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2.
Health Aff (Millwood) ; 40(7): 1176, 2021 07.
Article in English | MEDLINE | ID: covidwho-2197194
3.
Lancet ; 398(10308): 1317-1343, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-2184616

ABSTRACT

BACKGROUND: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
COVID-19/prevention & control , Developing Countries/economics , Economic Development , Healthcare Financing , International Agencies/economics , COVID-19/economics , COVID-19/epidemiology , Financing, Government/economics , Financing, Government/organization & administration , Global Health/economics , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Government Programs/trends , Gross Domestic Product , Health Expenditures/statistics & numerical data , Health Expenditures/trends , Humans , International Agencies/organization & administration , International Cooperation
6.
Lancet ; 400(10350): 462-468, 2022 08 06.
Article in English | MEDLINE | ID: covidwho-2170688

ABSTRACT

Epidemic risk assessment and response relies on rapid information sharing. Using examples from the past decade, we discuss the limitations of the present system for outbreak notifications, which suffers from ambiguous obligations, fragile incentives, and an overly narrow focus on human outbreaks. We examine existing international legal frameworks, and provide clarity on what a successful One Health approach to proposed international law reforms-including a pandemic treaty and amendments to the International Health Regulations-would require. In particular, we focus on how a treaty would provide opportunities to simultaneously expand reporting obligations, accelerate the sharing of scientific discoveries, and strengthen existing legal frameworks, all while addressing the most complex issues that global health governance currently faces.


Subject(s)
International Law , One Health , Disease Outbreaks , Global Health , Humans , International Cooperation
7.
Global Health ; 18(1): 55, 2022 05 26.
Article in English | MEDLINE | ID: covidwho-1866379

ABSTRACT

BACKGROUND: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. METHODS: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. RESULTS: The following four key 'foundations of resilience' were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: 'realigned relationships,' 'foresight,' 'motivation,' and 'emergency preparedness.' The attribute to 'integrate' was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. CONCLUSIONS: Health system resilience is a collective endeavour and a result of many stakeholders' consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. The experiences and perspectives of Swiss NGOs in this article highlight the vital role NGOs may play in building resilient health systems in their partner countries. Specifically, strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and bear the responsibility to support governments to prioritise investing in the key 'foundations of resilience' in order to activate greater attributes of resilience. Resilience building will not only prepare countries for future shocks but bridge the disparate health and development agenda in order to better address the nexus between humanitarian aid and development cooperation.


Subject(s)
Government Programs , Medical Assistance , Global Health , Humans , International Cooperation , Switzerland
8.
J Law Med Ethics ; 50(3): 625-627, 2022.
Article in English | MEDLINE | ID: covidwho-2126601

ABSTRACT

This is a pivotal moment in the global governance response to pandemic threats, with crucial global health law reforms being undertaken simultaneously in the coming years: the revision of the International Health Regulations, the implementation of the GHSA Legal Preparedness Action Package, and the negotiation of a new Pandemic Treaty. Rather than looking at these reforms in isolation, it will be necessary to examine how they fit together, considering: how these reforms can complement each other to support pandemic prevention, preparedness, and response; what financing mechanisms are necessary to ensure sustainable health governance; and why vital norms of equity, social justice, and human rights must underpin this new global health system.


Subject(s)
Global Health , Pandemics , Humans , Pandemics/prevention & control , Public Health , International Cooperation , Social Justice
9.
Nature ; 611(7935): 332-345, 2022 11.
Article in English | MEDLINE | ID: covidwho-2106424

ABSTRACT

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.


Subject(s)
COVID-19 , Delphi Technique , International Cooperation , Public Health , Humans , COVID-19/economics , COVID-19/epidemiology , COVID-19/prevention & control , Government , Pandemics/economics , Pandemics/prevention & control , Public Health/economics , Public Health/methods , Organizations , COVID-19 Vaccines , Communication , Health Education , Health Policy , Public Opinion
10.
Lancet Glob Health ; 10(11): e1675-e1683, 2022 11.
Article in English | MEDLINE | ID: covidwho-2106224

