Health without Borders

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Health without Borders

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Bibliographic details

• Authors: Rupa Chanda
• Published: July 11, 2023
• DOI: https://doi.org/10.1111/twec.13313

Global health security and recent infectious outbreaks

• Communicable diseases, including zoonotic diseases and rising drug-resistant germs, are posing new global health risks.
• Notable infectious outbreaks over the past two decades: SARS (2003), H1N1 (2009), MERS (2012), Ebola (2014), Zika (2015), Nipah (2018), and the COVID-19 pandemic.
• These outbreaks have drawn urgent attention to the financing and delivery of global public goods for health.

State of trade in health goods and services

• Medical goods trade rose by 13.2 percent in 2020 despite overall goods trade declining sharply that year.
• Critical COVID-19 goods such as face masks recorded an increase of more than 400 percent in April 2020, reflecting price surges due to shortages.
• Global trade in medical products grew by an average 4.7 percent each year between 2010 and 2019, compared with 2.8 percent for overall goods trade, reaching an estimated $1.3 trillion in 2019.
• Pharmaceuticals and medical equipment accounted for the largest share in the overall medical goods trade.
• Trade in health services registered an annual average growth rate of 7 percent compared with 4 percent for total global services trade between 2010 and 2019, reaching an estimated value of $78.6 billion in 2019.
• Global trade in health services declined by 9 percent in 2020.

Trade’s contributions to health outcomes and innovation

• Trade in pharmaceutical inputs, pharmaceuticals, and medical equipment facilitated transfer of technology and spurred innovation that enabled faster vaccine development.
• Countries without domestic capacity for vaccines, therapeutics, and diagnostics relied primarily on trade to meet urgent needs.
• Cross-border trade and regulatory frameworks were vital for countries importing consumer health products and inputs for domestic manufacturing.
• Empirical finding from the author’s study: people live longer in countries that spend more money on importing health products; this holds for overall health-related imports and specifically for imported medicines and their ingredients.
• Trade in health services expanded human resource capacity via cross-border mobility of professionals, foreign direct investment in hospitals and diagnostic centers, cross-border digital delivery, and medical tourism.

Risks and vulnerabilities of dependence on trade

• Dependence on trade can create vulnerability to restrictive trade policies, ad hoc protectionist measures, supply chain disruptions, and regulatory divergence.
• During the pandemic, vaccine-producing countries introduced export restrictions; by October 2022, nearly one-third of the 147 export restrictions worldwide directly impacted vaccine production and distribution.
• Concentration of critical health equipment production and raw materials in a few source countries impaired pandemic response and contributed to inequities in vaccine distribution.
• Some countries secured supplies sufficient to vaccinate their populations several times over, while others were import-dependent and could not secure supplies sufficient to vaccinate even 1 percent of their population.
• Border closures and travel restrictions complicated cross-border medical value travel and movement of health care workers.

Coordination of trade and health policies — policy recommendations

• Urgent coordination of trade and health policies and cooperation among stakeholders from both sectors is required to mitigate risks and deliver public goods such as health care.
• Promote global collective action via multilateral and plurilateral forums to ensure affordable and equitable access to health care and reform the global trade and health architecture.
• Strengthen cooperation between the World Health Organization and the World Trade Organization to jointly address:
  • intellectual property and technology transfer,
  • trade in essential health products,
  • harmonization of regulations.
• Possible steps recommended:
  • Call on countries to avoid trade barriers on critical medicines.
  • Commit to cooperation during global public health emergencies.
  • Create facilities for pooled procurement involving vaccine manufacturing and importing countries to secure better terms for access.
• Leverage regional efforts and mechanisms:
  • World Health Organization regional bodies and regional multilateral development banks can support regional technology platforms for collaboration and address endemic diseases.
  • Regional financing mechanisms such as the Pan American Health Organization’s Revolving Fund for Access to Vaccines and the African Union’s African Vaccine Acquisition Trust Initiative can play vital roles.
• Use regional and bilateral trade agreements to keep trade flowing in crises by facilitating regulatory cooperation for standards harmonization, trade facilitation, mutual recognition of regulatory approvals, traceability, technology transfer, and intellectual property management, while preserving partner countries’ flexibility to safeguard national interests.
• Emphasize that trade’s impact on health outcomes is conditioned by health sector regulations, institutions, skills, and regulatory capacity; greater coherence between trade and health sector policies is necessary nationally and globally.

Source: Rupa Chanda, “Health without Borders,” F&D Magazine, published July 11, 2023.