Focus on resilient healthcare

The race to vaccinate

Spotlight: The hidden pandemic

What do we know about how people feel?

A heavy toll on mental health

Young people hit hard

People are worried about jobs, finances & the future

How can governments help?

Key insights


Water Governance in African Cities

OECD Forum Virtual Events on vaccines

OECD Forum Virtual Events on vaccines


Development Co-operation Report 2020

Development Co-operation Report 2020

Latest policy advice


What we must do next

| Co-operation and vaccines |

Mobilising a Comprehensive, Rapid and Equitable Response

| Cross-sector collaboration |

Haves and Have-Nots: the geopolitical dilemma

| Vaccine access|

COVID vaccination tracker

by Our World in Data

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This report offers an initial overview of the available information regarding the circumstances, nature and outcomes of the education of schoolchildren during the first wave of COVID-19 lockdowns of March-April 2020. Its purpose is primarily descriptive: it presents information from high quality quantitative studies on the experience of learning during this period in order to ground the examination and discussion of these issues in empirical examples. Information is presented on three interrelated topics: the nature of the educational experience during the period of lockdowns and school closures; the home environment in which education took place for the vast majority of schoolchildren; the effects on the mental health and learning outcomes for children during this period. The data come primarily from 5 countries (France, Germany, Ireland, the United Kingdom and the United States) with additional information on some aspects for 6 additional countries (Australia, Belgium (Flanders), Canada, Finland, Italy and the Netherlands).This report will be of interest to policy makers, academics, education stakeholders and anyone interested in a first international empirical analysis of the effects of the pandemic on the lives and education of schoolchildren.
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This paper analyses the uneven geography of the COVID-19 health impact in OECD and European countries. It first describes the increase in all-cause mortality – i.e. excess mortality – across subnational regions between January and December 2020. Subsequently, it investigates the regional factors associated with higher excess mortality, looking at demographic, socio-economic, institutional and environmental features of regions. Results show that excess mortality has a significant spatial dimension, with the hardest hit regions having excess mortality rates that were, on average, 17 percentage points higher than the least affected regions in the same country. During the first year of the pandemic, lower health system capacity, followed by population density, air pollution, share of elderly population and lower institutional quality were associated with higher excess mortality. While health system capacity and population density have been strongly associated to excess mortality throughout the COVID-19 crisis, trust in government and air pollution showed stronger correlations with excess mortality in the later phases of the pandemic. Finally, prolonged remote working, particularly after two-months, is also associated with lower excess mortality.
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Digital technologies offer unique opportunities to strengthen health systems. However, the digital infrastructure only provide the tools, which on their own cannot transform the health systems, but need to be put to productive use by health workers. This report discusses how to engage and empower the health workforce to make the most of the digital revolution. While many health workers already use some digital tools and perceive the benefits that they bring to them and to patients, many also question the value digital technologies produce in health care or complain about technology getting in the way of work. Moreover, health workers often report not having sufficient opportunities for the up-skilling required to fully use new technologies or that the legal, financial, and organisational aspects of work – designed in the pre-digital era – do not enable them to reap the full benefits of these new technologies. Health workers and patients also demand appropriate safeguards against possible lack of transparency or threats to data privacy.
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Current population trends and the COVID-19 pandemic reinforce the need for efficient public service provision while guaranteeing good access to all. Population decline and ageing in rural regions affect the provision of services through lower economies of scale and scope, professional shortages and longer distances. Reliable estimates of the costs and access arising from demographic and geographical differences can help adapt the provision of services to different territorial realities. This report provides internationally comparable fine-grained present and future estimates of the cost and physical access to education (primary and secondary) and health services (cardiology, maternity and obstetrics) in European countries. The report finds that demographic change in the next decades will likely further strain the trade-off between costs and access, especially in remote rural areas. Adapting to changes in demand following lower fertility rates and ageing implies that services will need to become more widely available, while others will have to concentrate more. This report aims to support evidence-based policy decisions to ensure service provision allows for both cost efficiency and a sufficient level of access in all territories.
