The Mpox global health emergency: A critical reminder of the need to prioritize and invest in universal health coverage in the pandemic agreement

This op-ed was originally published on Geneva Health Files. 

As Member States meet from 9 September 2024 to 20 September 2024 for the 11^th session of the Intergovernmental Negotiating Body to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response (INB); they will do so with the Africa CDC and the World Health Organization having just declared the mpox virus a public health emergency of international concern on August 13 and 14, respectively.¹

With the more dangerous clade 1 mpox variant being reported outside Africa,² a global spread of the virus is an imminent threat. These developments should serve as a reminder to negotiators, decision makers, and governments, of the far-reaching impacts of health emergencies and our collective need for a coordinated global response to contain outbreaks, invest in health systems, and save lives, as UHC and health security are two intertwined goals if we aim to protect everyone, everywhere - in crisis and calm - and they are achieved through the same health system. We therefore call on all countries to build on their universal health coverage commitments by operationalizing these based on a primary health care approach as a fundamental element in the pandemic agreement.

Implementing strategies to achieve universal health coverage is crucial to addressing outbreaks. For example, available reports indicate that the mpox outbreak has been underreported for long periods, not only due to stigma but also due to inadequate access to quality health care and poor surveillance systems. Achieving health security depends on the ability of health and community systems to detect unusual events, which is not possible if people don’t have access to the promotive, preventive and curative health services they need. Gaps in access to health services undermine the most effective surveillance systems.

During an outbreak or to prevent one, timely access of everyone to health services is critical for early diagnosis, treatment, and containment. Universal health coverage means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship – everyone counts. By investing in universal health coverage, countries ensure that health systems are stronger and more resilient, and better prepared to prevent, detect and respond to outbreaks.

The surge in mpox cases shows how unprepared we are to adequately respond to such outbreaks and reflects the fundamental lack of adequate investment in health systems. According to the latest evidence from the WHO Global Health Expenditure Database,² government spending on health from domestic sources as a share of total health spending increased in response to the COVID-19 pandemic between 2019 and 2021 in about half of the low and lower-middle-income countries. However, the average share of government spending in these income groups remained below 40% of total health spending – meaning that the remaining 60% is covered by out-of-pocket spending and/or by international funding such as official development assistance (ODA). More efficient spending of domestic resources is needed in order to progressively expand the capacity of public health systems, along with maintaining external assistance needed to strengthen health systems in the poorest nations. The global shortfall of 10 million health and care workers is a powerful indicator of the gap of investment in health systems strengthening: health and care workers are the backbone of well-functioning health systems and play a critical role during outbreaks for early detection, diagnosis and treatment of diseases while maintaining essential and routine health care services and public health functions. WHO’s estimates on the resources needed to build equitable and resilient sustainable health systems show that comprehensive investments in health workforce, infrastructure and equipment, along with provision of essential health services, would require additional investments of $371 billion per year across low- and middle-income countries.³

To be effective, response efforts for all health emergencies must also address equity barriers, including financial barriers, that most-at-risk populations face in accessing healthcare. Ensuring equity in access to healthcare is not only a moral obligation but also a practical necessity before, during and after health emergencies. Investment in UHC through operationalizing primary health care is the most inclusive, equitable, cost-effective and efficient approach to enhancing people’s physical and mental health. It also builds the critical public health functions, such as health workers, laboratory and data capacity, and immunization, that are needed to rapidly detect and respond to outbreaks while ensuring continued access to essential health services.

The mpox virus outbreak reminds us that diseases and health emergencies can quickly spread across borders and that we are only as strong as the most vulnerable members of our global community. Countries must seize the pandemic agreement as the opportunity to come together as an international community to take collective action and prioritize support for health systems, especially the core health systems functions that are essential to protect everyone and promote health and well-being and include the core capacities to detect, assess and report public health events in line with the International Health Regulations. In coming together in solidarity to respond to the mpox outbreak, we call on Member States to support response efforts by:

• Incorporating core elements related to UHC and primary health care in relevant provisions of the pandemic agreement, recognizing universal health coverage, based on a primary health care approach, as a necessary means for achieving robust and sustainable pandemic prevention, preparedness and response;
• Maintaining access to essential and routine health services, with particular attention to the groups in the most vulnerable and marginalized situations, including those hardest to reach;
• Removing barriers to accessing needed health services, commodities and information, particularly by ensuring affordability and non-discrimination in access to countermeasures, which should preferably be free at point of delivery;
• Integrating prevention, preparedness and response planning into primary health care systems (such as by leveraging disaggregated data from routine primary health care records to enhance surveillance and monitoring);
• Accelerating global and local vaccine production as part of prevention and ensuring equitable distribution through primary health centers and public health providers.
• Sustaining a protected and well-supported health and care workforce;
• Institutionalizing participatory governance arrangements that enable meaningful multistakeholder, whole-of-society engagement, including civil society and communities. This is critical to respond to the needs of communities (especially considering various needs based on gender, ethnicity and socioeconomic status) and to build trust, which in turn leads to greater uptake of essential public health services.
• Addressing the interconnectedness of health issues across humans, animals, and the environment through a One Health approach while promoting and integrating health systems strengthening for UHC.

Achieving universal health coverage is critical for our collective response to global threats. Today, we have a simple and urgent message: Let’s all show solidarity in supporting countries affected by mpox to build health systems that protect everyone, prioritizing investment in primary health care. In doing so, it is crucial that we make universal health coverage and its inherent focus on equity and resilience an integral priority for the mpox response and a foundational element of the pandemic agreement. We will only be safe when everyone is safe.

 

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1. World Health Organization. “WHO Director-General Declares Mpox Outbreak a Public Health Emergency of International Concern.” Who.int, World Health Organization: WHO, 14 Aug. 2024, www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern.
2. World Health Organization. “Mpox (Monkeypox) Outbreak.” Who.int, World Health Organization: WHO, 14 Aug. 2024.
3. World Health Organization. “Global Health Expenditure Database.” 
4. World Health Organization: WHO. “WHO Estimates Cost of Reaching Global Health Targets by 2030.”, 17 July 2017, Accessed 30 Aug. 2024.