Failing to Invest in Health, Economic Folly Risks Future Pandemics

Jun 8 , 2024
By Mariana Mazzucato

The COVID-19 pandemic illustrated how crucial public investment is in health innovation. The development of vaccines, backed by 31.9 billion dollars in US public investment, illustrates this. In this commentary provided by Project Syndicate (PS), Mariana Mazzucato (PhD), a founding director of the UCL Institute for Innovation & Public Purpose, and chair of the World Health Organization’s (WHO) Council on the Economics of Health for All, argued that the benefits must be governed for the common good, ensuring health products are accessible and affordable worldwide.

The world urgently needs a new global framework that emphasises equity and draws on the lessons of the COVID-19 pandemic. Yet, member states’ failure to meet their deadline for a pandemic agreement looms large. Still, this year’s gathering offers some cause for hope, because member states will vote on a resolution on the “Economics of Health for All,” which is deeply informed by the work of the World Health Organization’s (WHO) Council on the Economics of Health for All, which I chaired.

If the resolution passes, the WHO will be mandated to implement the Council's recommendations through its work with member states. Highlighting the linkages between health and the economy, it identifies specific steps the organisation and governments can take to prioritise health and well-being in cross-cutting policymaking. The Council called on governments worldwide to invest in health for "all" and to organise economic systems that value, finance, innovate for, and build capacity to achieve this goal.

Shaping our economies to reflect the goal of "health for all" is crucial to preventing or responding faster to future pandemics. But, it requires aligning health, economic, social, and environmental policy objectives. While it is health ministers who will vote at this assembly, they should not be seen as the only ones responsible. Health for all requires a whole-of-government approach, and especially attention from ministers of finance and economic policy.

This is particularly true today.

The resolution urges member states to frame health spending as a long-term investment, not a short-term cost. But austerity has returned to many countries, threatening health budgets already under pressure from debt-servicing costs and inflation. This is not merely a point about messaging. Investments in health are, in fact, long-term drivers of growth. The debt-to-GDP metric is a ratio: If governments focus on cutting debt (the numerator) and eschew investments promoting future growth (the denominator), the ratio will not decrease, and may even rise.

Fortunately, industrial policy is back in favour around the world, offering governments an opportunity to orient their growth strategies around health and other critical priorities. Instead of focusing on select sectors or technologies, a modern industrial strategy should focus on bold social and environmental missions, catalysing investment, innovation, and growth across relevant segments of the economy.

Innovation is based on collective intelligence; it does not emerge spontaneously from just one company. Around the world, health innovation benefits massively from public investment. The mRNA COVID-19 vaccines were supported by about 31.9 billion dollars in US public investment. They represent just one example among many.

However, the benefits may not be widely shared unless innovation is governed for the common good. We will need a new approach to public-private collaboration to ensure proper sharing of risks and rewards. Governments should set stronger conditions for those seeking public support for health innovation, not least by requiring that health products and services be widely available and affordable.

The problem is that the pharmaceutical industry’s lobbying continues to limit the strength of these conditions. In the ongoing pandemic treaty negotiations, for example, special interests have managed to block important measures related to intellectual property rights.

These rights should not be structured to protect monopoly profits or to inhibit access to vital health innovations – for example, by blocking timely and affordable production or withholding knowledge and technology transfers. In a health emergency like a pandemic, everyone – and every economy – ultimately suffers if equitable access to tests, vaccines, and lifesaving health products is not a top priority. In the case of COVID-19, an estimated 14 million people died, and the global economy lost about 14 trillion dollars.

The negotiation of the pandemic agreement shows the necessity of designing policy instruments in a mission-oriented way. If the goal is to prevent catastrophic health threats, the agreement must be oriented around this goal. And that means emphasising equity. This is also true for the design of global finance. Low- and middle-income countries need fiscal space to make critical investments in health. The pandemic agreement makes some reference to the importance of debt-relief measures.

But, a much stronger commitment is required – in line with the demands of the Bridgetown Initiative, spearheaded by Barbadian Prime Minister Mia Mottley – to reform multilateral development banks. These reforms need to ensure that countries have access not only to the right quantity but also the right quality of finance and are not hampered by unsustainable debt from making critical, long-term investments in health, climate, and economic priorities.

The pandemic may be waning, but the world is still confronting multiple, interrelated crises related to health, climate, and rising inequality within and between countries. We are failing to heed the lessons of the past four years. Climate change ensures that outbreaks will become more frequent, yet funding for epidemic preparedness and response remains insufficient. Rather than pursuing economic growth regardless of the consequences, we should orient economic activity toward human health and well-being goals and toward ensuring a healthy and sustainable environment.

We must escape the deeply flawed economic thinking that allowed the COVID-19 pandemic to become as bad as it did.

Implementing such an economy is not a luxury aspiration. It is a necessity if we are going to avoid the human – and economic – costs of another pandemic. Beyond adopting the resolution, this will require leadership from the WHO and member-state delegates. If health for all is going to become a top priority – as it must – it should be reflected fully in the design of public finance structures and economic, industrial, and innovation policies.

PUBLISHED ON Jun 08,2024 [ VOL 25 , NO 1258]

is professor in the Economics of Innovation & Public Value at University College London. 

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