Health worker Basanta Malla walks across rice paddies in Jorayal Rural Municipality, in Doti District in Nepal’s remote far west, with a vaccine carrier en route to a community outreach session to vaccinate children under the routine vaccination program. A key factor in the success of Nepal’s vaccination programs has been the effective utilization of Female Community Health Volunteers (FCHVs), who are held in high regard in the rural communities they live in and who help to build trust in vaccines. Photo: Laxmi Prasad Ngakhusi / UNICEF
The COVID-19 pandemic derailed progress on meeting global health goals that was already too slow. And now, amid a series of compounding crises, time is running out to shore up our defenses against current and future health threats. Global leaders would be smart to double down on investments in global health now, to protect and accelerate progress before it’s too late.
According to The Sustainable Development Goals Report 2022, the COVID-19 pandemic wiped out four years of progress on poverty eradication and pushed 93 million people into extreme poverty. It also disrupted essential health services and forced 24 million students out of school.
The window of opportunity is rapidly closing to prevent further setbacks on the SDGs and protect the systems that keep our communities healthy, prosperous, and safe. As we approach 2023 — the halfway point to the 2030 deadline for the SDGs — time is running out for global leaders to make a down payment on a healthier and more secure future for all.
World leaders are understandably preoccupied with interconnected and complex crises, from climate change to food insecurity to conflict. But as the shockwaves of this pandemic continue to reverberate around the world, we must reckon with reality: Our collective health is foundational to every aspect of life and integral to all 17 SDGs. We can no longer afford to underfund the very systems, people, and resources that work to keep us healthy and prevent future health threats.
Political leaders can take two steps to end this pandemic and avert future pandemic threats.
Cold chain support staff Deepak Bohara packs supplies of the typhoid conjugate vaccine (TCV) at the district-level vaccine cold store in the Government of Nepal’s District Health Office in Doti District. In April 2022, the Government of Nepal introduced the TCV into the country’s routine immunization programme with support from Gavi, the Vaccine Alliance, WHO, UNICEF and other partners. Photo Credit: Laxmi Prasad Ngakhusi / UNICEF
1. Pandemic-Proof the World to Ensure a Healthier, More Secure Future
The COVID-19 pandemic is estimated to cost the global economy $12.5 trillion and will continue to cause economic aftershocks for the next decade, according to the International Monetary Fund. Considering these long-term impacts, financing new solutions must go beyond short-term political cycles and re-imagine pandemic prevention and preparedness as an investment, rather than an expense.
High-income countries in particular have radically underinvested in the kinds of solutions that could have massively curbed the trajectory of the current pandemic. For example, recent models from The Lancet Infectious Diseases suggest that 45% of deaths in low-income countries could have been averted if the 20% vaccination coverage target had been met by the end of 2021.
Many thoughtful and well-informed reports and high-level recommendations on how to address the failings of the current pandemic have already been developed and are being partially advanced through intergovernmental processes. These include the development of a new potential pandemic accord, strengthening the existing International Health Regulations, and the establishment of a fund for pandemic preparedness, approved in late June by the World Bank’s Board of Executive Directors.
Countries have financed the global response to COVID-19 largely through official development assistance (ODA), but that has proven to be insufficient to address the ever-widening gap between health needs and resources. This is one reason that the global response to the COVID-19 vaccination targets set by the World Health Organization (WHO) has been so slow.
If pandemic preparedness and response funding continues to be dependent on ODA, it will be subject to the whims of short-term political interests and forced to compete for funding with other critically important health and development needs. Therefore, all countries, as well as major global donors, need to allocate additional pandemic prevention, preparedness, and response funding outside of regular ODA commitments or we are destined to repeat the mistakes of the COVID-19 pandemic.
A batch of 400,000 doses of the Sinovac COVID-19 vaccine was received in September 2021 at N'Djili International Airport in the Democratic Republic of Congo. This donation from the Government of the People's Republic of China is part of the bilateral agreements between the two countries and aims to ensure equitable access to coronavirus vaccines. Photo Credit: Josué Mulala / UNICEF
2. Sustain Investments in Proven Collective Action
We have proof that investments in multilateral health partnerships are critical to addressing the epidemics and health threats of today, while also advancing the goal of health for all. Over the past 20 years, the world has made remarkable progress in stemming the tide of leading infectious killers of children and young people, thus increasing global life expectancy by six years between 2000 and 2019.
