Publication details

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

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 ALI Hiwa Abubaker ABU-GHARBIEH Eman ADEM Mohammed Hussien AFZAL Muhammad Sohail AHMADI Ali AHMED Haroon RASHID Tarik Ahmed AJI Budi AKBARIALIABAD Hossein AKELEW Yibeltal HANADI Al Hamad 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 SILVA Botelho Botelho Joao BRAITHWAITE Dejana BREITBORDE Nicholas J K BUSSE Reinhard CAHUANA-HURTADO Lucero CATALA-LOPEZ Ferran CHANSA Collins CHARAN Jaykaran CHATTU Vijay Kumar CHEN Simiao CHUKWU Isaac Sunday DADRAS Omid DANDONA Lalit DANDONA Rakhi DARGAHI Abdollah DEBELA Sisay Abebe DENOVA-GUTIERREZ Edgar DESYE Belay DHARMARATNE Samath Dhamminda DIAO Nancy DOAN Linh Phuong DODANGEH Milad MOMBAQUE dos Santos Wendel DOSHMANGIR Leila DUBE John EINI Ebrahim ZAKI Maysaa El Sayed MAHA El Tantawi ENYEW Daniel Berhanie ESKANDARIEH Sharareh ASAR Mohamad Ezati 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 Mohammad Salman ILESANMI Olayinka Stephen IMMURANA Mustapha IRADUKUNDA Arnaud ISMAIL Nahlah Elkudssiah ISOLA Gaetano MERIN Linda J JAKOVLJEVIC Mihajlo JALILI Mahsa JANODIA Manthan Dilipkumar JAVAHERI Tahereh JAYAPAL Sathish Kumar JEMERE Digisie Mequanint JOO Tamas JOSEPH Nitin JOZWIAK Jacek Jerzy JURISSON 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 KASHANI Hamid Reza Khayat KIFLE Zemene Demelash KIM Hanna KIM Jihee KIM Min Seo KIM Yun Jin KISA Adnan KOHLER Stefan KOMPANI Farzad KOSEN Soewarta LAXMINARAYANA Sindhura Lakshmi Koulmane KOYANAGI Ai KRISHAN Kewal KUSUMA Dian LAM 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 Laszlo LOZANO Rafael SINTRA Machado Machado Vanessa 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 ALBERTO Marrugo Arnedo Carlos MARTORELL Miquel MASOUD Ali MATHEWS Elezebeth MAUDE Richard James MECHILI Enkeleint A NASAB Entezar Mehrabi JOAO Joao Mendes Mendes Jose 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 ISFAHANI Haleh Mousavi 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 BALI Ahmed Omar ONWUJEKWE Obinna E OPIO John Nelson OTOIU Adrian OTSTAVNOV Nikita OTSTAVNOV Stanislav S OWOLABI Mayowa O PALICZ Tamas 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 Jr RENZAHO Andre M N REZAEI Maryam REZAEI Nazila RIAZ Mavra A ANTONIO Buendia Rodriguez Jefferson 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 Joao Vasco SANTRIC-MILICEVIC Milena M PIASSI Sao Jose Bruno SARIKHANI Yaser SATHIAN Brijesh SATPATHY Maheswar SAVIC Miloje SAYADI Yaser SCHWENDICKE Falk SENTHILKUMARAN Subramanian SEPANLOU Sadaf G SERVAN-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 MANUEL Lopes Rodrigues Silva Luis SIMEGN Wudneh SINGH Jasvinder A SINGH Kuldeep SKHVITARIDZE Natia SKRYABIN Valentin Yurievich SKRYABINA Anna Aleksandrovna SOCEA Bogdan SOLOMON Yonatan SONG Suhang STEFAN Simona Catalina SULEMAN Muhammad TABARES-SEISDEDOS Rafael TAT Nathan Y TAT Vivian Y TEFERA Belay Negash TICHOPAD Ales TOBE-GAI Ruoyan TOVANI-PALONE Marcos Roberto CAR Lorainne Tudor TUFA Derara Girma VASANKARI Tommi Juhani VASIC Milena VERVOORT Dominique VLASSOV Vasily BAY Vo VU Linh Gia WAHEED Yasir WAMAI Richard G WANG Cong WASSIE Gizachew Tadesse WICKRAMASINGHE Nuwan Darshana YAYA Sanni YIGIT Arzu YIGIT Vahit YONEMOTO Naohiro YOUNIS Mustafa Z YU Chuanhua YUNUSA Ismaeel ZAKI Leila ZAMAN Burhan Abdullah ZANGENEH Alireza DEHNAVI Ali Zare 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
Year of publication	2023
Type	Article in Periodical
Magazine / Source	LANCET GLOBAL HEALTH
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00007-4/fulltext
Doi	http://dx.doi.org/10.1016/S2214-109X(23)00007-4
Keywords	COVID-19; pandemic preparedness; global investments
Description	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 center dot 2 trillion (95% uncertainty interval [UI] 9 center dot 1-9 center dot 3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7 center dot 3 trillion (95% UI 7 center dot 2-7 center dot 4) in 2019; 293 center dot 7 times the $24 center dot 8 billion (95% UI 24 center dot 3-25 center dot 3) spent by low-income countries in 2019. That same year, $43 center dot 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 center dot 8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37 center dot 8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12 center dot 2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health -related COVID-19 response is 252 center dot 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.