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.
MICAH, Angela E, Kayleigh BHANGDIA, Ian E COGSWELL, Dylan LASHER, Brendan LIDRAL-PORTER, Emilie R MADDISON, Trang Nhu Ngoc NGUYEN, Nishali PATEL, Paola PEDROZA, Juan SOLORIO, Hayley STUTZMAN, Golsum TSAKALOS, Yifeng WANG, Wesley WARRINER, Yingxi ZHAO, Bianca S ZLAVOG, Cristiana ABBAFATI, Jaffar ABBAS, Mohsen ABBASI-KANGEVARI, Zeinab ABBASI-KANGEVARI, Michael ABDELMASSEH, Deldar Morad ABDULAH, Aidin ABEDI, Kedir Hussein ABEGAZ, E S ABHILASH, Richard Gyan ABOAGYE, Hassan ABOLHASSANI, Michael R M ABRIGO, Hiwa Abubaker ALI, Eman ABU-GHARBIEH, Mohammed Hussien ADEM, Muhammad Sohail AFZAL, Ali AHMADI, Haroon AHMED, Tarik Ahmed RASHID, Budi AJI, Hossein AKBARIALIABAD, Yibeltal AKELEW, Al Hamad HANADI, Khurshid ALAM, Fahad Mashhour ALANEZI, Turki M ALANZI, Mohammed Khaled AL-HANAWI, Robert Kaba ALHASSAN, Syed Mohamed ALJUNID, Sami ALMUSTANYIR, Rajaa M AL-RADDADI, Nelson ALVIS-GUZMAN, Nelson J ALVIS-ZAKZUK, Azmeraw T AMARE, Edward Kwabena AMEYAW, Mostafa AMINI-RARANI, Hubert AMU, Robert ANCUCEANU, Tudorel ANDREI, Sumadi Lukman ANWAR, Francis APPIAH, Muhammad AQEEL, Jalal ARABLOO, Morteza ARAB-ZOZANI, Aleksandr Y ARAVKIN, Olatunde AREMU, Raphael Taiwo ARULEBA, Seyyed Shamsadin ATHARI, Leticia AVILA-BURGOS, Martin Amogre AYANORE, Samad AZARI, Atif Amin BAIG, Abere Tilahun BANTIE, Amadou BARROW, Pritish BASKARAN, Sanjay BASU, Abdul-Monim Mohammad BATIHA, Bernhard T BAUNE, Zombor BEREZVAI, Nikha BHARDWAJ, Pankaj BHARDWAJ, Sonu BHASKAR, Micheal Kofi BOACHIE, Virginia BODOLICA, Botelho Botelho Joao SILVA, Dejana BRAITHWAITE, Nicholas J K BREITBORDE, Reinhard BUSSE, Lucero CAHUANA-HURTADO, Ferran CATALA-LOPEZ, Collins CHANSA, Jaykaran CHARAN, Vijay Kumar CHATTU, Simiao CHEN, Isaac Sunday CHUKWU, Omid DADRAS, Lalit DANDONA, Rakhi DANDONA, Abdollah DARGAHI, Sisay Abebe DEBELA, Edgar DENOVA-GUTIERREZ, Belay DESYE, Samath Dhamminda DHARMARATNE, Nancy DIAO, Linh Phuong DOAN, Milad DODANGEH, dos Santos Wendel MOMBAQUE, Leila DOSHMANGIR, John DUBE, Ebrahim EINI, Maysaa El Sayed ZAKI, El Tantawi MAHA, Daniel Berhanie ENYEW, Sharareh ESKANDARIEH, Mohamad Ezati ASAR, Adeniyi Francis FAGBAMIGBE, Emerito Jose A FARAON, Ali FATEHIZADEH, Hamed FATTAHI, Ginenus FEKADU, Florian FISCHER, Nataliya A FOIGT, Kayode Raphael FOWOBAJE, Alberto FREITAS, Takeshi FUKUMOTO, Nancy FULLMAN, Peter Andras GAAL, Amiran GAMKRELIDZE, M A GARCIA-GORDILLO, Mesfin GEBREHIWOT, Urge GEREMA, Mansour GHAFOURIFARD, Seyyed-Hadi GHAMARI, Reza GHANBARI, Ahmad GHASHGHAEE, Ali GHOLAMREZANEZHAD, Mahaveer GOLECHHA, Davide GOLINELLI, Yitayal Ayalew GOSHU, Girma Garedew