Clarke Lorcan, Patouillard Edith, Mirelman Andrew J, Ho Zheng Jie Marc, Edejer Tessa Tan-Torres, Kandel Nirmal
World Health Organization, Geneva, Switzerland.
EClinicalMedicine. 2022 Jan 27;44:101269. doi: 10.1016/j.eclinm.2021.101269. eCollection 2022 Feb.
Investing in health emergency preparedness is critical to the safety, welfare and stability of communities and countries worldwide. Despite the global push to increase investments, questions remain around how much should be spent and what to focus on. We conducted a systematic review and analysis of studies that costed improvements to health emergency preparedness to help to answer these questions.
We searched for studies that estimated the costs of improving health emergency preparedness and that were published between 1 January 2000 and 14 May 2021, using PubMed, Web of Science, Google Scholar, EconLit, and National Health Service Economic Evaluation Databases (PROSPERO CRD42021254428). We also searched grey literature repositories and contacted subject experts. We included studies that estimated the costs of improving preparedness at the global level and/or at the national level across at least ten countries, covered two or more technical areas in the WHO Benchmarks for International Health Regulations (IHR) Capacities, and included activities focused on human health. We mapped costs across technical areas in the WHO Benchmarks for IHR Capacities.
Ten studies met our inclusion criteria. Costing methods varied substantially across included studies and cost estimates ranged from US$1·6 billion per year to improve capacities across 139 low- and middle-income countries (LMICs) to US$43 billion per year to support national-level activities worldwide and implement global-level initiatives, such as research and development for health technologies (diagnostics, therapeutics, and vaccines). Two recent studies estimated costs by drawing on IHR Monitoring and Evaluation Framework country capacity data, with one study estimating costs across 67 LMICs of US$15·4 billion per year (US$29·1 billion including upfront capital costs) and the other calculating costs for the 196 States Parties to the IHR of US$24·8 billion per year. Differences in included studies' methods, and the characteristics of countries considered, mean it is difficult to make like-for-like comparisons of the absolute costs or per-capita costs estimated by studies.
Improving health emergency preparedness worldwide will require substantial and sustained increases in investments. Further guidance on estimating the size of those investments can help to standardise methods, allowing greater interpretation and comparison across studies/countries. As well as greater transparency and detail in the reporting of methods by studies focused on this topic, this can help support estimates of global resource requirements and facilitate investments towards improving preparedness for future pandemics.
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投资于卫生应急准备工作对于全球社区和国家的安全、福祉及稳定至关重要。尽管全球都在推动增加投资，但在应投入多少资金以及重点关注哪些方面仍存在疑问。我们对估算卫生应急准备工作改进成本的研究进行了系统综述和分析，以帮助回答这些问题。
我们使用PubMed、科学网、谷歌学术、EconLit和国家卫生服务经济评估数据库（PROSPERO CRD42021254428），搜索了2000年1月1日至2021年5月14日期间发表的估算改进卫生应急准备成本的研究。我们还搜索了灰色文献库并联系了主题专家。我们纳入了估算全球层面和/或至少十个国家的国家层面改进准备成本的研究，涵盖了《国际卫生条例》（IHR）能力的世卫组织基准中的两个或更多技术领域，并包括侧重于人类健康的活动。我们绘制了IHR能力世卫组织基准中各技术领域的成本。
十项研究符合我们的纳入标准。纳入研究的成本计算方法差异很大，成本估计范围从每年16亿美元用于提高139个低收入和中等收入国家（LMIC）的能力，到每年430亿美元用于支持全球范围内的国家层面活动并实施全球层面的倡议，如卫生技术（诊断、治疗和疫苗）研发。最近两项研究利用IHR监测和评估框架国家能力数据估算成本，一项研究估计67个低收入和中等收入国家每年的成本为154亿美元（包括前期资本成本为291亿美元），另一项研究计算《国际卫生条例》196个缔约国每年的成本为248亿美元。纳入研究的方法差异以及所考虑国家的特征意味着难以对研究估计的绝对成本或人均成本进行同类比较。
在全球范围内改进卫生应急准备工作将需要大幅且持续增加投资。关于估算这些投资规模的进一步指导有助于使方法标准化，从而能够在不同研究/国家之间进行更多解读和比较。除了专注于该主题的研究在方法报告方面提高透明度和详细程度外，这有助于支持对全球资源需求的估计，并促进对改进未来大流行准备工作的投资。
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