Wang, Yifeng
AU - Warriner, Wesley
AU - Zhao, Yingxi
AU - Zlavog, Bianca S.
AU - Abbafati, Cristiana
AU - Abbas, Jaffar
AU - Abbasi-Kangevari, Mohsen
AU - Abbasi-Kangevari, Zeinab
AU - Abdelmasseh, Michael
AU - Abdulah, Deldar Morad
AU - Abedi, Aidin
AU - Abegaz, Kedir Hussein
AU - Abhilash, E. S.
AU - Aboagye, Richard Gyan
AU - Abolhassani, Hassan
AU - Abrigo, Michael R.M.
AU - Abubaker Ali, Hiwa
AU - Abu-Gharbieh, Eman
AU - Adem, Mohammed Hussien
AU - Afzal, Muhammad Sohail
AU - Ahmadi, Ali
AU - Ahmed, Haroon
AU - Ahmed Rashid, Tarik
AU - Aji, Budi
AU - Akbarialiabad, Hossein
AU - Akelew, Yibeltal
AU - Al Hamad, Hanadi
AU - Alam, Khurshid
AU - Alanezi, Fahad Mashhour
AU - Alanzi, Turki M.
AU - Al-Hanawi, Mohammed Khaled
AU - Alhassan, Robert Kaba
AU - Aljunid, Syed Mohamed
AU - Almustanyir, Sami
AU - Al-Raddadi, Rajaa
AU - Alvis-Guzman, Nelson
AU - Alvis-Zakzuk, Nelson J.
AU - Amare, Azmeraw T.
AU - Ameyaw, Edward Kwabena
AU - Amini-Rarani, Mostafa
AU - Amu, Hubert
AU - Ancuceanu, Robert
AU - Andrei, Tudorel
AU - Anwar, Sumadi Lukman
AU - Appiah, Francis
AU - Aqeel, Muhammad
AU - Arabloo, Jalal
AU - Arab-Zozani, Morteza
AU - Aravkin, Aleksandr Y.
AU - Aremu, Olatunde
AU - Aruleba, Raphael Taiwo
AU - Athari, Seyyed Shamsadin
AU - Avila-Burgos, Leticia
AU - Ayanore, Martin Amogre
AU - Azari, Samad
AU - Baig, Atif Amin
AU - Bantie, Abere Tilahun
AU - Barrow, Amadou
AU - Baskaran, Pritish
AU - Basu, Sanjay
AU - Batiha, Abdul-Monim Mohammad
AU - Baune, Bernhard T.
AU - Berezvai, Zombor
AU - Bhardwaj, Nikha
AU - Bhardwaj, Pankaj
AU - Bhaskar, Sonu
AU - Boachie, Micheal Kofi
AU - Bodolica, Virginia
AU - Botelho, João Silva Botelho
AU - Braithwaite, Dejana
AU - Breitborde, Nicholas J.K.
AU - Busse, Reinhard
AU - Cahuana-Hurtado, Lucero
AU - Catalá-López, Ferrán
AU - Chansa, Collins
AU - Charan, Jaykaran
AU - Chattu, Vijay Kumar
AU - Chen, Simiao
AU - Chukwu, Isaac Sunday
AU - Dadras, Omid
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Dargahi, Abdollah
AU - Debela, Sisay Abebe
AU - Denova-Gutierrez, Edgar
AU - Desye, Belay
AU - Dharmaratne, Samath Dhamminda
AU - Diao, Nancy
AU - Doan, Linh Phuong
AU - Dodangeh, Milad
AU - dos Santos, Wendel Mombaque
AU - Doshmangir, Leila
AU - Dube, John
AU - Eini, Ebrahim
AU - El Sayed Zaki, Maysaa
AU - El Tantawi, Maha
AU - Enyew, Daniel Berhanie
AU - Eskandarieh, Sharareh
AU - Ezati Asar, Mohamad
AU - Fagbamigbe, Adeniyi Francis
AU - Faraon, Emerito Jose A.
AU - Fatehizadeh, Ali
AU - Fattahi, Hamed
AU - Fekadu, Ginenus
AU - Fischer, Florian
AU - Foigt, Nataliya A.
AU - Fowobaje, Kayode Raphael
AU - Freitas, Alberto
AU - Fukumoto, Takeshi
AU - Fullman, Nancy
AU - Gaal, Peter Andras
AU - Gamkrelidze, Amiran
AU - Garcia-Gordillo, M. A.
