Covid-19 and health system

COVID-19: Make health systems a global public good

By Milindo Chakrabarti, Professor, O.P. Jindal Global University and Visiting Fellow, Research and Information System for Developing Countries (RIS)

This blog* is part of a series on tackling COVID-19 in developing countries. Visit the OECD dedicated page to access the OECD’s data, analysis and recommendations on the health, economic, financial and societal impacts of COVID-19 worldwide*.

Pandemics are always unpredictable and, unlike natural disasters that are mostly localised, they affect countries across the globe. Within a span of less than five months, millions have been affected by COVID-19 and thousands have perished. It has taken its toll across countries irrespective of their levels of income. To more effectively prevent and fight pandemics, we must shift from a national approach to health services to investing in health as a truly global public good. This will require action on pandemic insurance, on the development of pandemic-related infrastructure, and on intellectual property rights.

COVID-19: a crisis beyond income levels

The World Bank categorizes countries in terms of their per capita income. There are 80 High Income Countries, 60 Upper Middle Income Countries, 47 Lower Middle Income Countries and 31 Low Income Countries. These four categories are often used as a proxy for a country’s overall level of development. Has COVID-19 infection and mortality rates correlated with the level of income?

High Income Countries, in spite of extensive health support facilities, have been overwhelmed by the crisis and account as of 28 April for more than 86% of total deaths. Countries lower down the income ladder, in spite of a lower number of registered cases, have been less able to prevent deaths due to low capacity in providing post infection support. The extent of testing varies greatly too. High Income Countries have a little more than 16310 tests per million population. The corresponding numbers are around 2743, 670 and a little over 180 for Upper Middle Income, Lower Middle Income and Lower Income countries, respectively. The lack of testing capabilities increases as we go down the income ladder. The higher rate of testing may also account for the higher level of identification of cases in Higher Income Countries. In short, COVID-19 is taking a heavy toll across all income groups – but the poorest countries are likely to see the impacts amplified given their pre-existing vulnerabilities and more limited resources to respond.

Towards making health services a global public good

It is true that pandemics do not occur frequently. But make no mistake, the next one could appear in the coming century, or even decade. The chances are magnified by the threats of climate change, deforestation and rapid loss of biodiversity and the resulting disturbance for genetic diversity. COVID-19 attacked the respiratory system. But the next one may harm the renal or nervous system or even the enteric system. Medical support in each of these situations would demand availability of separate sets of testing kits, medical devices and prophylactics.

How do we prepare for this? The present crisis shows us that a change in approach is urgently needed. The WHO Access to COVID-19 Tools Accelerator, aiming to accelerate equitable global access to safe, quality, effective, and affordable COVID-19 diagnostics, therapeutics and vaccines for all, is a step in the right direction. Going forth, three additional collective global efforts must be set in motion, which needless to say, would require a considerable shift in the mind-set and political will at the global level.

Setting up a global pandemic insurance fund

The first is to set up a global pandemic insurance fund. As we are experiencing, pandemics require “global isolation”, leading to economic shocks that disrupt regular supply chains, production activities and service delivery. The resulting loss in livelihood opportunities renders a vast proportion of the global population vulnerable and in need of support from external sources that are well beyond their individual control. The increasingly large number of developing countries approaching multilateral financial institutions for emergency financial support highlights the extent of damage caused by the pandemic on developing economies. A newly designed Marshall Plan is often being mentioned. The creation of a global pandemic insurance fund could be considered too. With contributions from participating countries and managed by a select group of health and insurance professionals, it would facilitate a global recovery that cuts across the income divide. For this fund to deliver, it would need to be operated in a participatory manner, upholding the spirit of multilateralism to facilitate collective action. Given the experiences from the present pandemic and its disastrous effects on us all, one can expect that there would not be much opposition to make this fund an operational reality. It is now amply clear that the cost of collective inaction can be highly disastrous for present and future generations alike. And the lack of action in countries with more limited capabilities to cope with pandemics may have ripple effects on other countries – close-by or far – since viruses travel fast and respect no borders.

Investing globally in pandemic related infrastructure

The second is to set up a specialized agency or vehicle that would invest in the development of necessary pandemic-related infrastructure, including testing hardware, isolation and quarantine facilities, and critical life support systems across all countries. The agency would pool investible resources from sovereign funds, pension funds, philanthropy, multilateral organizations, donor agencies, civil society organizations, corporate sectors and even retail investors. Some of the funds allocated under the rubric of South-South cooperation may also be transferred to this agency. The rate of return would undoubtedly be low, compared to investments with a short-term focus. However, with the recent trends of social and impact investments, there is a potential to attract significant resources; investments would be low-risk with guaranteed steady returns, however low. These investments would ensure immediate action against the spread of a disease once the virus is identified and testing procedures are in place. The generated infrastructure would complement the existing and overstretched health systems in poorer countries. Such an effort must not get monopolized by a powerful entity. It has to remain global in the truest sense of the term.

Unlocking intellectual property rights: a global R&D fund

Finally, health related innovations are mostly patented under intellectual property rights (IPR) regimes. Considering Article 25(1) of Universal Declaration of Human Rights, it is high time for these innovations – drugs, vaccines, medical devices etc. – to be brought out of the purview of individual patent rights and for global property rights to be created instead. A global R&D fund that engages in health related open source innovation through a global network of research units is the ultimate requirement for achieving SDG3 – “Good Health and Well-being”. Such research would be socially responsible, inclusive and encourage innovation. The units in the network would carry out coordinated research, clinical trials and knowledge sharing, abandoning competition among themselves to generate private profits, in a cooperative approach that would enhance social welfare. Time is ripe for making health services a global public good with property rights vested in every single citizen around the world. Such a fund may pick up some clues from the features of the already established International Solar Alliance. The proposal by the President of Costa Rica in 2019 to develop a global coalition of nations to push for a deal for nature may also provide some leads in making health services a truly global public good.

*This blog series contributes to the debate on new approaches to international co-operation and public funding to support sustainable development and global public goods. The COVID-19 crisis is showing us that international co-operation is vital. So, what lessons can we draw from the response to global challenges such as pandemics and the climate emergency?

Offering personal insights from across the globe, this series, co-hosted by Development Initiatives, United Nations University International Institute for Global Health and OECD Development Centre complements Wilton Park’s Future of Aid dialogue, with partners Joep Lange Institute and Coalition for Global Prosperity.