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Universal health coverage (UHC) is about ensuring that people have access to the health care they need without suffering financial hardship. It is key to achieving the World Bank Group’s (WBG) twin goals of ending extreme poverty and increasing equity and shared prosperity, and as such it is the driving force behind all of the WBG’s health and nutrition investments. 

UHC allows countries to make the most of their strongest asset: human capital. Supporting health represents a foundational investment in human capital and in economic growth—without good health, children are unable to go to school and adults are unable to go to work. It is one of the global economy’s largest sectors and provides 50 million jobs, with the majority held by women. 

COVID-19 has highlighted the urgent need for collective action to augment the existing global health security financing system and to mobilize additional resources to build health systems and strengthen capacity for pandemic prevention, preparedness, and response (PPR). Avoiding future pandemics requires investing substantially more in PPR; these investments will help avert the much larger costs that the world would incur if we were to be caught unprepared for the next global health crisis. Countries must step up domestic investments in the core capacities needed to strengthen health preparedness and prevent and contain future pandemics, in accordance with the International Health Regulations. This must be complemented by enhanced external financing, particularly for developing countries.

Key messages:

1. A global Pandemic Preparedness and Response (PPR) architecture consists of five sub-systems that are interlinked and must be deployed at national, regional and global level:

• Surveillance, collaborative intelligence, and early warning
• Prioritized research and equitable access to countermeasures and essential supplies
• Public health and social measures and engaged, resilient communities
• Lifesaving, safe and scalable health interventions, and resilient health systems
• PPR strategy, coordination, and emergency operations

2. The case for investing in PPR is clear. The frequency and impact of pandemic-prone pathogens are increasing. Modest investments in PPR capacities can prevent and contain disease outbreaks, thereby drastically reducing the cost of response and the broader economic and social impacts of a pandemic or large-scale outbreak. Such investments will also help address longstanding challenges that are key drivers of mortality today, including HIV/AIDS, tuberculosis, malaria and anti-microbial resistance.

1. COVID-19 has highlighted an urgent need for global collective action to substantially scale up investments and support to strengthen the capacity of developing countries to prevent, prepare for, and respond to the next pandemic. The pandemic has demonstrated that investing in prevention, preparedness, and response (PPR) is a global public good that benefits every nation—regardless of income or wealth. This requires investments at the country, regional, and global levels. It is the collective responsibility of the international community to ensure that the necessary investments in PPR are made, on an urgent and sustained basis, so that low-income and lower-income countries and regions are better prepared to face the next pandemic.

The Member States of the WHO are about to commence the most significant negotiations that could set the paradigm for international legal obligations for preparedness and response to future pandemics. These negotiations focus on amendments to the International Health Regulations (2005) (IHR) as well as the negotiation of a treaty or other legal instrument under the WHO Constitution that will complement the IHR to ensure better preparedness and response to future pandemics, drawing from the experiences of the ongoing COVID-19 pandemic. The most critical consideration for developing countries in these negotiations will be mainstreaming equity concerns, currently missing from the existing rules and mechanisms available globally to enable developing countries to effectively prevent and respond to a pandemic outbreak. In this context, this brief suggests some elements of equity that should be pursued through specific textual proposals by developing countries through amendments to the IHR.

This paper advances that WHO Member States, having agreed to the objectives of advancing equity and solidarity for future pandemic prevention, preparedness and response, now must operationalize these. The paper offers suggestions for the ongoing WHO processes of: 1) review of recommendations under examination by the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies, 2) consideration of potential amendments to the International Health Regulations (IHR) 2005, and 3) elaboration of a draft text for an international instrument on pandemic preparedness and response.

Since 1994 (and the coming into force of the TRIPS (Trade Related Intellectual Property Rights) Agreement) there has been a dramatic strengthening of intellectual property (IP) protection with protection for product as well as process, increasing duration of protection and powerful new sanctions to encourage countries to adopt the new standards. (Scherer and Watal (2001) point out that many of today’s developed countries excluded pharmaceutical products from patent protection until quite recently: Germany until 1968; Switzerland until 1977; Italy until 1978; Spain until 1992; Portugal until 1992; Norway until 1992; Finland until 1995, and Iceland until 1997.)

Proponents for increasing IP protection, in particular the research based pharmaceutical manufacturers (RBPM) and their nation-state proxies, argue that it is necessary to support innovation.

Opponents to high levels of IP protection argue that:

For the first time, a World Health Organization committee has recommended the global agency form a working group to explore policies for contending with the high prices of medicines that are considered essential, but unaffordable in many low and middle-income countries.

The suggestion was made in the latest report about treatments to be added to the WHO list of essential medicines. The list, which is updated every two years, contains the most effective, safe and cost‐effective drugs for treating high-priority illnesses and running a functioning health care system. For this reason, the list is influential because many countries consult the list for determining reimbursement.

On October 1, 2021, the WHO published the new edition of its Model Lists (the EML) of Essential Medicines and Essential Medicines for Children.

The 22nd Model EML includes “new treatments for various cancers, insulin analogues and new oral medicines for diabetes, new medicines to assist people who want to stop smoking, and new antimicrobials to treat serious bacterial and fungal infections.”

Potentially more consequential, the WHO Report “recommended establishing a standing EML Working Group to support the Expert Committee to provide advice to WHO on policies and rules to make highly priced essential medicines more affordable and accessible.”

While the COVID-19 pandemic has resulted in huge setbacks for health systems – it has also highlighted the needs. And one of the biggest is the need for greater investment in basic primary health care systems as a pathway for ensuring  Universal Health Coverage (UHC).

Delegates speaking during a high-level strategic session on the third day of the 74th World Health Assembly, Wednesday, said that while there has been progress in some areas of primary health care, stronger policies, more public-private partnerships and more socially inclusive participation is needed.