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New variants of the virus are spreading which, together with seasonal effects, are estimated to be able to raise effective reproduction numbers by up to 90%. Meanwhile, many countries are rolling out vaccination programmes, but at varying speeds. Hence the race is on to beat the variants with the vaccines. Vaccination is very powerful at reducing virus transmission: fully vaccinating 20% of the population is estimated to have the same effect as closing down public transport and all-but-essential workplaces; fully vaccinating 50% of the population would have a larger effect than simultaneously applying all forms of containment policies in their most extreme form (closure of workplaces, public transport and schools, restrictions on travel and gatherings and stay-at-home requirements). For a typical OECD country, relaxing existing containment policies would be expected to raise GDP by about 4-5%. Quick vaccination would thus help limit the extent to which containment policies need to be escalated in future epidemic waves, providing huge welfare benefits both in terms of fewer infections and stronger economic activity.
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Artificial intelligence (AI) has the potential to make health care more effective, efficient and equitable. AI applications are on the rise, from clinical decision-making and public health, to biomedical research and drug development, to health system administration and service redesign. The COVID-19 pandemic is serving as a catalyst, yet it is also a reality check, highlighting the limits of existing AI systems. Most AI in health is actually artificial narrow intelligence, designed to accomplish very specific tasks on previously curated data from single settings. In the real world, health data are not always available, standardised, or easily shared. Limited data hinders the ability of AI tools to generate accurate information for diverse populations with potentially very complex conditions. Having appropriate patient data is critical for AI tools because decisions based on models with skewed or incomplete data can put patients at risk. Policy makers should beware of the hype surrounding AI and identify and focus on real problems and opportunities that AI can help address. In setting the foundations for AI to help achieve health policy objectives, one key priority is to improve data quality, interoperability and access in a secure way through better data governance. More broadly, policy makers should work towards implementing and operationalising the OECD AI Principles, as well as investing in technology and human capital. Strong policy frameworks based on inclusive and extensive dialogue among all stakeholders are also key to ensure AI adds value to patients and to societies. AI that influences clinical and public health decisions should be introduced with care. Ultimately, high expectations must be managed, but real opportunities should be pursued.
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Mental ill-health affects millions of people, and drives economic costs of more than 4% of GDP. A good mental health system helps people stay in good mental health, and connects those in need to appropriate support to manage their mental health condition or even fully recover from it. However, mental health care has long been neglected and under-funded, and unmet need for care is still high. The long-lasting COVID-19 crisis and the toll it is taking on mental health has made mental health systems more important than ever. This timely report provides an in-depth analysis of how well countries are delivering the policies and services that matter for mental health system performance. The report highlights recent reforms countries have taken to strengthen mental health performance, including by increasing access to mental health care, ensuring that service users take the lead in planning and even delivering services, and prioritising integration and mental health promotion. The report also identifies promising approaches countries should pursue to better meet their populations’ mental health needs. This report sets up a framework for understanding mental health performance through internationally comparable indicators, an approach set to grow stronger still in the coming years as more data become available.
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OECD Ministers have endorsed a new initiative to promote safe international travel during the COVID-19 pandemic at the OECD’s annual Ministerial meeting in Paris. The Initiative involves a safe travel blueprint and a temporary international cross-sectoral forum for knowledge sharing. The forum will allow governments and stakeholders to share information in real time on plans and approaches facilitating travel. The blueprint promotes greater certainty, safety and security in travel as re-opening takes place. It builds on existing initiatives and aims to increase interoperability amongst travel regimes. It will be implemented by countries on a voluntary basis.
