Summit of the Americas: Our region must take a longer view of public health spending

As leaders gather for the Ninth Summit of the Americas, hospitals are filling up and COVID-19 deaths are rising in countries across the region — again.

We find ourselves at a pivotal moment, in the ongoing response to the pandemic, but also in the history of our region’s public health. Above all else, that history, and our future, will be shaped by how much governments choose to spend on health, and whether they make those investments wisely.

Before the pandemic, investment in health had been neglected for too long in too many countries. In the Americas, only the United States, Suriname, Uruguay, Canada and Cuba spent at least 6 percent of GDP on health, a threshold for public spending recommended by the Pan American Health Organization.

This chronic underinvestment is a key reason we were so unprepared for COVID-19.

Over the past two years, our region has endured its worst public health crisis in a century. We have lost more than 2.7 million people to the virus and millions more from rising burdens of maternal mortality, malnutrition and inequality brought on by the pandemic.  

The impact extends far beyond health — over 4.7 million people have fallen into poverty, and a generation of young people have fallen behind on years of education.

But the pandemic has also demonstrated what can be done when we make health a priority.

When the virus arrived, governments responded quickly by mobilizing emergency funding and reallocating existing resources. International agencies freed up finances by suspending debt and donors across the region provided aid to help their neighbors withstand the surge.

In total, more than $135 billion (USD) has been mobilized across the region to protect the health, wellbeing and livelihoods of our people since 2020.

This stimulus helped power the farthest-reaching immunization effort in the world. Since COVID-19 vaccines were first introduced in March 2021, we have distributed more than 1.8 billion doses across the Americas, reaching over 65 percent of the eligible population of Latin America and the Caribbean.

Never before has the case for investing in health been made so clearly, and the consequences of under-investment been rendered so starkly.

Yet, progress and investment are stalling. External funding for health in 2022 is expected to fall far short of the more than $4.39 billion dedicated in 2021, and the $2.49 billion in 2020.

At the same time, the region’s slow economic recovery is hindering governments from sustaining financing and resourcing for public health, threatening the capacity of health systems to address current and future health needs.

COVID-19 is the latest reminder that health, security and economic stability are regional concerns, not national ones. To get back on track, we must work together.

That means our region’s leaders must commit to increasing every country’s domestic allocation to the recommended threshold of 6 percent of GDP each year, not just in the years when crisis hits. It also means maintaining financial support for countries that don’t have the capacity to do so.

Our region must take a longer view of public health spending, which includes investing in expanding coverage of health systems and building local manufacturing capacity for vaccines, medicines and other health technologies — which are central to effective emergency response, yet cannot be built overnight.

We can also better leverage the collective power of our region’s health and economic sectors. Countries should coordinate more closely on cross-cutting issues that impact both sectors, including resource allocation and regulation, fiscal space for health and pandemic preparedness, and financial and social protection.

The Summit of the Americas will be a moment for difficult decisions. Our region faces a host of challenges at a time of economic uncertainty and ongoing pandemic, and countries will be forced to decide where to invest, collaborate and prioritize.

Investing in health should be among our easier choices. Health is not a competing priority; it is central to everything the countries of our region covet for their future — security and resilience, economic prosperity, and limitless opportunity for all citizens.

I hope we make the right choice.

Dr. Carissa F. Etienne is serving her second term as the director of the Pan American Health Organization (PAHO), the specialized health agency of the Inter-American System and Regional Office for the Americas of the World Health Organization (WHO), the specialized health agency of the United Nations. Under her leadership, PAHO has led preparedness and response efforts to the COVID-19 pandemic, the Zika and chikungunya epidemics in the region as well as to the cholera and yellow fever outbreaks in Haiti and Brazil. Under her tenure, the region has become the first WHO region to successfully eliminate the endemic transmission of measles, rubella and congenital rubella.