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Pandemic-Proofing the Future: Lessons from the G20’s COVID-19 Response and Recovery


Debosmita Sarkar, Soumya Bhowmick, Oommen C. Kurian and Shoba Suri, Pandemic-Proofing the Future: Lessons from the G20’s COVID-19 Response and Recovery, November 2023, Observer Research Foundation.

Executive Summary

The COVID-19 pandemic presented unique global health, economic, and social challenges that required urgent and coordinated action by countries and international organisations worldwide. The G20 countries, for instance, supported initiatives for equitable vaccine access, strengthened their respective healthcare systems, and promoted pandemic preparedness on a global scale. Not all the G20 economies are equal, however, and there were disparities in their COVID-19 responses and the outcomes. Indeed, the challenges they faced during the pandemic were unique, to begin with, given the differences in the structures and workings of their healthcare systems. In this post-COVID-19 era characterised by greater awareness that health security is of paramount importance to the overall security of nations, it is imperative to evaluate, through a comprehensive lens, the efficiency and effectiveness of healthcare systems.

This report conducts an evaluation of the G20 countries in the context of their pandemic response and uses the ‘sustainomics’ framework that emphasises equity, efficiency, and sustainability. Equity is scrutinised as systems grapple with the influx of patients, revealing disparities in health outcomes across the globe; efficiency—a cornerstone of economic thinking—is tested in timely resource allocation to mitigate health insecurities; and sustainability becomes paramount as nations redirect resources towards crisis management while ensuring continuity in essential healthcare services.

As nations navigate the consequences of the pandemic, understanding progress in equity, efficiency, and sustainability is crucial. In pursuing these goals, there is an opportunity for collaborative efforts between nations to strengthen global health security, acknowledging the interconnectedness of goals in health with those in broader economic and social domains.

This report studied the G20 countries’ responses to the COVID-19 pandemic to gain insights into their contributions to global health security during the period. It identifies four key dimensions: overall efforts; contributions to global health equity; variations in domestic resources and response mechanisms; and the time-use efficiency of resources.

Data sources include the WTO-IMF COVID-19 Vaccine Trade Tracker, ACT Funding Commitment Tracker, ODI reports, UNICEF COVID-19 Supply Dashboard, Our World in Data, and World Bank. The analysis uses a three-stage framework: the mu-sigma classification method, mean difference test, and variance comparison test. The aim is to identify the disparities between G20 countries with respect to their role in addressing global health security during the COVID-19 emergency.

Key Findings

1. Dimension 1: Contribution to Global Equity

Emerging economies have led in vaccine exports, while advanced economies contributed significantly to the Access to COVID-19 Tools (ACT) Accelerator. The TRIPS waiver, aimed at enhancing vaccine manufacturing capacity and ensuring equitable vaccine access, received support from most G20 countries. There were significant disparities in vaccine production capabilities across emerging nations, emphasising the need for addressing this imbalance in the global vaccine distribution effort.

2. Dimension 2: Domestic Pandemic Prevention

There were large divergences between the domestic vaccination efforts of advanced and emerging economies. Emerging economies took more than 300 days on average to achieve 70 percent vaccination coverage of their respective populations. In contrast, some advanced economies were able to reach the same benchmark coverage in less than 150 days.

3. Dimension 3: Domestic Pandemic Recovery

Dynamic variables on recovery reflect the effectiveness of a country’s infrastructure and health system in responding to a surge in infections. There was a marked disparity observed within the Global South in terms of pandemic recovery efficiency. While China emerges as a relatively stronger player in the context of this dimension, data reporting challenges in the country make its variables largely incomparable to the pandemic situation of other G20 nations and require closer inspection.

4. Dimension 4: Health Personnel and Infrastructure

The Global North outperformed the Global South across all indicators within this dimension. The imperative is greater cooperation, particularly among countries in the Global South, to address disparities in UHC service coverage, hospital beds, OOPE, and other health infrastructure and personnel indicators.

5. Contribution to global equity has been at par (on average), with respective groups of countries playing to their strengths.

In domestic pandemic prevention, the Global North outperformed the Global South, indicating a need for better and more efficient vaccination delivery infrastructure in emerging economies. At the same time, the average performance of the emerging countries on pandemic recovery has been on a par with, if not better than, the advanced nations. In health personnel and infrastructure, the Global North-South divide is pronounced across various parameters.

6. Some countries from the Global South witnessed notable improvements in their healthcare systems, while others continue to lag.

The developing G20 countries exhibit a high divergence among themselves compared to the advanced economies. Under dimensions 3 and 4, the variations in testing capacities, and demographic and financial stressors are significantly higher among the emerging G20 economies, compared to the advanced G20 countries.  While the Global North-South divide in health outcomes is more apparent, there exist pockets of performance among the group of emerging and developing G20 economies. These economies can partner with Global South leaders to build stronger healthcare systems, improve health outcomes, and reduce health inequalities with a more inward-looking or regional approach.

The next public health crisis has become inevitable; it is now only a matter of ‘when’ and not ‘if’. The G20 countries must build, as the whole world does, robust health systems characterised by the ability to preventabsorbadapt, and transform. A robust health system is not only resilient during health crises, but also recovers, learns from them, and improves in the aftermath.

This report outlines a comprehensive strategy that can serve as the building tenets of a G20-level pandemic plan for collaboration among its member countries, international organisations, and other stakeholders for pandemic-proofing the future. The report offers the following recommendations to nurture a strong health system that can effectively respond to public health emergencies.

  1. Strengthen Preventive Capacities: The G20 should prioritise strengthening the preventive capacities of health systems. This involves developing strategies for tracking demographic and financial stressors at the population level and implementing effective communication strategies for widespread information dissemination.
  2. Promote Absorption and Adaptation: The G20 should focus on initiatives that enhance the ability of health systems to absorb shocks and adapt to crises. This includes monitoring the range of available resources, mapping systemic strengths and weaknesses, and fostering equitable health systems.
  3. Advocate for Transformative Changes: The G20 should advocate for transformative changes to health systems. This includes promoting flexibility in health governance frameworks and crisis management plans and advocating for localisation of response mechanisms.
  4. Shift Perspective on Healthcare Spending: The G20 should lead a shift in perspective from ‘healthcare expenditure’ to ‘healthcare investment’. This could include expanding key sectors such as pharmaceuticals and harnessing digital health innovations for improving coverage.
  5. Promote the Pandemic Treaty and strengthen the Pandemic Fund: The G20 should consider actively promoting and supporting the proposed Pandemic Treaty, as well as raising more resources for the Pandemic Fund. Both are key inclusive tools for improving global health governance and ensuring coordinated and equitable response during health crises.

Read the monograph here.

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Debosmita Sarkar

Debosmita Sarkar

Debosmita Sarkar is a Junior Fellow with the SDGs and Inclusive Growth programme at the Centre for New Economic Diplomacy at Observer Research Foundation, India. ...

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Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

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Shoba Suri

Shoba Suri

Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...

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Soumya Bhowmick

Soumya Bhowmick

Soumya Bhowmick is an Associate Fellow at the Centre for New Economic Diplomacy at the Observer Research Foundation. His research focuses on sustainable development and ...

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