One in three adults has engaged in binge drinking at least once in the previous month, and one in five teenagers has experienced drunkenness by age 15. Harmful patterns of alcohol consumption have far-reaching consequences for individuals, society and the economy. Using microsimulation modelling, this book analyses the cost of alcohol consumption in 52 countries (including OECD, European Union and G20 countries), showing how alcohol-related diseases reduce life expectancy, increase health care costs, decrease workers’ productivity and lower GDP. While recognising the importance of the alcohol industry in many countries, the report makes a strong economic case for enhancing policies to tackle harmful alcohol consumption.
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The COVID‑19 pandemic and its associated government measures to limit mobility impacted patterns and places of alcohol consumption. While the path to recovery remains long and difficult, this crisis also increases the risk that individuals engage in harmful drinking to cope with stress. During the COVID‑19 pandemic, there has been an increase in domestic violence, for which harmful alcohol consumption is a risk factor.Harmful alcohol consumption damages health, causes diseases and injuries, weakens response to COVID‑19, and leads to significant economic and societal costs. Comprehensive policy packages built on a PPPP approach including Pricing policies, Policing to counter drink-driving, Primary care‑based counselling for heavy drinkers, and regulating alcohol Promotion activities, improve health, and support a stronger economic and social recovery in the aftermath of the pandemic.
The COVID‑19 crisis has heightened the risk factors generally associated with poor mental health – financial insecurity, unemployment, fear – while protective factors – social connection, employment and educational engagement, access to physical exercise, daily routine, access to health services – fell dramatically. This has led to a significant and unprecedented worsening of population mental health. Across countries, the mental health of unemployed people and those experiencing financial insecurity was worse than that of the general population – a trend that pre‑dates the pandemic, but seems to have accelerated in some cases. OECD countries have responded with decisive efforts to scale‑up mental health services, and put into place measures to protect jobs and incomes, thereby reducing mental distress for some. However, the scale of mental distress since the start of the pandemic requires more integrated, whole‑of-society mental health support if it is not to lead to permanent scarring.
The mental health of young people has been significantly impacted by the COVID‑19 crisis. Prevalence of symptoms of anxiety and depression has risen dramatically among young people and remains higher than pre‑crisis levels even with the partial re‑opening of the economy, and compared to other age groups, even as economies partially re-open. The worsening of mental health can be attributed to disruptions to access to mental health services, the wide‑ranging impacts of school closures, and a labour market crisis that is disproportionately affecting young people. With adequate support and timely intervention, young people experiencing mental distress may be able to bounce back as we recover from the COVID‑19 crisis. This will require a scaling up of existing mental health support in education systems, workplaces and health systems, and comprehensive policies to support young people to remain in education, or to find and keep a job.
While the rapid development of vaccines against COVID‑19 is an extraordinary achievement, successfully vaccinating the global population presents many challenges, from production to distribution, deployment, and importantly, acceptance. Trust in the vaccines is vital, and is critically dependant on the ability of governments to communicate the benefits of vaccination, and to deliver the vaccines safely and effectively. This brief addresses the role of governments in promoting confidence in the effectiveness and safety through effective communication, as well as trust in their ability to procure and distribute them efficiently and equitably. While only a small minority of the population holds strong anti-vaccination views, hesitancy about COVID‑19 vaccination is evident in many countries. Recognising that vaccination campaigns of the magnitude needed are unprecedented, government actions to garner trust will be essential to their success, and to the emergence of more resilient societies after the crisis.
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The COVID-19 pandemic has been a global health tragedy. Yet as the world inches towards the end of the health crisis, another injury threatens to leave a more enduring scar: that of entrenched economic insecurity. The 2020 round of the OECD Risks that Matter survey presents a stark picture of economic disruption and rising worries about health and financial security across 25 OECD countries. Despite massive government investments in social protection during the pandemic, people in most OECD countries are looking for more public support to lift them out of the crisis – and many report a willingness to pay more in taxes in order to fund better health, pensions, employment and long-term care programmes.
