Mariana Mazzucato | The economics of health for all

The world urgently needs a new global framework that emphasises equity and draws on the lessons of the COVID-19 pandemic. Yet as the World Health Assembly gets under way, 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 Council on the Economics of Health for All, which I chaired.

If the resolution passes, the WHO will have a mandate to start implementing the council’s recommendations through its work with member states. Highlighting the linkages between health and the economy, it identifies specific steps that the organisation and governments can take to establish health and well-being as a cross-cutting policymaking priority. The council called on governments around the world 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 at least 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 as a short-term cost. But austerity has returned to many countries, threatening health budgets that are 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 that will promote 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, which will then catalyse investment, innovation, and growth across relevant segments of the economy.

As the council I headed stressed, 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 US$31.9 billion in US public investment, and they represent just one example among many.

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

As I have previously argued, 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 US$14 trillion.

The negotiation of the pandemic agreement highlights the necessity of designing policy instruments in a mission-oriented way: if the goal is to prevent catastrophic health threats, then 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 and 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. Moreover, 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 towards the goals of human health and well-being, and towards 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.

Mariana Mazzucato, founding director of the UCL Institute for Innovation and Public Purpose, was Chair of the World Health Organization’s Council on the Economics of Health for All.

© Project Syndicate 2024

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