Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026. Issue 3 (March 2023)

• Record Type: Journal Article
• Authors: Micah, Angela E; Bhangdia, Kayleigh; Cogswell, Ian E; Lasher, Dylan; Lidral-Porter, Brendan; Maddison, Emilie R; Nguyen, Trang Nhu Ngoc; Patel, Nishali; Pedroza, Paola; Solorio, Juan; Stutzman, Hayley; Tsakalos, Golsum; Wang, Yifeng; Warriner, Wesley; Zhao, Yingxi; Zlavog, Bianca S; Abbafati, Cristiana; Abbas, Jaffar; Abbasi-Kangevari, Mohsen; Abbasi-Kangevari, Zeinab; Abdelmasseh, Michael; Abdulah, Deldar Morad; Abedi, Aidin; Abegaz, Kedir Hussein; Abhilash, E S; Aboagye, Richard Gyan; Abolhassani, Hassan; Abrigo, Michael R M; Abubaker Ali, Hiwa; Abu-Gharbieh, Eman; Adem, Mohammed Hussien; Afzal, Muhammad Sohail; Ahmadi, Ali; Ahmed, Haroon; Ahmed Rashid, Tarik; Aji, Budi; Akbarialiabad, Hossein; Akelew, Yibeltal; Al Hamad, Hanadi; Alam, Khurshid; Alanezi, Fahad Mashhour; Alanzi, Turki M; Al-Hanawi, Mohammed Khaled; Alhassan, Robert Kaba; Aljunid, Syed Mohamed; Almustanyir, Sami; Al-Raddadi, Rajaa M; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J; Amare, Azmeraw T; Ameyaw, Edward Kwabena; Amini-Rarani, Mostafa; Amu, Hubert; Ancuceanu, Robert; Andrei, Tudorel; Anwar, Sumadi Lukman; Appiah, Francis; Aqeel, Muhammad; Arabloo, Jalal; Arab-Zozani, Morteza; Aravkin, Aleksandr Y; Aremu, Olatunde; Aruleba, Raphael Taiwo; Athari, Seyyed Shamsadin; Avila-Burgos, Leticia; Ayanore, Martin Amogre; Azari, Samad; Baig, Atif Amin; Bantie, Abere Tilahun; Barrow, Amadou; Baskaran, Pritish; Basu, Sanjay; Batiha, Abdul-Monim Mohammad; Baune, Bernhard T; Berezvai, Zombor; Bhardwaj, Nikha; Bhardwaj, Pankaj; Bhaskar, Sonu; Boachie, Micheal Kofi; Bodolica, Virginia; Botelho, João Silva Botelho; Braithwaite, Dejana; Breitborde, Nicholas J K; Busse, Reinhard; Cahuana-Hurtado, Lucero; Catalá-López, Ferrán; Chansa, Collins; Charan, Jaykaran; Chattu, Vijay Kumar; Chen, Simiao; Chukwu, Isaac Sunday; Dadras, Omid; Dandona, Lalit; Dandona, Rakhi; Dargahi, Abdollah; Debela, Sisay Abebe; Denova-Gutiérrez, Edgar; Desye, Belay; Dharmaratne, Samath Dhamminda; Diao, Nancy; Doan, Linh Phuong; Dodangeh, Milad; dos Santos, Wendel Mombaque; Doshmangir, Leila; Dube, John; Eini, Ebrahim; El Sayed Zaki, Maysaa; El Tantawi, Maha; Enyew, Daniel Berhanie; Eskandarieh, Sharareh; Ezati Asar, Mohamad; Fagbamigbe, Adeniyi Francis; Faraon, Emerito Jose A; Fatehizadeh, Ali; Fattahi, Hamed; Fekadu, Ginenus; Fischer, Florian; Foigt, Nataliya A; Fowobaje, Kayode Raphael; Freitas, Alberto; Fukumoto, Takeshi; Fullman, Nancy; Gaal, Peter Andras; Gamkrelidze, Amiran; Garcia-Gordillo, M A; Gebrehiwot, Mesfin; Gerema, Urge; Ghafourifard, Mansour; Ghamari, Seyyed-Hadi; Ghanbari, Reza; Ghashghaee, Ahmad; Gholamrezanezhad, Ali; Golechha, Mahaveer; Golinelli, Davide; Goshu, Yitayal Ayalew; Goyomsa, Girma Garedew; Guha, Avirup; Gunawardane, Damitha