How Budget 2023 Can Help Address Global Health Inequities

The COVID-19 pandemic has led to a huge regression in the development of health systems around the world. On top of this, COVID-19 is still taking many lives on a weekly basis. This is most evident in low-income countries, where only 20% of people are fully vaccinated and less than 1% of people are boosted. Millions of people have died since the emergence of the Omicron variant, and the majority of these deaths have been in low- and middle-income countries.

The Irish government’s recent failure to support a true TRIPS waiver, despite support for it from the Joint Committee on Enterprise, Trade and Employment, the Seanad and the majority of the Irish public, will exacerbate the situation. One of the main stated reasons for the government’s lack of support was the need for more focus on ‘getting the vaccines into people's arms’. However, the Irish government has not contributed its fair share to the Access to COVID-19 Tools (ACT) Accelerator; one of the main means of strengthening health systems’ response to COVID-19 and improving vaccination rates. The ACT Accelerator has been seeking to address many of the challenges faced by low-income countries trying to increase the number of vaccinations. However, it has faced large shortfalls in funding. The fair share of funding from Ireland in 2022 was approximately €190 million, yet Ireland has only contributed €10.7 million of this, which represents less than 6% of Ireland’s fair share.[1] Ireland’s fair contribution is part of a global call for of US$16.8 billion for the ACT Accelerator, and is based on the Ireland’s wealth level along with the potential for economic recovery post-COVID-19.

The ACT-A is set to transition organisationally in the coming months. However, the need to support health systems strengthening and vaccination uptake remains. Therefore, Ireland must increases its funding towards global COVID-19 vaccination efforts in Budget 2023 to address vaccine inequity and help save millions of lives. This could be achieved through additional funding to the WHO or through Ireland’s partnerships with countries with low-vaccination rates such as Tanzania (7% double vaccinated), Sierra Leone (23%) and Ethiopia (32%).[2] The funding could be devoted to several areas, including service delivery, cold chain equipment, knowledge management, monitoring and surveillance, and/or vaccine hesitancy. It should be noted that because COVID-19 has had such a huge negative impact on health system strengthening, it is vital that this increased funding is not at the expense of existing aid budgets.

Another way in which the Irish government can mitigate the recent World Trade Organisation (WTO) agreement on COVID-19 vaccinations is by pushing the EU to support an extension to the scope of this WTO agreement, to partially waive intellectual property rights for COVID-19 diagnostics and medicines. This is set to be considered by the WTO in the next three months. In countries with low vaccination rates, medicines and diagnostics are even more vital as the virus is more likely to transmit and it is more likely to lead to severe disease and death among vulnerable groups who are unvaccinated.

The COVID-19 pandemic has shown that it is vital that efforts to strengthen health systems in low-income countries. This should include increased staffing, improved healthcare infrastructure, greater access to equipment, user fee reduction/removal, and improved social supports for patients. As an example of the level of need, in 2018 only four countries, of the 47 countries in the WHO African region, had reached or exceeded the Sustainable Development Goal threshold of 4.45 doctors, nurses and midwives per 1000 population. In Ireland, where there is widespread acceptance that there are major healthcare workforce shortages, there are 16.4 doctors, nurses and midwives per 1000 population. In Mozambique, Tanzania and Sierra Leone, countries that Ireland has partnerships with, there is a density of less than one healthcare worker per 1,000 population. Here, there is a clear need for massive increases in the health workforce to provide wide access to safe healthcare. Through their partnerships, Ireland should increase funding to support recruitment of healthcare workers to meet the SDG goal of 4.45 doctors, nurses and midwives per 1000 population.

Overall, Ireland needs to increase its ODA, and in particular its ODA spend on health. In 2020, Ireland devoted only 0.04% of GNI to health ODA, and health only formed 14% of the overall Irish ODA budget. The Commission of the World Health Organization recommends that 0.1% of GDP should be devoted to funding for global health. The Irish government must meet this goal by increasing its funding for global health to 0.1% of GNI[3] by 2030. To achieve this, the Irish government must increase funding for global health by €30 million in 2023.

• Ensure Ireland increases its funding towards global COVID-19 vaccination efforts to make up for Ireland’s shortfalls in contributions to the Access to COVID-19 Tools (ACT) Accelerator.
• Advocate that the EU supports an extension to the scope of the recent WTO agreement on COVID-19 vaccines, to partially waive intellectual property rights for COVID-19 diagnostics and medicines.
• Increase funding for global health by €30 million in 2023 with a view to increasing it further from 0.04% of GNI to 0.1% of GNI by 2030, as recommended by the WHO.

For more details of how Budget 2023 can contribute to addressing inequality, ending poverty and creating a more sustainable world please see our pre-budget submission.

[1] ACT-A consultant, personal communication, 23 June 2022 [2]Our World in Data. (2022) Coronavirus (COVID-19) Vaccinations. Available at: https://ourworldindata.org/covid-vaccinations (Accessed: 14 July 2022) [3]GNI is being used because GDP has a falsely inflated value which provides a misleading picture of the Irish economy