GOYOMSA, Avirup GUHA, Damitha Asanga GUNAWARDANE, Bhawna GUPTA, Samer HAMIDI, Harapan HARAPAN, Reza HASHEMPOUR, Khezar HAYAT, Golnaz HEIDARI, Ileana HEREDIA-PI, Claudiu HERTELIU, Demisu Zenbaba HEYI, Kamal HEZAM, Yuta HIRAIKE, Mbuzeleni Mbuzeleni HLONGWA, Ramesh HOLLA, Mohammad Enamul HOQUE, Mehdi HOSSEINZADEH, Sorin HOSTIUC, Mohammad Salman HUSSAIN, Olayinka Stephen ILESANMI, Mustapha IMMURANA, Arnaud IRADUKUNDA, Nahlah Elkudssiah ISMAIL, Gaetano ISOLA, Linda J MERIN, Mihajlo JAKOVLJEVIC, Mahsa JALILI, Manthan Dilipkumar JANODIA, Tahereh JAVAHERI, Sathish Kumar JAYAPAL, Digisie Mequanint JEMERE, Tamas JOO, Nitin JOSEPH, Jacek Jerzy JOZWIAK, Mikk JURISSON, Billingsley KAAMBWA, Vidya KADASHETTI, Rajendra KADEL, Dler Hussein KADIR, Laleh R KALANKESH, Rajesh KAMATH, Himal KANDEL, Rami S KANTAR, Shama D KARANTH, Ibraheem M KARAYE, Salah Eddin KARIMI, Bekalu Getnet KASSA, Gbenga A KAYODE, Leila KEIKAVOOSI-ARANI, Vikash Ranjan KESHRI, Cumali KESKIN, Yousef Saleh KHADER, Morteza Abdullatif KHAFAIE, Himanshu KHAJURIA, Hamid Reza Khayat KASHANI, Zemene Demelash KIFLE, Hanna KIM, Jihee KIM, Min Seo KIM, Yun Jin KIM, Adnan KISA, Stefan KOHLER, Farzad KOMPANI, Soewarta KOSEN, Sindhura Lakshmi Koulmane LAXMINARAYANA, Ai KOYANAGI, Kewal KRISHAN, Dian KUSUMA, Judit LAM, Demetris LAMNISOS, Anders O LARSSON, Sang-woong LEE, Shaun Wen Huey LEE, Wei-Chen LEE, Yo Han LEE, Jacopo LENZI, Lee-Ling LIM, Laszlo LORENZOVICI, Rafael LOZANO, Machado Machado Vanessa SINTRA, Farzan MADADIZADEH, Abd El Razek Mohammed MAGDY, Razzagh MAHMOUDI, Azeem MAJEED, Mohammad-Reza MALEKPOUR, Ana Laura MANDA, Borhan MANSOURI, Mohammad Ali MANSOURNIA, Lorenzo Giovanni MANTOVANI, Marrugo Arnedo Carlos ALBERTO, Miquel MARTORELL, Ali MASOUD, Elezebeth MATHEWS, Richard James MAUDE, Enkeleint A MECHILI, Entezar Mehrabi NASAB, Joao Mendes Mendes Jose JOAO, Atte MERETOJA, Tuomo J MERETOJA, Mohamed Kamal MESREGAH, Tomislav MESTROVIC, Andreea MIRICA, Erkin M MIRRAKHIMOV, Mizan Kiros MIRUTSE, Moonis MIRZA, Mohammad MIRZA-AGHAZADEH-ATTARI, Awoke MISGANAW, Marcello MOCCIA, Javad MOGHADASI, Esmaeil MOHAMMADI, Mokhtar MOHAMMADI, Abdollah MOHAMMADIAN-HAFSHEJANI, Marita MOHAMMADSHAHI, Shafiu MOHAMMED, Mohammad MOHSENI, Ali H MOKDAD, Lorenzo MONASTA, Elias MOSSIALOS, Ebrahim MOSTAFAVI, Haleh Mousavi ISFAHANI, Christine MPUNDU-KAAMBWA, Shruti MURTHY, Saravanan MUTHUPANDIAN, Ahamarshan Jayaraman NAGARAJAN, Kovin S NAIDOO, Mukhammad David NAIMZADA, Vinay NANGIA, Atta Abbas NAQVI, Biswa Prakash NAYAK, Rawlance NDEJJO, Trang Huyen NGUYEN, Nafise NOROOZI, Jean Jacques NOUBIAP, Khan M NURUZZAMAN, Chimezie Igwegbe NZOPUTAM, Ogochukwu Janet