The rationale for spending on crisis preparedness and critical care capacities to respond to global health threats is clear. The COVID‑19 pandemic resulted in millions of lives lost and triggered the deepest global recession in decades. Current estimates indicate a 2‑3% annual probability of a pandemic with transmission and mortality characteristics similar to COVID‑19 – suggesting that a pandemic of this scale could occur approximately once every 50 years (G20/World Health Organization/World Bank, 2024[1]).
OECD estimates indicate that OECD countries spent an average of USD 101 per capita on prevention, preparedness, and response (PPR) in 2023, including, for example, on certain immunisation programmes, disease surveillance, and national laboratory systems (Figure 7.22). The United States was the highest spender at USD 279 per capita, followed by Germany at USD 209. Latvia, Mexico, and Costa Rica reported the lowest levels of per capita spending on PPR at below USD 40 in 2023. Between 2013 and 2019, PPR spending declined as a share of overall health expenditure, with annual per capita spending on PPR growing by an average of 2.4% – slightly below the 2.5% growth rate of total health spending. However, several countries – including Korea, Lithuania, and Estonia, as well as accession countries Bulgaria and Romania – increased their PPR spending by more than 60% over this period.
Driven by emergency COVID‑19‑related expenditures, PPR spending accelerated between 2019 and 2023, increasing by 6% annually on average. Spending peaked dramatically in 2021, at nearly USD 140 per capita on average across OECD countries. Spending in Japan temporarily reached more than USD 300 per capita in 2021, and over USD 200 in Australia, Denmark, Germany, Switzerland, the United Kingdom and the United States.
Scaling up crisis preparedness and critical care capacity within OECD countries alone is insufficient to combat global health threats without parallel efforts across all health systems, but levels of investment are very uneven. In 2022, high-income countries (predominantly OECD countries) spent approximately five times more (USD 96) on a per capita basis than the average upper-middle‑income country (USD 18), and significantly more than lower-middle‑income (USD 5.5) and low-income (USD 3.7) countries (Figure 7.23). In high-income countries, public sources accounted for 85% of spending on PPR, with the remaining 15% financed through private sources. On the other hand, over 60% of PPR spending in low-income countries and more than 45% in lower-middle‑income countries was financed through external sources in 2022.
A main source of external financing for health is official development assistance (ODA), government aid that supports a range of activities in the healthcare sector including PPR, but also infrastructure, primary healthcare, and health system strengthening. In 2023, OECD countries of the Development Assistance Committee (DAC) committed nearly USD 15 billion in bilateral ODA to health in developing countries (Figure 7.24). The United States was by far the largest donor in absolute terms, contributing over USD 7.5 billion, followed by Japan and the United Kingdom. As a share of their Gross National Income (GNI), DAC countries allocated an average of 0.02% to health, with Luxembourg Sweden, and Norway committing 0.04% or more of their GNI.
However, ODA is at a critical juncture. The COVID‑19 pandemic had a profound impact on both public health and economic stability worldwide. Rising demands from competing development priorities are putting pressure on limited ODA resources, and evolving geopolitical dynamics are reshaping the aid commitments of traditional donors. Announced cuts from major donors mean DAC countries’ net ODA for health is projected to fall by 6% in 2024 and 14‑29% in 2025 (OECD, 2025[2]). This has direct implications for the beneficiary countries concerned, but also brings new risks for global health security.