Underpinned by the technical, procurement, and delivery expertise of the UN system, especially WHO and the United Nations Children’s Fund (UNICEF), these multilateral partnerships have provided high returns, saving millions of lives. Sustaining these investments will allow communities and countries to augment the systems and infrastructure required to fight the epidemics of today and tomorrow.
After two years of severe disruptions to essential health services, global health disparities today are wider than they have been in recent history. Some 25 million children missed out on critical vaccines in 2021, 6 million more than before the COVID-19 pandemic in 2019. Almost all children who have never received a dose of any vaccine live in low- and middle-income countries, especially in Africa and Southeast Asia.
Similarly, the COVID-19 pandemic has reversed years of progress on HIV, TB, and malaria. Compared with 2019, HIV testing fell by 22% and the number of people being treated for TB fell by more than 1 million in 2020. For the first time in over a decade, TB deaths increased in 2020. The disruption of malaria prevention, diagnosis, and treatment due to COVID-19 in 2020 caused a 12% increase in global deaths from malaria.
A shelf with protective gear, boots, and face guards at the Ghana infectious disease centre in Accra, Ghana. UNICEF leads the supply operation for COVAX, working with manufacturers and partners on the procurement of COVID-19 vaccine doses, as well as freight, logistics and storage. Photo Credit: Gemma Taylor / UNICEF
In September, the Global Fund will host its Seventh Replenishment Conference in New York City where it will call on donors to commit at least $18 billion to save 20 million lives between 2024 and 2026 and cut the death rate from HIV, TB, and malaria by 64% in 2026 compared with 2020. Over the past 20 years, the Global Fund has helped save 44 million lives and reduced the combined death rate from these illnesses by more than half. However, for the first time in the Global Fund’s history, key programmatic results declined across all three diseases in 2020 and 2021 because of service delivery, supply chain, and treatment interruptions. While $18 billion is a high ask for donors, millions of lives are on the line. These funds are needed more than ever to alter the trajectories of mortality and incidence for the world’s three deadliest and longest-lasting infectious diseases.
In October, GPEI will seek $4.8 billion to reinvigorate polio eradication efforts. Though great progress has been made since countries around the world joined forces over three decades ago to eradicate this insidious disease — achieving more than a 99.9% reduction in cases — progress is extremely fragile, and the job is not yet done. In the past year alone, over 20 countries have reported at least one case of polio, a sharp uptick from 2020 cases that is largely attributed to grave interruptions to polio immunization campaigns during the pandemic.
The replenishments of these and other global health multilaterals this year are an opportunity for governments to fortify disease prevention programs so they can make up for setbacks caused by COVID-19. The lingering pandemic and other global crises such as the war in Ukraine have reduced many donors’ ability to subsidize disease prevention — putting even status quo investments in jeopardy. If we are to meet the health-related SDGs, the impact of every dollar must be optimized to rid the world of diseases that have plagued humanity for far too long. Such investments, which play a crucial role in supporting existing health systems, must be made alongside, not at the expense of, new pandemic reforms and financing.
Sarah Yar is photographed with her 18-month-old son at the UNICEF/World Bank-supported Pariak Primary Health Care Centre in Pariak in Jonglei State, South Sudan. South Sudan has some of the worst health indicators globally with an under-five mortality rate of 96 deaths per 1,000 live births and 75% of child deaths due to the preventable diseases of diarrhoea, malaria and pneumonia. Photo Credit: Mark Naftalin / UNICEF
Defining the Path to 2025 and Beyond
In 15 months, during the same year we cross the midway point of the Sustainable Development Goals, the UN will host another High-Level Meeting on Universal Health Coverage. The financing choices that political leaders make this year are a litmus test on whether there is sufficient high-level political will and commitment to chart a course toward good health and well-being for all.
Making these investments today will allow communities and countries to continue building resilient health systems that can respond to a variety of health threats and sustain primary health services even in the face of a future pandemic threat.
The COVID-19 pandemic has shown that weakness in one part of the global health system — be it vaccination, surveillance, or health care workforce — is a threat to our ability to control, prevent, and eradicate diseases.
The window of opportunity to transform how we use global investments to strengthen the systems that keep our communities healthy, prosperous, and safe is closing quickly. With the health of millions of people at stake, the expense of inaction is far greater than the cost of action.