NZOPUTAM, Bogdan OANCEA, Felix Chukwudi Abrahams OBI, Abiola OGUNKOYA, In-Hwan OH, Osaretin Christabel OKONJI, Andrew T OLAGUNJU, Tinuke O OLAGUNJU, Babayemi Oluwaseun OLAKUNDE, Ahmed Omar BALI, Obinna E ONWUJEKWE, John Nelson OPIO, Adrian OTOIU, Nikita OTSTAVNOV, Stanislav S OTSTAVNOV, Mayowa O OWOLABI, Tamas PALICZ, Raffaele PALLADINO, Adrian PANA, Tarang PAREKH, Deepak Kumar PASUPULA, Jay PATEL, George C PATTON, Uttam PAUDEL, Mihaela PAUN, Shrikant PAWAR, Simone PERNA, Navaraj PERUMALSAMY, Ionela-Roxana PETCU, Zahra Zahid PIRACHA, Mohsen POURSADEQIYAN, Naeimeh POURTAHERI, Sergio I PRADA, Sima RAFIEI, Pankaja Raghav RAGHAV, Fakher RAHIM, Mohammad Hifz Ur RAHMAN, Mosiur RAHMAN, Amir Masoud RAHMANI, Chhabi Lal RANABHAT, Temam Beshir RARU, Sina RASHEDI, Mohammad-Mahdi RASHIDI, Ramin RAVANGARD, Salman RAWAF, Reza RAWASSIZADEH, Elrashdy Moustafa Mohamed REDWAN, Robert C Jr REINER, Andre M N RENZAHO, Maryam REZAEI, Nazila REZAEI, Mavra A RIAZ, Buendia Rodriguez Jefferson ANTONIO, Aly M A SAAD, Basema SADDIK, Saeid SADEGHIAN, Mohammad Reza SAEB, Umar SAEED, Maitreyi SAHU, Morteza SAKI, Payman SALAMATI, Hedayat SALARI, Sana SALEHI, Abdallah M SAMY, Juan SANABRIA, Francesco SANMARCHI, Joao Vasco SANTOS, Milena M SANTRIC-MILICEVIC, Sao Jose Bruno PIASSI, Yaser SARIKHANI, Brijesh SATHIAN, Maheswar SATPATHY, Miloje SAVIC, Yaser SAYADI, Falk SCHWENDICKE, Subramanian SENTHILKUMARAN, Sadaf G SEPANLOU, Edson SERVAN-MORI, Naomi SETSHEGETSO, Allen SEYLANI, Saeed SHAHABI, Masood Ali SHAIKH, Murad Ziyaudinovich SHAKHMARDANOV, Mohd SHANAWAZ, Mequannent Melaku Sharew SHAREW, Nigussie Tadesse SHAREW, Rajesh SHARMA, Maryam SHAYAN, Aziz SHEIKH, Suchitra M SHENOY, Adithi SHETTY, Pavanchand H SHETTY, K M SHIVAKUMAR, Lopes Rodrigues Silva Luis MANUEL, Wudneh SIMEGN, Jasvinder A SINGH, Kuldeep SINGH, Natia SKHVITARIDZE, Valentin Yurievich SKRYABIN, Anna Aleksandrovna SKRYABINA, Bogdan SOCEA, Yonatan SOLOMON, Suhang SONG, Simona Catalina STEFAN, Muhammad SULEMAN, Rafael TABARES-SEISDEDOS, Nathan Y TAT, Vivian Y TAT, Belay Negash TEFERA, Ales TICHOPAD, Ruoyan TOBE-GAI, Marcos Roberto TOVANI-PALONE, Lorainne Tudor CAR, Derara Girma TUFA, Tommi Juhani VASANKARI, Milena VASIC, Dominique VERVOORT, Vasily VLASSOV, Vo BAY, Linh Gia VU, Yasir WAHEED, Richard G WAMAI, Cong WANG, Gizachew Tadesse WASSIE, Nuwan Darshana WICKRAMASINGHE, Sanni YAYA, Arzu YIGIT, Vahit YIGIT, Naohiro YONEMOTO, Mustafa Z YOUNIS, Chuanhua YU, Ismaeel YUNUSA, Leila ZAKI, Burhan Abdullah ZAMAN, Alireza ZANGENEH, Ali Zare DEHNAVI, Mikhail Sergeevich ZASTROZHIN, Wu ZENG, Zhi-Jiang ZHANG, Liesl J ZUHLKE, Yves Miel H ZUNIGA, Simon I HAY, Christopher J L MURRAY and Joseph L DIELEMAN. Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026. LANCET GLOBAL HEALTH. OXFORD: ELSEVIER SCI LTD, 2023, vol. 11, No 3, p. "E385"-"E413", 29 pp. ISSN 2214-109X. Available from: https://dx.doi.org/10.1016/S2214-109X(23)00007-4.
