WHAT DOES COVID-19 TELL US ABOUT APPROACHES TO PRIORITY-SETTING IN HEALTH?

ABSTRACT

Introduction Given the devastating effects COVID-19 has had, many may think it is obvious that more should have been spent on pandemic preparedness and mitigation measures. But this would have required investment to be taken away from existing health problems to be put towards a problem that may arise in the future at an uncertain time. When the resources available for health are finite, priorities need to be determined. How does pandemic preparedness fit into current approaches to determining health priorities? Methods Conceptual analysis of how pandemic preparedness work compares against other global health priorities, using a framework of three common factors in discussion of the ethics of health-priority setting: scale, cost-effectiveness and justice. Outcome The present-orientation of standard conceptions of burden of disease estimates omits the potential burden from new pandemics, and the uncertainty of pandemics makes it difficult to include them in projections of global disease burden. The use of high discount rates and relatively short time horizons may lead cost-effectiveness estimates to under-value pandemic preparedness work. Whether pandemic preparedness is considered a priority from the perspective of equity depends on how well-off we expect future generations to be relative to the present, and the scale of future pandemic events. Finally, many of the actions to reduce pandemic risks happen outside of the healthcare system. This suggests a need for increased focus on approaches to priority-setting outside of healthcare, including in health research and government and institutional attention. Conclusion The uncertainty and future-orientation of pandemic preparedness activities mean that this area of work doesn't easily fit into traditional approaches to determining global health priorities. Approaches to determining global health priorities need to adapt to enable comparison of stochastic, future-oriented issues to problems of existing health burden.