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Invest in health systems for economic prosperity

Investment in primary health care must increase, because investment gaps in health widen during difficult times such as we are experiencing now

No one could have predicted the extent to which Covid-19 would erode decades of progress in global public health. And the world is still reeling from the shock. But we have the opportunity – and the duty – to learn the right lessons to mitigate the ongoing pandemic, while minimizing the risk of similar events in the future.

Though there are new threats on the horizon, we must not allow our focus to move away from Covid-19. The pandemic highlighted significant gaps in our global health systems. To leave them unaddressed would be bad public policy and bad economics, because there can never be a trade-off between health and economic development. Covid-19 has demonstrated that health is central to development, prosperity, and national security.

The pandemic’s disruption of health services has resulted in spikes in HIV, tuberculosis, malaria, and many non-communicable diseases – both unreported cases and deaths. These are diseases that the world had previously made great gains toward controlling. Making matters worse, the pandemic has led to decreased life expectancy, lower basic immunization coverage, and increased psychosocial and mental-health challenges.

Compounding the pandemic’s painful legacy, the war in Ukraine has triggered an extensive humanitarian crisis, endangered global food supplies, increased food and energy prices, and threatens to cause recession and economic hardship around the world. In September, the International Monetary Fund warned that “the impact of higher import costs for food and fertilizer for those highly exposed to food insecurity will add $9 billion to their balance of payments pressures – in 2022 and 2023. This will erode countries’ international reserves, and their ability to pay for food and fertilizer imports.”

Moreover, higher interest rates and tightening financial conditions have raised the specter of widespread debt distress in low- and middle-income countries. By subjecting public finances to great strain, recent global shocks have put vital, long-term health investment at risk.

Global solidarity and equity are the underpinnings of any effective response to the challenges we face. We must advance on three fronts to preserve the central role that health systems – and more precisely primary health care – play at all times, and especially when economic crises hit.

First, investment in primary health care must increase, because investment gaps in health widen during difficult times such as we are experiencing now. These gaps, in turn, increase the risks people face from global threats, manmade or otherwise. It is in everybody’s interest to help all countries that lack resources to invest sufficiently in health-system resilience and pandemic preparation and response.

Second, innovation in life sciences needs more financing, especially to scale it up in a sustainable manner. This means supporting local production or mental-health service delivery innovations that reach millions of people and are incorporated into the primary health-care system.

Third, multilateral organizations should collaborate to prepare us all to confront future health threats more effectively. Here, initiatives such as a legally binding pandemic accord, developed and ratified by countries and rooted in the World Health Organization constitution, can provide the desperately needed playbook for preventing and responding to pandemics.

Unfortunately, even before Covid-19, the world was lagging in the race to meet globally agreed health targets, including many of those enshrined in the Sustainable Development Goals for 2030. The pandemic has set us back further.

In times of rising debt and increasing risks to debt sustainability, governments, international organizations, and financial institutions must cooperate closely to get us back on track. While illustrating the many shortcomings in global cooperation, Covid-19 has also demonstrated the importance of working together.

That is why our two organizations have committed to combining our strengths to promote and increase investments in health.

For example, with support from the European Investment Bank, the WHO, the Wellcome Trust, and others, the AMR Action Fund is investing in innovative solutions to tackle antimicrobial resistance and ensure that there is a pipeline of new drugs to address key needs. The scientific community already identifies antimicrobial resistance as “the silent pandemic” and a serious threat to global health and development.

Moreover, we are working to channel additional resources from other partners, such as the European Commission, development finance institutions, and private-sector actors, to boost health services where they are needed most. Earlier this year, we announced a partnership, in cooperation with the European Commission and the African Union, to strengthen health systems, in particular primary health care, in Africa. The EIB has pledged to make at least €500 million ($520 million) available to mobilize more than €1 billion in investment, with a particular focus on primary health care in Sub-Saharan Africa.

New cooperative projects are already moving ahead in Africa and the Middle East. In Rwanda, the WHO will directly advise the government on rebuilding the country’s National Health Laboratory, with financing from the European Commission and the EIB. The new laboratory will perform more than 80,000 tests each year, serving a population of more than 12 million.

To have a measurable impact in these countries, we focus on using innovative finance mechanisms that spur domestic funding and promote our shared goal of health for all. At the same time, we are committed to promoting sustainability in debt management, so that our partner countries’ investments in health do not result in financial pain. Again, to invest in health is to promote good economic policy.

Good health and well-being are goals the whole world shares. To accelerate the deployment of innovative health solutions, countries and institutions must work together, fostering cooperation not only between states, but also between governments and the private sector.

- Werner Hoyer is President of the European Investment Bank. Tedros Adhanom Ghebreyesus is Director-General of the World Health Organization.