@article{2379837, author = {Micah, Angela E and Bhangdia, Kayleigh and Cogswell, Ian E and Lasher, Dylan and LidralandPorter, Brendan and Maddison, Emilie R and Nguyen, Trang Nhu Ngoc and Patel, Nishali and Pedroza, Paola and Solorio, Juan and Stutzman, Hayley and Tsakalos, Golsum and Wang, Yifeng and Warriner, Wesley and Zhao, Yingxi and Zlavog, Bianca S and Abbafati, Cristiana and Abbas, Jaffar and AbbasiandKangevari, Mohsen and AbbasiandKangevari, Zeinab and Abdelmasseh, Michael and Abdulah, Deldar Morad and Abedi, Aidin and Abegaz, Kedir Hussein and Abhilash, E S and Aboagye, Richard Gyan and Abolhassani, Hassan and Abrigo, Michael R M and Ali, Hiwa Abubaker and AbuandGharbieh, Eman and Adem, Mohammed Hussien and Afzal, Muhammad Sohail and Ahmadi, Ali and Ahmed, Haroon and Rashid, Tarik Ahmed and Aji, Budi and Akbarialiabad, Hossein and Akelew, Yibeltal and Hanadi, Al Hamad and Alam, Khurshid and Alanezi, Fahad Mashhour and Alanzi, Turki M and AlandHanawi, Mohammed Khaled and Alhassan, Robert Kaba and Aljunid, Syed Mohamed and Almustanyir, Sami and AlandRaddadi, Rajaa M and AlvisandGuzman, Nelson and AlvisandZakzuk, Nelson J and Amare, Azmeraw T and Ameyaw, Edward Kwabena and AminiandRarani, Mostafa and Amu, Hubert and Ancuceanu, Robert and Andrei, Tudorel and Anwar, Sumadi Lukman and Appiah, Francis and Aqeel, Muhammad and Arabloo, Jalal and ArabandZozani, Morteza and Aravkin, Aleksandr Y and Aremu, Olatunde and Aruleba, Raphael Taiwo and Athari, Seyyed Shamsadin and AvilaandBurgos, Leticia and Ayanore, Martin Amogre and Azari, Samad and Baig, Atif Amin and Bantie, Abere Tilahun and Barrow, Amadou and Baskaran, Pritish and Basu, Sanjay and Batiha, AbdulandMonim Mohammad and Baune, Bernhard T and Berezvai, Zombor and Bhardwaj, Nikha and Bhardwaj, Pankaj and Bhaskar, Sonu and Boachie, Micheal Kofi and Bodolica, Virginia and Silva, Botelho Botelho Joao and Braithwaite, Dejana and Breitborde, Nicholas J K and Busse, Reinhard and CahuanaandHurtado, Lucero and CatalaandLopez, Ferran and Chansa, Collins and Charan, Jaykaran and Chattu, Vijay Kumar and Chen, Simiao and Chukwu, Isaac Sunday and Dadras, Omid and Dandona, Lalit and Dandona, Rakhi and Dargahi, Abdollah and Debela, Sisay Abebe and DenovaandGutierrez, Edgar and Desye, Belay and Dharmaratne, Samath Dhamminda and Diao, Nancy and