Asanga; Gupta, Bhawna; Hamidi, Samer; Harapan, Harapan; Hashempour, Reza; Hayat, Khezar; Heidari, Golnaz; Heredia-Pi, Ileana; Herteliu, Claudiu; Heyi, Demisu Zenbaba; Hezam, Kamal; Hiraike, Yuta; Hlongwa, Mbuzeleni Mbuzeleni; Holla, Ramesh; Hoque, Mohammad Enamul; Hosseinzadeh, Mehdi; Hostiuc, Sorin; Hussain, Salman; Ilesanmi, Olayinka Stephen; Immurana, Mustapha; Iradukunda, Arnaud; Ismail, Nahlah Elkudssiah; Isola, Gaetano; J, Linda Merin; Jakovljevic, Mihajlo; Jalili, Mahsa; Janodia, Manthan Dilipkumar; Javaheri, Tahereh; Jayapal, Sathish Kumar; Jemere, Digisie Mequanint; Joo, Tamas; Joseph, Nitin; Jozwiak, Jacek Jerzy; Jürisson, Mikk; Kaambwa, Billingsley; Kadashetti, Vidya; Kadel, Rajendra; Kadir, Dler Hussein; Kalankesh, Laleh R; Kamath, Rajesh; Kandel, Himal; Kantar, Rami S; Karanth, Shama D; Karaye, Ibraheem M; Karimi, Salah Eddin; Kassa, Bekalu Getnet; Kayode, Gbenga A; Keikavoosi-Arani, Leila; Keshri, Vikash Ranjan; Keskin, Cumali; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khajuria, Himanshu; Khayat Kashani, Hamid Reza; Kifle, Zemene Demelash; Kim, Hanna; Kim, Jihee; Kim, Min Seo; Kim, Yun Jin; Kisa, Adnan; Kohler, Stefan; Kompani, Farzad; Kosen, Soewarta; Koulmane Laxminarayana, Sindhura Lakshmi; Koyanagi, Ai; Krishan, Kewal; Kusuma, Dian; Lám, Judit; Lamnisos, Demetris; Larsson, Anders O; Lee, Sang-woong; Lee, Shaun Wen Huey; Lee, Wei-Chen; Lee, Yo Han; Lenzi, Jacopo; Lim, Lee-Ling; Lorenzovici, László; Lozano, Rafael; Machado, Vanessa Sintra Machado; Madadizadeh, Farzan; Magdy Abd El Razek, Mohammed; Mahmoudi, Razzagh; Majeed, Azeem; Malekpour, Mohammad-Reza; Manda, Ana Laura; Mansouri, Borhan; Mansournia, Mohammad Ali; Mantovani, Lorenzo Giovanni; Marrugo Arnedo, Carlos Alberto; Martorell, Miquel; Masoud, Ali; Mathews, Elezebeth; Maude, Richard James; Mechili, Enkeleint A; Mehrabi Nasab, Entezar; Mendes, José João João Mendes; Meretoja, Atte; Meretoja, Tuomo J; Mesregah, Mohamed Kamal; Mestrovic, Tomislav; Mirica, Andreea; Mirrakhimov, Erkin M; Mirutse, Mizan Kiros; Mirza, Moonis; Mirza-Aghazadeh-Attari, Mohammad; Misganaw, Awoke; Moccia, Marcello; Moghadasi, Javad; Mohammadi, Esmaeil; Mohammadi, Mokhtar; Mohammadian-Hafshejani, Abdollah; Mohammadshahi, Marita; Mohammed, Shafiu; Mohseni, Mohammad; Mokdad, Ali H; Monasta, Lorenzo; Mossialos, Elias; Mostafavi, Ebrahim; Mousavi Isfahani, Haleh; Mpundu-Kaambwa, Christine; Murthy, Shruti; Muthupandian, Saravanan; Nagarajan, Ahamarshan Jayaraman; Naidoo, Kovin S; Naimzada, Mukhammad David; Nangia, Vinay; Naqvi, Atta Abbas; Nayak, Biswa Prakash; Ndejjo, Rawlance; Nguyen, Trang Huyen; Noroozi, Nafise; Noubiap, Jean Jacques; Nuruzzaman, Khan M; Nzoputam, Chimezie Igwegbe; Nzoputam, Ogochukwu Janet; Oancea, Bogdan; Obi, Felix Chukwudi Abrahams; Ogunkoya, Abiola; Oh, In-Hwan; Okonji, Osaretin Christabel; Olagunju, Andrew T; Olagunju, Tinuke O; Olakunde, Babayemi Oluwaseun; Omar Bali, Ahmed; Onwujekwe, Obinna E; Opio, John