It has never been more apparent that diseases not only present health costs, but also significant economic costs. In this blog, MSc student Kellie Maher reports on a recent lecture delivered by Lord Jim O’Neill, Embedding Health Policy into Broader Economic Thinking.
A year after the word ‘pandemic’ became common parlance, the numbers are eye-watering on all accounts. Currently, more than 2.5 million deaths worldwide are attributable to COVID-19 and, collectively, global economies have amassed around $19.5 trillion of debt. We have a ‘huge opportunity to use the scale of this crisis and the understandable attention that it’s getting […] to put in place a better framework to help us manage the future’, said Lord Jim O’Neill as he delivered the Department of Health Policy’s annual lecture on 16 March.
In his lecture, Lord O’Neill discussed how his experience working on Antimicrobial Resistance (AMR) convinced him that we cannot – and must not – divorce health from the economy. Given the interconnectedness of animal, environmental, and human health – which are all in turn connected to the global economy – there is a need for a more integrated approach. Such an approach could involve treating health as a global public good to be protected by the international community. Smart investments, reforms to the global financial system, international and multi-sectoral collaboration, and the strengthening of governance structures, will all be essential when rethinking the role of health in policy priorities.
Lessons from AMR
With microorganisms (viruses, bacteria etc.) developing resistance to therapeutics like antibiotics, the threat posed by Antimicrobial Resistance (AMR) is truly universal. The 2016 AMR review chaired by Lord O’Neill included the alarming prediction that, if nothing changes, AMR-related fatalities could reach 10 million a year by 2050. This human cost could be accompanied by an economic cost of $100 trillion in that time.
In order to avoid these substantial health and economic costs, the review set out 29 recommendations. Among the recommendations are some that aim to reduce unnecessary demand for antimicrobials, while others aim to boost supply of viable alternatives. These objectives are, however, largely at odds with the business ambitions of the pharmaceutical industry, which generally focuses on increasing supply and having as much demand for their products as possible. To tackle this, the review includes proposals that aim to better align the public health needs with commercial incentives, such as a global system of market entry rewards to encourage research and development into new therapeutics.
There is also an important role for vaccines in tackling AMR. If we can increase the supply of new vaccines – especially for diseases with drug-resistant strains, such as tuberculosis – demand for antimicrobials will be reduced. However, innovative solutions to complex problems depend upon international collaboration in order to become a reality. Here, COVID-19 has some lessons for AMR: vaccine development is just the first hurdle; the next is getting vaccines into arms all around the world. While the WHO’s COVAX initiative was set up to facilitate fair distribution of vaccines, its success is dependent upon the financial and political support invested in it, both of which have so far proved to be insufficient.
Breaking down silos
Modern crises – such as AMR, COVID-19, and climate change – straddle multiple systems, and therefore require coordinated responses. In COVID-19, we have witnessed positive examples of what can be achieved when traditional bureaucratic and sectoral silos are ignored, particularly in relation to technological solutions. It is essential that we build upon and encourage further collaboration, including on the international political stage.
In the spirit of collaboration, the independent Monti Commission was convened in August 2020 to rethink policy priorities in the light of pandemics. In its recently published ‘Call to Action’, the commission recommends the adoption of a ‘One Health’ approach, which acknowledges the interdependence of human, animal, and environmental health. To oversee this approach, Lord O’Neill proposes a greater alignment between the WHO and other UN agencies specialised agricultural, environmental, and animal health – namely, the FAO and OIE. Perhaps, he suggests, it is possible to imagine the creation of a World One Health Organization (WOHO) in the future.
At the national level, there is a need to move beyond the tendency to view health issues as solely the preserve of health ministries. COVID-19 has shown that the separation of health and the economy is a false dichotomy, which reinforces the perception of competing values. Acknowledging the often-symbiotic relationship between the two is not only relevant in health emergencies, but it is also essential to efforts to improve overall population health. The pandemic has exposed multiple vulnerabilities and inequalities within and between societies, which negatively impact health outcomes – both in relation to COVID-19, and overall. Since health is not only determined by health systems but is also influenced by a broad range of social factors, population health requires governments and ministries to adopt a more holistic approach.
There was no shortage of commitment for urgent, collaborative action on the international financial stage following the 2008 crash. Out of the crisis came the Financial Stability Board (FSB), which introduced mechanisms to address vulnerabilities in the global financial system. If this is possible for finance, could a similar body not be developed to protect “goods” such as global population health? This is what the Monti Commission envisages when it recommends that a Global Health Board be created at the G20 level, which could evolve into a Global Public Goods Board that harnesses international support for the protection of public goods, including health.
Out of the  crisis came the Financial Stability Board (FSB), which introduced mechanisms to address vulnerabilities in the global financial system. If this is possible for finance, could a similar body not be developed to protect “goods” such as global population health?
While crises inevitably cost money, spending that is purely reactive is the equivalent of the metaphorical band-aid. Developing health systems that are sustainable and resilient is fundamental to minimise health and economic costs. Calls for Universal Health Coverage emphasise that access to health care globally should be a shared goal, which is not only central to treating health as a human right, but also for achieving healthier economies. As Lord O’Neill highlighted, the economic progress of some emerging economies is currently hindered by insufficient investment in this area. Governments, argues Lord O’Neill, must think about how money is spent. The key to smart spending should differentiate between investment – into, say, research and development – and the “consumption” of primary and secondary care services.
All in this together?
The field of Global Health Security teaches us that in moments of perceived existential threat, societies can be very effective at directing attention and resources towards responding quickly to a crisis. As we have witnessed, however, ideas around what or whom should be protected as a priority do not always align. It is becoming increasingly clear that competitive ‘me-first’ approaches may prolong pandemics, increasing both the health and economic costs globally. A stark example can be seen in the insufficient support for WHO’s mechanism to deploy vaccines, diagnostics and treatment to every part of the world as soon as possible (ACT-A). Aside from the obvious health benefits, Lord O’Neill sees this as ‘probably the biggest no brainer form of economic stimulus any economic policymaker could consider signing onto.’
Arguably, one of the greatest challenges we face is the pandemic of short-term thinking. There is a tendency for governments to be influenced by electoral cycles, and the private sector to prioritise profit margins. In relation to the private sector, Lord O’Neill urges a ‘profit with purpose’ approach. Businesses need to consider how they might form part of the solution, rather than leaving problem-solving to policymakers. In particular, the pharmaceutical industry, whose remarkable potential has been demonstrated in this pandemic, will need to further consider the future of its role in the systems within which it operates.
At the global level, we need to strengthen international bodies and ensure that governance structures embrace a more integrated approach to health and the economy. This will in turn hopefully also encourage effective leadership and decision-making for the next crisis at national levels. It is impossible to quantify the true costs of failure to cooperate in times of crisis. Investing in the future will require us to take a look at the bigger picture and appreciate the interconnectedness of systems and societies. The time to prepare for future crises is now.
You can watch Lord O’Neill’s lecture again via the LSE YouTube channel.
The views expressed in this post are those of the author and in no way reflect those of the Global Health Initiative blog or the London School of Economics and Political Science.
Photo by UNICEF Ethiopia. Licensed under creative commons (CC BY-NC-ND 2.0).