AU - Gebrehiwot, Mesfin
AU - Gerema, Urge
AU - Ghafourifard, Mansour
AU - Ghamari, Seyyed-Hadi
AU - Ghanbari, Reza
AU - Ghashghaee, Ahmad
AU - Gholamrezanezhad, Ali
AU - Golechha, Mahaveer
AU - Golinelli, Davide
AU - Goshu, Yitayal Ayalew
AU - Goyomsa, Girma Garedew
AU - Guha, Avirup
AU - Gunawardane, Damitha Asanga
AU - Gupta, Bhawna
AU - Hamidi, Samer
AU - Harapan, Harapan
AU - Hashempour, Reza
AU - Hayat, Khezar
AU - Heidari, Golnaz
AU - Heredia-Pi, Ileana
AU - Herteliu, Claudiu
AU - Heyi, Demisu Zenbaba
AU - Hezam, Kamal
AU - Hiraike, Yuta
AU - Hlongwa, Mbuzeleni Mbuzeleni
AU - Holla, Ramesh
AU - Hoque, Mohammad Enamul
AU - Hosseinzadeh, Mehdi
AU - Hostiuc, Sorin
AU - Hussain, Salman
AU - Ilesanmi, Olayinka Stephen
AU - Immurana, Mustapha
AU - Iradukunda, Arnaud
AU - Ismail, Nahlah Elkudssiah
AU - Isola, Gaetano
AU - J, Linda Merin
AU - Jakovljevic, Mihajlo
AU - Jalili, Mahsa
AU - Janodia, Manthan Dilipkumar
AU - Javaheri, Tahereh
AU - Jayapal, Sathish Kumar
AU - Jemere, Digisie Mequanint
AU - Joo, Tamas
AU - Joseph, Nitin
AU - Jóźwiak, Jacek Jerzy
AU - Jürisson, Mikk
AU - Kaambwa, Billingsley
AU - Kadashetti, Vidya
AU - Kadel, Rajendra
AU - Kadir, Dler Hussein
AU - Kalankesh, Laleh R.
AU - Kamath, Rajesh
AU - Kandel, Himal
AU - Kantar, Rami S.
AU - Karanth, Shama D.
AU - Karaye, Ibraheem M.
AU - Karimi, Salah Eddin
AU - Kassa, Bekalu Getnet
AU - Kayode, Gbenga A.
AU - Keikavoosi-Arani, Leila
AU - Keshri, Vikash Ranjan
AU - Keskin, Cumali
AU - Khader, Yousef Saleh
AU - Khafaie, Morteza Abdullatif
AU - Khajuria, Himanshu
AU - Khayat Kashani, Hamid Reza
AU - Kifle, Zemene Demelash
AU - Kim, Hanna
AU - Kim, Jihee
AU - Kim, Min Seo
AU - Kim, Yun Jin
AU - Kisa, Adnan
AU - Kohler, Stefan
AU - Kompani, Farzad
AU - Kosen, Soewarta
AU - Laxminarayana, Sindhura Lakshmi Koulmane
AU - Koyanagi, Ai
AU - Krishan, Kewal
AU - Kusuma, Dian
AU - Lám, Judit
AU - Lamnisos, Demetris
AU - Larsson, Anders O.
AU - Lee, Sang-woong
AU - Lee, Shaun Wen Huey
AU - Lee, Wei-Chen
AU - Lee, Yo Han
AU - Lenzi, Jacopo
AU - Lim, Lee-Ling
AU - Lorenzovici, László
AU - Lozano , Rafael
AU - Machado, Vanessa Sintra
AU - Madadizadeh, Farzan
AU - Abd El Razek, Mohammed Magdy
AU - Mahmoudi, Razzagh
AU - Majeed, Azeem
AU - Malekpour, Mohammad-Reza
AU - Manda, Ana Laura
AU - Mansouri, Borhan
AU - Mansournia, Mohammad Ali
AU - Mantovani, Lorenzo Giovanni
AU - Marrugo Arnedo , Carlos Alberto
AU - Martorell, Miquel
AU - Masoud, Ali
AU - Mathews, Elezebeth
AU - Maude, Richard James
AU - Mechili, Enkeleint A.
AU - Mehrabi Nasab, Entezar
AU - Mendes, José João João Mendes
AU - Meretoja, Atte
AU - Meretoja, Tuomo J.
AU - Mesregah, Mohamed Kamal
AU - Mestrovic, Tomislav
AU - Mirica, Andreea
AU - Mirrakhimov, Erkin M.
AU - Mirutse, Mizan Kiros
AU - Mirza, Moonis
AU - Mirza-Aghazadeh-Attari, Mohammad
AU - Misganaw, Awoke
AU - Moccia, Marcello
AU - Moghadasi, Javad
AU - Mohammadi, Esmaeil
AU - Mohammadi, Mokhtar
AU - Mohammadian-Hafshejani, Abdollah
AU - Mohammadshahi, Marita
AU - Mpundu-Kaambwa, Christine
PY - 2023/3
Y1 - 2023/3
N2 - Background: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness.Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need.Findings: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1–9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3–25·3) spent by low-income countries in 2019. That same year, $43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP.Interpretation: There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.
AB - Background: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness.Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need.Findings: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1–9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3–25·3) spent by low-income countries in 2019. That same year, $43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP.Interpretation: There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.
KW - Global Burden of Disease
KW - COVID-19
KW - pandemic preparedness
KW - Health systems
KW - Health funding
KW - Health policy
UR - http://www.scopus.com/inward/record.url?scp=85148306723&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(23)00007-4
DO - 10.1016/S2214-109X(23)00007-4
M3 - Article
SN - 2214-109X
VL - 11
SP - e385-e413
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 3
ER -