The first WHO investment case in 2018¹ showed what could be achieved by investing in universal health coverage, protecting people from health emergencies and supporting healthy populations.

Universal health coverage billion

The first WHO investment case in 2018 showed that, by 2023, 24.4 million lives could be saved owing to improving access to universal health coverage, with a market-valued rate of return of US$ 1.4 for every US$ 1 invested, rising to US$ 9 for every US$ 1 invested if the intrinsic value of human life is included. WHO has a unique added value in galvanizing progress towards universal health coverage, particularly in the areas of noncommunicable diseases and mental health conditions where WHO is the only global actor setting normative standards and global health sector strategies. The global economic cost of depression and anxiety due to lost productivity alone is about US$ 1.15 trillion per annum². However, treatment rates for depression range from 7% to 28% across country groupings by income, and for anxiety from 5% to 20%.

Given these large treatment gaps in almost all countries there is considerable scope to reap benefits from increasing coverage rates, and a return on investment of up to US$ 5.70 for every dollar spent is expected. As the only global health agency including mental health outcomes in its mandate, WHO’s Comprehensive Mental Health Action Plan (2013–2030)³, mental health treatment guidelines and the Secretariat’s technical assistance to Member States to support the inclusion of mental health services into national strategic planning will be instrumental in closing these treatment gaps.

Vaccinations administered between 2021 and 2030 can avert 51 million deaths, the largest numbers being for measles and hepatitis B, accounting for 19 million and 14 million deaths averted respectively⁴. Lower-middle-income and low-income countries stand to be the major beneficiaries of the vaccination benefits. The health benefits arising from immunization programmes give rise to economic and social benefits as a result of deaths and disability avoided.

WHO is responsible for developing position papers on immunizations under the guidance of its Strategic Advisory Group of Experts on immunization, and advises on routine immunizations for all age groups. Through the programme on prequalification of vaccines, WHO ensures that vaccines used in immunization programmes are safe and effective, through the application of regular monitoring of international standards in the manufacturing process. Through the implementation plan for the Immunization Agenda 2030, WHO aims to close the gap in equitable access to immunizations worldwide over the next decade.

Health emergency protection billion

The first WHO investment case in 2018⁵ estimated that 1.5 million lives would be saved at an average rate of return of US$ 8.4 for every US$ 1 invested if this target were achieved. Due to the COVID-19 pandemic in the time since this analysis was undertaken, it is unlikely that these returns remain valid. New analysis undertaken during the COVID-19 pandemic shows the bigger picture of the potential economic benefits of better protection from health emergencies. With an estimated 25% probability of another major pandemic comparable to COVID-19 emerging in the coming decade,⁶ and a conservative estimate of the costs of such a pandemic at US$ 10 trillion, the probability-adjusted benefit of preventing such a pandemic would be US$ 2.5 trillion. Recent estimates indicate the costs of better preparedness to amount to over US$ 31.1 billion per year.⁷ The benefits of better controlling and managing an epidemic once it has emerged can be estimated by comparing highest and lowest performing countries in responding to the COVID-19 pandemic, with probability-adjusted benefits of US$ 750 billion in year one and US$ 1.2 trillion over a three-year period.⁸ Many of the benefits of activities within the Universal Health Coverage, Health Emergency Protection and Healthier Populations billions will be seen long beyond the timeframe of the Thirteenth General Programme of Work, with return on investments in both health and financial terms accruing for years to come. Investing in these targets, therefore, is not only cost effective but also impactful and sustainable.

Healthier populations billion

In the first WHO investment case in 2018⁹, the healthier populations billion was predicted to save at least 3.8 million lives over the subsequent 5 years, with returns on investment ranging from US$ 1.50 to US$ 121 for every US$ 1 invested depending on the area. The recent 2021 analyses¹⁰ for interventions in relation to tobacco, alcohol, healthy diets and physical activity estimated that for as little as US$ 0.84 per person per year, seven million additional lives can be saved by 2030 in low-and middle-income countries, for a return on investment of US$ 7 for every US$ 1 invested. When considering tobacco control interventions in low-and middle-income countries alone, for example, a conservative estimate for the economic benefits generated over 10 years is US$ 17.5 billion, compared with an implementation cost of about US$ 2.3 billion. Likewise, other interventions show significant return on investment, including alcohol (1:8) and healthy diets (1:12). Moreover, investments to meet the global nutrition targets have large economic returns and benefits on the lives of children and women in low and middle-income countries, including a 1:4 ratio for wasting control and 1:35 for breastfeeding promotion, protection and support.¹¹

Many of the benefits of activities within the universal health coverage, health emergency protection and healthier populations billions will be seen long beyond the timeframe of the Thirteenth General Programme of Work, with return on investments in both health and financial terms accruing for years to come. Investing in these targets, therefore, is not only cost-effective but also impactful and sustainable.

1. A healthier humanity: the WHO investment case for 2019–2023. Geneva: World Health Organization; 2018 (WHO/DGO/CRM/18.2; https://apps.who.int/iris/handle/10665/274710).
2. Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016;3(5):P415–24. https://doi.org/10.1016/S2215-0366(16)30024-4.
   
3. Comprehensive mental health action plan 2013–2030. Geneva: World Health Organization; 2021 ( https://apps.who.int/iris/handle/10665/345301).
   
4. Carter A, Msemburi W, Sim SY, Gaythorpe KAM, Lindstrand A, Hutubessy RCW. Modeling the impact of vaccination for the Immunization Agenda 2030: deaths averted due to vaccination against 14 pathogens in 194 countries from 2021–2030. SSRN Electronic Journal. 2021. doi: http://dx.doi.org/10.2139/ssrn.3830781.
   
5. A healthier humanity: the WHO investment case for 2019–2023. Geneva: World Health Organization; 2018 (WHO/DGO/CRM/18.2; https://apps.who.int/iris/handle/10665/274710).
   
6. Marani M, Katulb GG, Pan WK, Parolari AJ. Intensity and frequency of extreme novel epidemics. Proc Nat Acad Sci.2021;118: e2105482118. https://doi.org/10.1073/pnas.2105482118.
   
7. Clarke L, Patouillard E, Mirelman AJ, Jie ZH, Ho M, Tan-Torres Edejer T, Kandel N. The costs of improving health emergency preparedness: a systematic review and analysis of multi-country studies. eClinicalMedicine. 2022;44:101269 ( https://www.thelancet.com/pdfs/journals/eclinm/PIIS2589-5370(21)00550-2.pdf, accessed 17 March 2022).
   
8. WHO investment case 2.0: technical report. Melbourne: Victoria Institute for Strategic Economic Studies; 2022 ( https://www.vu.edu.au/sites/default/files/who-investment-case-technical-report-march-2022.pdf).
   
9. A healthier humanity: the WHO investment case for 2019–2023. Geneva: World Health Organization; 2018 (WHO/DGO/CRM/18.2; https://apps.who.int/iris/handle/10665/274710).
   
10. Saving lives, spending less: the case for investing in noncommunicable diseases. Geneva: World Health Organization; 2021 ( https://apps.who.int/iris/rest/bitstreams/1399949/retrieve).
    
11. Reddy S, Saluja K, Wang Q, Zhu Y, Li Y, Chu X et al. (under review for publication in Implementation Science) Improving WHO’s understanding of WHO guideline uptake and use in Member States: a rapid review.