Enhancing co-operation to create better health policies for safer and healthier lives

By Franceca Colombo, Head, OECD Health Division

The COVID-19 pandemic has shown how the world was unprepared to deal with a pandemic of the scale and intensity we have seen over the past year. Health systems, even in most advanced economies, were caught by surprise. Now, as political attention turns to how to improve future preparedness for health emergencies, deepening international cooperation has a huge role to play. Many reviews have been launched to learn lessons for the future, emphasising the need to strengthen the existing international health architecture. Better mechanisms for improving the early detection of new emerging diseases, particularly at the animal-human interface, are badly needed.

Past health crises — such as SARS, H1N1, MERS and Ebola – also demonstrated the critical importance of sharing timely information, both between and within countries. Yet despite the rapid sharing of data on the viral genome, enabling the rapid development of testing kits and vaccines, there has been a need to better co-ordinate across countries actions to flatten the curve of the pandemic, be it containment measures and travel restrictions.

We should also learn from the way different health systems responded to the crisis. Consensus is growing that countries need to invest more in making health systems more resilient for the future.

On average across the OECD, an estimated additional 1.5% of GDP in core investments would be necessary both to strengthen the foundations of health systems – through investing in prevention to tackle health risk factors and addressing factors that make people vulnerable such as poverty and inequality – and to build capacity to maintain high quality health services for all in time of crisis. These would be investments in the economy, with a very positive rate of return. International collaboration can help steer policy development through sharing of evidence on what works, economic analyses to support investment cases, and improved co-ordination of policies and their outcomes.

Stronger international co-operation will help reinforce the health workforce. The pandemic has shown the terrific dedication of staff working against the odds to save lives. However, health worker shortages are the most significant limiting factor in addressing health emergencies and maintaining health services for all. While countries need to expand their national training capacities, shortages of health workers cannot be solved by domestic measures alone. Across the OECD, nearly one in four doctors was born abroad and one fifth were trained abroad, with similarly high proportions of nurses. With an estimated global shortfall of 18 million health workers by 2030, there is a need for a global response to the global health worker shortage.

International co-operation is key to avoiding poaching of health workers across countries, which further weakens fragile health systems.

The OECD-WHO-ILO International Platform on Health Worker Mobility can help advance our understanding of health workforce mobility and support dialogue on policy approaches to better and more ethically manage international health worker migration. Developing harmonised approaches to health data governance is another important area for international co-operation. At present, health lags far behind other sectors of the economy in being able to harness data held in different databases.

Over the course of the pandemic, despite a few, clear cases illustrating how effective data integration improves pandemic responses (such as in South Korea), there have been numerous cases of decisions made with incomplete or no data, and of many systems being unable to report data in real time. In 2017 OECD countries adopted an OECD Council Recommendation on Health Data Governance, which set out key principles for realising the dual goals of protecting privacy and data security, and making data accessible for surveillance, monitoring, clinical optimisation and research.

Ongoing monitoring by OECD of progress in developing national health data governance, to enable data to be safely shared and accessed within and across countries, will provide impetus for countries to put health data to work and as a result, be better prepared to respond to future health crises. One of the key lessons of the international response to COVID-19 relates to the supply of medical goods.

In the early days of the pandemic, shortages of personal protective equipment, ventilators, and therapeutics were exacerbated by export bans. This highlighted the vulnerability of medical supply chains arising from the concentration of production capacity and sources of materials necessary for the manufacturing of certain products. Besides helping to shed light on this vulnerability, international collaboration should support identifying how best to adapt health, trade and industrial policies to ensure reliable and diversified global medical supply chains.

Finally, advances in genomics and the rapid sharing of sequencing data helped the development of COVID-19 vaccines in record time. The COVAX facility was established, with substantial European and other funding, to help support access to COVID-19 vaccines in developing countries.

However, as of early May richer countries still held the vast majority of vaccine supplies. Not only is this inequitable, it is also short-sighted. Mutations of the virus, especially in those countries where the virus is spreading rapidly in the absence of effective vaccination, risk the spread of further variants for which existing vaccines offer reduced protection. Enhancing international co-operation to eliminate barriers that hinder the expansion of global supply and distribution of vaccines has never been more critical to save lives and support economic recovery.