Nelson; Otoiu, Adrian; Otstavnov, Nikita; Otstavnov, Stanislav S; Owolabi, Mayowa O; Palicz, Tamás; Palladino, Raffaele; Pana, Adrian; Parekh, Tarang; Pasupula, Deepak Kumar; Patel, Jay; Patton, George C; Paudel, Uttam; Paun, Mihaela; Pawar, Shrikant; Perna, Simone; Perumalsamy, Navaraj; Petcu, Ionela-Roxana; Piracha, Zahra Zahid; Poursadeqiyan, Mohsen; Pourtaheri, Naeimeh; Prada, Sergio I; Rafiei, Sima; Raghav, Pankaja Raghav; Rahim, Fakher; Rahman, Mohammad Hifz Ur; Rahman, Mosiur; Rahmani, Amir Masoud; Ranabhat, Chhabi Lal; Raru, Temam Beshir; Rashedi, Sina; Rashidi, Mohammad-Mahdi; Ravangard, Ramin; Rawaf, Salman; Rawassizadeh, Reza; Redwan, Elrashdy Moustafa Mohamed; Reiner, Robert C; Renzaho, Andre M N; Rezaei, Maryam; Rezaei, Nazila; Riaz, Mavra A; Rodriguez, Jefferson Antonio Buendia; Saad, Aly M A; Saddik, Basema; Sadeghian, Saeid; Saeb, Mohammad Reza; Saeed, Umar; Sahu, Maitreyi; Saki, Morteza; Salamati, Payman; Salari, Hedayat; Salehi, Sana; Samy, Abdallah M; Sanabria, Juan; Sanmarchi, Francesco; Santos, João Vasco; Santric-Milicevic, Milena M; Sao Jose, Bruno Piassi; Sarikhani, Yaser; Sathian, Brijesh; Satpathy, Maheswar; Savic, Miloje; Sayadi, Yaser; Schwendicke, Falk; Senthilkumaran, Subramanian; Sepanlou, Sadaf G; Serván-Mori, Edson; Setshegetso, Naomi; Seylani, Allen; Shahabi, Saeed; Shaikh, Masood Ali; Shakhmardanov, Murad Ziyaudinovich; Shanawaz, Mohd; Sharew, Mequannent Melaku Sharew; Sharew, Nigussie Tadesse; Sharma, Rajesh; Shayan, Maryam; Sheikh, Aziz; Shenoy, Suchitra M; Shetty, Adithi; Shetty, Pavanchand H; Shivakumar, K M; Silva, Luís Manuel Lopes Rodrigues; Simegn, Wudneh; Singh, Jasvinder A; Singh, Kuldeep; Skhvitaridze, Natia; Skryabin, Valentin Yurievich; Skryabina, Anna Aleksandrovna; Socea, Bogdan; Solomon, Yonatan; Song, Suhang; Ștefan, Simona Cătălina; Suleman, Muhammad; Tabarés-Seisdedos, Rafael; Tat, Nathan Y; Tat, Vivian Y; Tefera, Belay Negash; Tichopad, Ales; Tobe-Gai, Ruoyan; Tovani-Palone, Marcos Roberto; Tudor Car, Lorainne; Tufa, Derara Girma; Vasankari, Tommi Juhani; Vasic, Milena; Vervoort, Dominique; Vlassov, Vasily; Vo, Bay; Vu, Linh Gia; Waheed, Yasir; Wamai, Richard G; Wang, Cong; Wassie, Gizachew Tadesse; Wickramasinghe, Nuwan Darshana; Yaya, Sanni; Yigit, Arzu; Yiğit, Vahit; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Yunusa, Ismaeel; Zaki, Leila; Zaman, Burhan Abdullah; Zangeneh, Alireza; Zare Dehnavi, Ali; Zastrozhin, Mikhail Sergeevich; Zeng, Wu; Zhang, Zhi-Jiang; Zuhlke, Liesl J; Zuniga, Yves Miel H; Hay, Simon I; Murray, Christopher J L; Dieleman, Joseph L;
• Is Part Of: Lancet. Volume 11:Issue 3(2023)
• Page Start: e385
• Page End: e413
• Publication Date: 2023-03
• Subjects: World health -- Periodicals; 362.105
• DOI: 10.1016/S2214-109X(23)00007-4
• Languages: English
• ISSNs: 2214-109X

Abstract

Summary: 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. Funding: Bill & Melinda Gates Foundation.