ABSTRACT

In response to the COVID-19 pandemic, several international initiatives have been developed to strengthen and reform the global architecture for pandemic preparedness and response, including proposals for a pandemic treaty, a Pandemic Fund, and mechanisms for equitable access to medical countermeasures. These initiatives seek to make use of crucial lessons gleaned from the ongoing pandemic by addressing gaps in health security and traditional public health functions. However, there has been insufficient consideration of the vital role of universal health coverage in sustainably mitigating outbreaks, and the importance of robust primary health care in equitably and efficiently safeguarding communities from future health threats. The international community should not repeat the mistakes of past health security efforts that ultimately contributed to the rapid spread of the COVID-19 pandemic and disproportionately affected vulnerable and marginalised populations, especially by overlooking the importance of coherent, multisectoral health systems. This Health Policy paper outlines major (although often neglected) gaps in pandemic preparedness and response, which are applicable to broader health emergency preparedness and response efforts, and identifies opportunities to reconceptualise health security by scaling up universal health coverage. We then offer a comprehensive set of recommendations to help inform the development of key pandemic preparedness and response proposals across three themes-governance, financing, and supporting initiatives. By identifying approaches that simultaneously strengthen health systems through global health security and universal health coverage, we aim to provide tangible solutions that equitably meet the needs of all communities while ensuring resilience to future pandemic threats.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Global Health , Humans , International Cooperation , Pandemics/prevention & control , Universal Health Insurance
13.
J Law Med Ethics ; 49(4): 688-691, 2021.
Article in English | MEDLINE | ID: covidwho-2093425

ABSTRACT

Antimicrobial resistance (AMR) is one of the defining global health threats of our time, but no international legal instrument currently offers the framework and mechanisms needed to address it. Fortunately, the actions needed to address AMR have considerable overlap with the actions needed to confront other pandemic threats.


Subject(s)
Anti-Bacterial Agents , Pandemics , Drug Resistance, Bacterial , Global Health , Humans , International Cooperation , Pandemics/prevention & control
14.
Transbound Emerg Dis ; 69(5): 2405-2406, 2022 09.
Article in English | MEDLINE | ID: covidwho-2053043
15.
Lancet ; 400(10358): 1091-1092, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-2050107
16.
Afr Health Sci ; 22(Spec Issue): 1-10, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2044107

ABSTRACT

The Infectious Diseases Institute (IDI), established in 2001, was the first autonomous institution of Makerere University set up as an example of what self-governing institutes can do in transforming the academic environment to become a rapidly progressive University addressing the needs of society This paper describes the success factors and lessons learned in development of sustainable centers of excellence to prepare academic institutions to respond appropriately to current and future challenges to global health. Key success factors included a) strong collaboration by local and international experts to combat the HIV pandemic, along with b) seed funding from Pfizer Inc., c) longstanding collaboration with Accordia Global Health Foundation to create and sustain institutional strengthening programs, d) development of a critical mass of multi-disciplinary research leaders and managers of the center, and e) a series of strong directors who built strong governance structures to execute the vision of the institute, with subsequent transition to local leadership. Conclusion: Twenty years of sustained investment in infrastructure, human capital, leadership, and collaborations present Makerere University and the sub-Saharan Africa region with an agile center of excellence with preparedness to meet the current and future challenges to global health.


Subject(s)
Capacity Building , Communicable Diseases , Humans , Universities , International Cooperation , Delivery of Health Care
17.
Science ; 375(6576): 31-33, 2022 Jan 07.
Article in English | MEDLINE | ID: covidwho-2042845

ABSTRACT

Risky research on lab-modified self-spreading viruses has yet to present credible paths to upsides.


Subject(s)
Animals, Wild , Organisms, Genetically Modified , Pest Control, Biological , Vaccines, Attenuated , Viral Vaccines , Viruses , Animals , Evolution, Molecular , Humans , International Cooperation , Policy , Virus Physiological Phenomena , Viruses/genetics
19.
Health Policy Plan ; 37(7): 932-934, 2022 08 03.
Article in English | MEDLINE | ID: covidwho-2017933
20.
J Law Med ; 29(3): 663-676, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2011820

ABSTRACT

The World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) provides for global minimum standard patents. These patents potentially limit access to products and processes for the surveillance, tracking, diagnosis and treatment of COVID-19. A possible solution currently under consideration is a TRIPS waiver of the implementation, application and enforcement for the prevention, containment or treatment of COVID-19. This article addresses the ways that TRIPS patents might be mediated including through TRIPS flexibilities. The article argues that there are sufficient means of derogating from patents (and potentially copyright, industrial designs and undisclosed information), although they alone will not resolve the access problems. The article concludes that the key patent problem is the transfer of know-how and that developing new ideas about addressing these patent know-how transfers is the presently unaddressed challenge.


Subject(s)
COVID-19 , Intellectual Property , COVID-19/epidemiology , COVID-19/prevention & control , Commerce , Drug Industry , Humans , International Cooperation , Pandemics/prevention & control
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