A hidden trend

When COVID-19 hit, donor assistance for health surged to help countries respond to the pandemic. But this surge financing has disguised a concerning trend: excluding COVID-19 funding, official development assistance (ODA) for health reached a 13-year low in 2021. It only rebounded slightly in 2022 and initial insights from subsequent years don’t look promising. 

Surge financing was essential to help countries respond to COVID-19. It helped fortify health systems, strengthen surveillance, and increase access to tools needed to respond to COVID-19, like personal protective equipment, diagnostics, and vaccines. 

But it came at the cost of other health priorities as donors reshuffled budgets instead of increasing overall spending. These short-sighted funding decisions during periods of health emergencies, while most helpful for immediate response, risk reversing progress against other health priorities and building better preparedness for future health emergencies. 

When COVID-19 funding is excluded, health funding from many major donors has not rebounded to pre-pandemic levels

When excluding COVID-19 funding, health ODA in 2022 remains below pre-pandemic levels in the UK, Canada, EU Institutions, France, and the Netherlands. It also declined between 2021 and 2022 in the US, UK, Germany, France, and Italy. 

The cuts are most dramatic in the UK, where even including COVID-19 funding, health ODA has seen a sharp decline.

These declines illustrate that major economies are deprioritizing long-term, consistent investments in health. But consistent funding is needed to advance routine health services like immunizations, maternal and child health care, and programs that fight preventable diseases like HIV/AIDS, tuberculosis, and malaria. 

This comes at a time when progress against preventable deaths is at risk of backsliding. Malaria cases have steadily increased since 2018, partly due to changing weather patterns driven by climate change. 14.5 million “zero-dose” children did not receive a single shot of routine vaccines in 2023 due to disruptions from COVID-19. That’s 13% more than in 2019. And outbreaks of cholera and mpox are spreading across a number of low- and middle-income countries.   

Over-relying on surge financing during an emergency is also short-sighted. Crises like COVID-19 highlight the damage that a lack of resilience in health systems can do to economies, societies, and people. Some estimates suggest that there were nearly 15 million excess deaths associated both directly or indirectly with COVID-19 between January 2020 and December 2021 alone. And there are economic costs too: the IMF estimated that COVID’s impact amounted to US$12.5 trillion. 

The countries that benefit from health ODA have some of the youngest and fastest-growing populations on the planet. Pulling back on health investments now severely undermines the potential of this human capital.

Outlook is bleak for health ODA without reprioritization 

This analysis uses data from 2022, the latest available data. But we know that donor funding for COVID-19 has declined since then. Donor funding decreased by nearly 65% to the agencies collaborating on the global response to COVID-19 under the ACT-Accelerator, from US$17.8 billion for 2020-2021 to US$6.3 billion for 2021-2022, to US$138.9 million for the period October 2022-March 2023. The World Health Organization declared the COVID-19 global health emergency over in May 2023, effectively removing pandemic response from the political agenda.

Without COVID-19 funding, health ODA is at risk of backsliding further. And the outlook is bleak: the EU, France, Germany, and US made cuts to overall ODA totalling nearly US$9 billion in 2024, with further cuts planned in France and Germany for 2025. Meanwhile, some donors are increasingly spending their aid budget at home to cover rising in-country refugee costs. 

Health ODA must be reprioritised in a post-COVID world to maintain progress against preventable diseases and ensure all countries are better prepared for the next global health emergencies.

Methodology and sources

COVID-19 related aid means health projects/activities marked with the “#COVID-19” keyword, projects/activities reported under the COVID-19 control sector code (12264), or financing provided by the “COVID-19 Response and Recovery Multi-Partner Trust Fund”. You can read more about our methodology, the data and its limitations in this notebook. For replication code, please visit this report’s GitHub repository.