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Global Health Governance Still Faces Major Challenges

Pedro Pita Barros is Professor of Economics at Universidade Nova de Lisboa where he teaches industrial organization and health economics. He is also a research fellow at the Centre for Economic Policy Research (London).Pedro Pita Barros’ research focuses on issues on health economics and on regulation and competition policy. His work has covered different topics including health expenditure determinants, waiting lists, bargaining in health care, competition policy in Portugal and in the European Union, among others. Pedro Pita Barros is currently Editor of the International Journal of Health Care Finance and Economics and Associate Editor of Journal of Health Economics, Health Economics, and Health Care Management Science.

2022 is the third year of the global epidemic of COVID-19. This “black swan” incident has had a far-reaching impact on global health security, economic and trade cooperation and personnel communication. The Center conducted an in-depth and exclusive interview with Pedro Pita Barros, hoping to obtain his views on national epidemic prevention measures and the challenges of global health governance under the background of epidemic normalization.

Pedro Pita Barros: Global Health Governance Still Faces Major Challenges

The opening of countries to international relations leads to new challenges, of which three are more likely, in my view, to have long term impact in the economics of health systems. First, technology (either pharmaceuticals or equipment or health and medical procedures) become widespread and available to all countries. This brings the issue of what prices technology, in this broad sense, will be available in which countries. Second, health workforce migration flows may intensify, as some regions will have a clear need of more professionals. Brain drain from countries with less developed health systems and lower wages will put a stress on those health systems. Third, “health tourism” (patients’ flows to other countries) in certain (clinical) areas is likely to resume growth. In those three areas is difficult to envisage how the World Health Organization can have a role that is accepted by the countries.

In addition to these challenges, the current pandemic of COVID-19 makes us remember that biology knows no human-defined administrative borders of countries. Thus, surveillance on new and emerging diseases, especially infectious diseases, requires that countries exchange information and share knowledge. The WHO can, in this context, have an important role, coordinating activities and ensuring a common “technical language” and ensuring standards and best practices to be known to all health systems.

Global health governance will have to deal with very different health systems across the globe. Even though health systems may often share overall goals (improve population health, promote equity in health care access and in health, provide financial protection against the consequences of lack of health, etc.), the way the goals are achieved vary widely, even across neighboring countries. Thus, the WHO, or any other institution concerned with health and health care at the international arena, has to work through voluntary participation of countries, and focus on the technical aspects of health promotion and health protection rather than setting specific policies (which should be defined in every country in line with the characteristics of its own health system).

The view that epidemic control in any given country can only be achieved if there is epidemic control in every country is probably a simple idea that should be present in the minds of decision makers in all places. Unless a country can cut off all international ties, including movements of people inward and outward of the country, there will always be a chance that an epidemic in one place will eventually reach everywhere. This of course will also depend a lot on the infectious agent. In the past 30 years, we had respiratory viruses that stayed mainly around the geographic areas where they first appear and we had viruses that spread around the globe. Even now, under the COVID-19 pandemic, efforts to isolate full countries from the epidemic sooner or later fail. Thus, if the epidemic control is not achieved by restrictions in movement of people, then it must be achieved by protecting people everywhere. In the COVID-19 case, setting up that protection requires widespread vaccination. Therefore, we should see and we need to see a continued effort at international level to increase vaccination levels. Other health emergencies may require coordination of other sorts of products and services of health care.

In many countries, the policies for epidemic control followed the same pattern, with main focus on mobility restrictions before a vaccine was available and on vaccination of population, with some mobility restrictions in periods of diffusion of new, more infectious, variants. The same pattern emerged, with control of initial epidemic waves being achieved whenever mobility restrictions were enacted, enforced and population complied. After vaccination become widespread, there is less reliance on strong and long-lasting mobility constraints. The variants of the virus leading to COVID-19 have created new epidemic waves, milder in terms of deaths and severe disease (strong effect) and of new cases (less strong) due to vaccination. It is rather illustrative of this that daily new cases in early 2022 in UK was much more than one year before (end of 2020 and early 2021), though the mortality impact was much slower in 2022 than in 2021. The decisions on epidemic control result from a mix of technical policies and of politics in each country. The politics balance in each country the population support for the policies, concerns about economic consequences of lockdowns and mobility restrictions and the impact on the health system. There is little international coordination on these. Contextual elements probably make it a national matter not prone for international coordination, at least under the current diversity of health systems.


Contact: Wang Qi

Questioner: Zhang Ran

Translator: Li Yuhan

Corrector: Xu houkun

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