The COVID-19 pandemic has acted as a magnifying glass on pressing water and sanitation challenges in African cities, stressing and widening inequalities, especially for the 56% of the urban population living in informal settlements, lacking basic handwashing facilities, and relying on public water points and shared toilets. Before the pandemic, African countries and cities were already facing mounting water challenges with, in Sub-Saharan Africa only, 418 million people lacking basic access to water supply and 717 million to sanitation, in addition to concomitant floods, droughts and pollution issues. Megatrends related to climate change, urbanisation and population growth add more pressure on water resources and require urgent attention for African cities to cope with future water challenges. Building on a Survey on Water Governance across 36 cities of all size in Africa, this report provides a regional overview of the allocation of roles and responsibilities for water management, the existence and implementation of institutional, policy and regulatory frameworks, as well as the critical governance gaps that need to be bridged in order to boost city government capacity to drive water security in the continent.
Following the extraordinarily rapid development of COVID‑19 vaccines, immunisation is underway in many OECD countries. However, demand will continue to outstrip supply for some time and currently, distribution is strongly skewed in favour of high-income countries. This both inequitable and inefficient. Directing vaccine to where need is greatest would maximise the number of lives saved and speed bringing the pandemic under control, by slowing transmission and reducing the likelihood of the emergence of viral variants of concern. Governments should therefore act now to accelerate vaccination globally, regardless of international borders, by reallocating supplies to areas of greatest need; continuing the scaling-up of production; ensuring that necessary logistics and health care infrastructure are in place; providing further financial and in-kind support to COVAX; and developing long-term strategies that include commitments to making vaccines available where they are needed most, including through sharing intellectual property and facilitating technology transfer.
COVID-19 has put renewed focus on the importance of addressing longstanding challenges that OECD governments face in delivering public services, especially in regions with people spread over a wider area where economies of scale are more difficult to achieve. The physical infrastructure needed to provide good quality education and health services can be more complex and expensive in rural and remote regions that also struggle to attract and retain education and health care professionals. Acute ageing trends in many rural regions and, in some cases, a shrinking population will require sustainable policy responses that will need to be coherent with pressure to drive efficiencies in public spending. This report examines the nuances specific to the delivery of education and health care to people everywhere, offering recommendations on how to better adapt provision to the realities of today and the emerging realities of tomorrow to face the challenges of distance, demographic change and fiscal belt-tightening. The report also examines digital connectivity issues in rural and remote regions, recognising the significant scope for digital delivery of services to mitigate challenges related to distance. Finally, the report looks at governance issues, including fiscal issues, through which the delivery of these critical services is administered and paid for.
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This paper explores the health financing challenges that countries face when they transition from low-income towards middle-income level and beyond. While domestic actors bear an increasing share of the national health expenditure in this process, the transition is not automatic nor necessarily smooth. The challenges that emerge in the process are recently exacerbated by the COVID-19 crisis, which risks diverting resources away from basic health services. The role of development actors during this stage can be critical in setting up sustainable systems of health financing in those countries. The paper starts with a review of the progress on the global health agenda by taking stock of past achievements and remaining challenges. Then, it explores how the health financing landscape transitions with the income level of a country, tracing how this can give rise to transition setbacks. Finally, the paper zooms in on the role of development finance and how it can be reshaped to better facilitate the transition process of countries.
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Genomic and biobank collaborative platforms hold significant promise for the development of new discoveries and therapies. This paper explores the complex technical, legal and business challenges arising from genomics and biobanks, and brings together ideas and best practices from major national and international platforms, and from a diverse range of experts. The global sharing of biological samples and genomic data has been critical for accelerating our understanding of the biology and spread of COVID-19, and for the development of vaccines and diagnostics. Although some of the policy challenges in the field are well known, they have been reconfigured by the digitalisation of health innovation combined with the increasing complexity and volume of data, the push for global collaboration, and the growing awareness of ethical, legal, and social implications.
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This blog drafted by Anthony Gooch argues that heading into 2021, light has begun to appear at the end of the COVID-19 tunnel as the first vaccines are approved and deployed. But the biggest public policy challenge of all is perhaps to come.
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