Policy Brief: COVID-19 and Universal Health Coverage

In the space of nine months, COVID-19 has spread to more than 190 countries, with over 30 million cases reported. Over one million lives have been lost. The pandemic has laid bare long-ignored risks, including inadequate health systems, gaps in social protection and structural inequalities. It has also brought home the importance of basic public health, and strong health systems and emergency preparedness, as well as the resilience of a population in the face of a new virus or pandemic, lending ever greater urgency to the quest for universal health coverage (UHC).

Health is a fundamental human right, and univer­sal health coverage is a critical tool for achieving health for all. Universal health coverage is defined as a situation where all individuals and communities receive the health services they need without undue financial hardship. However, at least half of the world’s population still do not have full coverage of essential health services, and over 800 million people spend at least 10 per cent of their household budgets to pay for health. It will be important to remove as much as possible financial barriers to accessing health services. This is challenging during an economic recession, but COVID-19 has shown that effec­tive epidemic control benefits the economy. It has also exposed the down sides of financing health coverage primarily through wage-based contributions. In the context of a global eco­nomic crisis where unemployment increases, and where entitlement to services is linked to such contributions, access to health services is reduced at the time people need it the most.

The world is now at a critical juncture of the COVID-19 pandemic. After some initial success in suppressing transmission, many countries are now experiencing a resurgence after easing of restrictions. With the flu season approaching in some part of the world, and with cases and hospitalizations increasing, many countries find themselves struggling to strike the right balance between protecting public health, protecting per­sonal liberties and keeping their economies going.

With universal health coverage in place, countries could more effectively and efficiently address the three ways in which the COVID-19 crisis is directly and indirectly causing morbidity and mortality: the first is due to the virus itself, the second is due to the inability of health systems to provide ongoing essential health services, and the third is linked to its socioeconomic impact.

We have witnessed that the virus poses the greatest risk to those groups that were already in situations of greater vulnerability: those living in poverty, older people, those with pre-existing health conditions, women, children, migrants and those who have been forcibly displaced. In a matter of months, entire regions that were making progress on eradicating poverty and narrowing inequality have been set back years. Human development has gone backwards for the first time since we began to measure it in 1990.

There can no longer be any question about the links between public health and the broader resilience of economies and societies. COVID-19 has reinforced existing evidence that investments in health have long-term returns, while underin­vestment has potential devastating large-scale global social and economic effects that could last for years. The pandemic is costing the global economy $375 billion a month and 500 million jobs since the crisis erupted. The focus needs to remain on addressing the root cause of the economic crisis — which is COVID-19. In this regard, WHO has provided comprehensive guidance on effective public health measures.

Safe and effective vaccines, diagnostics and therapeutics will also be vital for ending the pan­demic and accelerating the global recovery. It has also become abundantly clear that it is in every country’s national and economic self-interest to work together massively to expand access to tests and treatments, and to support a vaccine as a global public good — a “people’s vaccine” available and affordable for everyone, every­where. The Access to COVID-19 Tools Accelerator (ACT-Accelerator) with its COVAX Facility is the best global solution for getting us there.

Longer term, pandemic preparedness and response can be seen as a global public good with commensurate global and national-level investments. It requires a standardized outbreak alert system linked to concrete actions by national and local health authorities. As of now, only one third of countries have put in place the capacities for their public health emergency management systems as required under the International Health Regulations (2005).

Coming out of the COVID-19 pandemic will require a whole-of-government, whole-of-society and a global coordinated approach. The lessons learned call for universal health coverage that ensures equal access to quality health care without financial risks for everyone and that effectively protects societies from another health crisis with its devastating effects on lives and livelihoods. All United Nations Member States have agreed to try to achieve universal health coverage by 2030, as part of the Sustainable Development Goals and in keeping with the 2019 Political Declaration on Universal Health Coverage.

There are clear steps that can be taken in the context of the COVID-19 response and recovery measures to address the weaknesses that the pandemic has exposed and to invest in more resilient public health in the future. Ultimately, it is a political choice to ensure a pandemic of this scale and impact does not occur again.