Doan, Linh Phuong and Dodangeh, Milad and Mombaque, dos Santos Wendel and Doshmangir, Leila and Dube, John and Eini, Ebrahim and Zaki, Maysaa El Sayed and Maha, El Tantawi and Enyew, Daniel Berhanie and Eskandarieh, Sharareh and Asar, Mohamad Ezati and Fagbamigbe, Adeniyi Francis and Faraon, Emerito Jose A and Fatehizadeh, Ali and Fattahi, Hamed and Fekadu, Ginenus and Fischer, Florian and Foigt, Nataliya A and Fowobaje, Kayode Raphael and Freitas, Alberto and Fukumoto, Takeshi and Fullman, Nancy and Gaal, Peter Andras and Gamkrelidze, Amiran and GarciaandGordillo, M A and Gebrehiwot, Mesfin and Gerema, Urge and Ghafourifard, Mansour and Ghamari, SeyyedandHadi and Ghanbari, Reza and Ghashghaee, Ahmad and Gholamrezanezhad, Ali and Golechha, Mahaveer and Golinelli, Davide and Goshu, Yitayal Ayalew and Goyomsa, Girma Garedew and Guha, Avirup and Gunawardane, Damitha Asanga and Gupta, Bhawna and Hamidi, Samer and Harapan, Harapan and Hashempour, Reza and Hayat, Khezar and Heidari, Golnaz and HerediaandPi, Ileana and Herteliu, Claudiu and Heyi, Demisu Zenbaba and Hezam, Kamal and Hiraike, Yuta and Hlongwa, Mbuzeleni Mbuzeleni and Holla, Ramesh and Hoque, Mohammad Enamul and Hosseinzadeh, Mehdi and Hostiuc, Sorin and Hussain, Mohammad Salman and Ilesanmi, Olayinka Stephen and Immurana, Mustapha and Iradukunda, Arnaud and Ismail, Nahlah Elkudssiah and Isola, Gaetano and Merin, Linda J and Jakovljevic, Mihajlo and Jalili, Mahsa and Janodia, Manthan Dilipkumar and Javaheri, Tahereh and Jayapal, Sathish Kumar and Jemere, Digisie Mequanint and Joo, Tamas and Joseph, Nitin et al.}, article_location = {OXFORD}, article_number = {3}, doi = {http://dx.doi.org/10.1016/S2214-109X(23)00007-4}, keywords = {COVID-19; pandemic preparedness; global investments}, language = {eng}, issn = {2214-109X}, journal = {LANCET GLOBAL HEALTH}, title = {Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026}, url = {https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00007-4/fulltext}, volume = {11}, year = {2023} }
TY - JOUR ID - 2379837 AU - 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 et al. PY - 2023 TI - Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026 JF - LANCET GLOBAL HEALTH VL - 11 IS - 3 SP - "E385"-"E413" EP - "E385"-"E413" PB - ELSEVIER SCI LTD SN - 2214109X KW - COVID-19 KW - pandemic preparedness KW - global investments UR - https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00007-4/fulltext 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 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. ER -
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