The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

Abstract

Background Investing in health emergency preparedness is critical to the safety, welfare and stability of communities and countries worldwide. Despite the global push to increase investments, questions remain around how much should be spent and what to focus on. We conducted a systematic review and analysis of studies that costed improvements to health emergency preparedness to help to answer these questions. MethodsWe searched for studies that estimated the costs of improving health emergency preparedness and that were published between 1 January 2000 and 14 May 2021, using PubMed, Web of Science, Google Scholar, EconLit, and National Health Service Economic Evaluation Databases (PROSPERO CRD42021254428). We also searched grey literature repositories and contacted subject experts. We included studies that estimated the costs of improving preparedness at the global level and/or at the national level across at least ten countries, covered two or more technical areas in the WHO Benchmarks for International Health Regulations (IHR) Capacities, and included activities focused on human health. We mapped costs across technical areas in the WHO Benchmarks for IHR Capacities.Findings Ten studies met our inclusion criteria. Costing methods varied substantially across included studies and cost estimates ranged from US$1¢6 billion per year to improve capacities across 139 low-and middle-income countries (LMICs) to US$43 billion per year to support national-level activities worldwide and implement global-level initiatives, such as research and development for health technologies (diagnostics, therapeutics, and vaccines). Two recent studies estimated costs by drawing on IHR Monitoring and Evaluation Framework country capacity data, with one study estimating costs across 67 LMICs of US$15¢4 billion per year (US$29¢1 billion including upfront capital costs) and the other calculating costs for the 196 States Parties to the IHR of US$24¢8 billion per year. Differences in included studies' methods, and the characteristics of countries considered, mean it is difficult to make like −for−like comparisons of the absolute costs or per-capita costs estimated by studies.Interpretation Improving health emergency preparedness worldwide will require substantial and sustained increases in investments. Further guidance on estimating the size of those investments can help to standardise methods, allowing greater interpretation and comparison across studies/countries. As well as greater transparency and detail in the reporting of methods by studies focused on this topic, this can help support estimates of global resource requirements and facilitate investments towards improving preparedness for future pandemics.

Relevance of the world health organization in a multipolar world in solving global health challenges

“…On many occasions the movement of people is an obstacle in following IHR ( 19 ). There is a need for substantial and sustained increases in investments by WHO and various countries to prepare for global health emergencies with effective IHR ( 20 – 22 ). There is a need to share administrative powers by the WHO with various actors for effective decision-making and implementation of IHR rather than a top-down approach ( 23 , 24 ).…”

Investing in preparedness for rapid detection and control of epidemics: analysis of health system reforms and their effect on 2021 Ebola virus disease epidemic response in Guinea

“…However, as the results of this investment in preparedness are not immediate and visible (especially when successful), 7 many governments inadequately invest in building preventative capacities and implementing preventive interventions during the ‘preoutbreak’ period. 11 …”

Viewing the global health system as a complex adaptive system – implications for research and practice

“…Equally, efforts to estimate the costs of pandemic preparedness at the global, regional and national levels and to identify mechanisms to finance these, often ignore the interconnections between global, regional and national systems, and how investments at one level will affect costs and resource needs at other levels. 29 The value of a complex adaptive systems approach A CAS approach can be used to study the supra-national actors and systems that support global health consistent with the definition of the GHS provided earlier. 2 Through a CAS lens, the GHS can also be conceptualised as a multi-level health system, a continuum of health systems from local to global, comprising all the national systems globally together with the supranational global 'health system' architecture, as illustrated in the simplified configuration in Figure 1.…”

“…patients uptake or not of vaccines) influencing global responses. 35 The importance of taking a multi-scale approach to health is only slowly starting to be recognised in relation to COVID-19, 29 while multi-level governance systems and the study of cross-scale interactions have long been the subject of climate research. 30 Beyond an alternate conceptualization of the GHS, as we set out below, a CAS approach can help to visualize and understand system structure and dynamics, quantify the effect of a problem, and predict system behaviour in response to exogenous shocks or policy reforms.…”