Global health spending at record high post COVID-19, but can this be sustained?

The COVID-19 pandemic was revolutionary for global health financing that, at a record $37.8 billion, witnessed an 810 per cent increase in the first two years of the public health emergency, compared to the preceding two decades (2000-2019), according to a new report.

Despite the urgency of the situation, low- and middle-income countries were handed a raw deal. India, Bangladesh, Bhutan, Nepal and Pakistan accounted for 27.2 per cent of global COVID-19 deaths that occurred in low- and middle-income countries, but received barely 15 per cent of the development assistance for health (DAH) for COVID-19.

The findings were published in The Lancet Global Health on January 24, 2023 as part of the Financing Global Health report by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine.

In 2019, India’s health spending per person was $69 which, the paper estimated, will increase to $93 by 2026. In comparison, health expenditure as part of the gross domestic product (GDP) will improve marginally to 3.1 per cent in 2026 from 3 per cent in 2019. Government health spending per person is estimated to increase to $33 from $28 in the same time period.

In January 2021, the G20 established a High-Level Independent Panel (HLIP) which proposed national governments should contribute an additional 1 per cent of GDP towards health, inclusive of pandemic preparedness and an additional $15 billion in development assistance support annually from 2021-2026.

For India, this translates into government health spending per person of $51 by 2026. But the paper’s estimates suggested a 65 per cent difference between the HLIP target and the projected figures for India.

Through the pandemic, the United States ($6.5 billion), Japan ($3.4 billion) and Germany ($3.3 billion) were the largest contributors to DAH, according to the report. Vaccine procurement and coordination, planning and monitoring received the most of this funding.

“Despite the spike in spending due to pandemic-related support, sustaining this level of investment going forward is a serious concern,” said lead author Dr Angela Esi Micah, assistant professor at IHME. “While countries may be expected to contribute to global pandemic preparedness as they are able, greater participation and coordination globally before the next pandemic are critical.”

After the Ebola outbreak in 2015, resources towards pandemic preparedness followed a predictable trajectory — first increasing to $1.01 billion the same year and declining thereafter to $478 million by 2017.

The available data suggest that the costs of previous epidemics were high and so will be the cost of the next pandemic, the researchers wrote in the paper. “The estimated global economic cost of severe acute respiratory syndrome in 2013 was $40 billion. For the current pandemic, estimates of total financial loss between 2020 and 2024 have been as high as $13.8 trillion.”

The way forward, according to HLIP, is to invest in pandemic preparedness now.

Global health spending is predicted to increase to $16.9 trillion or $1,827 per person by 2050 from $9.2 trillion or $1,183 per person in 2019, the findings showed.

The US, Switzerland and Bermuda are expected to have the highest per person health spending at $20,501, $16,580 and $14,546 respectively, the report stated. In comparison, Somalia, Eritrea and South Sudan will fare the worst, at a measly health expenditure per person of $9, $27 and $29.

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