Context

In 2019, the WHO set the ambitious “Triple Billion Targets” for healthier populations (one billion more people enjoying better health and well-being), UHC (one billion people benefiting from universal health coverage), and health emergencies (one billion people better protected from health emergencies) by 2025, in support of the SDGs. Before the COVID-19 pandemic, the world was off track to meet the triple billion targets, and the health-related SDGs – progress has been further stifled by the pandemic. Despite the challenges of the pandemic, the global health community has made historic achievements. In the past 5 years, the wild poliovirus reached its lowest levels, 58 countries adopted policies eliminating trans-fat, tobacco use is decreasing in 150 countries, 15 countries have eliminated mother-to-child transmission of HIV and/or syphilis, 52 million people have been vaccinated against yellow fever, and a malaria vaccine expected to save 40,000-80,000 annually was developed. Additionally, the global health sphere has seen the emergence of new actors, agencies, foundations, and new forms of investment.

To get back on track toward achieving the “triple billion targets” and health SDGs, the global community must mobilize to address the consequences of the COVID-19 pandemic and ongoing pandemic response, climate change, and emerging and shifting disease burdens. Achieving development goals is increasingly challenging as domestic resourcing is constrained, ODA budgets are shrinking, and pressure increases on multilateralism and international solidarity in an increasingly complex global health arena.

Funding Trends

How is ODA to global health evolving?

The global health sector receives one of the largest shares of development assistance among social sectors. In 2022, funding for global health stood at US$34.8 billion, nearly level with 2021. Funding to global health increased sharply, by 32%, in 2021 compared to US$26.5 billion in 2020, largely attributable to increased global spending on health in response to the COVID-19 pandemic.

Supply of multilateral ODA to global health from DAC donors peaked in 2021, but continued growth is not expected to continue at this pace. Core contributions to health multilaterals hit an all-time high of US$13.3 billion in 2021 because of exceptional funding in response to the COVID-19 pandemic. Earmarked funding through multilaterals also reached an all-time high of US$6.5 billion in 2021, partially driven by US$2.4 billion of vaccine dose donations. However, most global health ODA flows bilaterally. On average, over the past 5 years, only 32% of funding was channeled as core contributions to multilaterals, and 2022 saw the lowest proportion of funding to multilaterals (28%) in this period.

Multilateral funding

The majority of DAC donors’ core multilateral contributions go to the Global Fund and Gavi, which generally accounts for more than two-thirds of all core multilateral funding. Growth in volume in 2020 and 2021 is partially inflated by COVID-19 pandemic-related funding channeled through the Global Fund and Gavi as part of ACT-A. Agencies also receive earmarked funding through multilaterals rather than core funding.

Top Donors & Sectors

Who are the top donors to global health?

In 2022, the G7 countries were the top donors to global health, contributing 82% of all global health funding. The largest donor was by far the US, followed by Germany, Japan, the UK, and France.

US contributions to global health (US$15.8 billion) were unusually high due to ongoing COVID-19 pandemic-related commitments. Germany’s ODA to global health (US$4.4 billion) increased by 40% in absolute terms, between 2020 and 2021 due to Germany’s engagement in the multilateral response to the COVID-19 pandemic, but fell slightly in 2022. Due to substantial cuts to its ODA budget, the UK fell from the third-largest to fourth-largest donor to global health in 2022.

The US and Canada lead the DAC countries in prioritizing global health in relative terms, though both have declined slightly from 2021 to 2022. Despite sitting among the top five absolute contributors to global health, Germany, France, and Japan contribute less than 15% of their total bilateral ODA to global health.

The reelection of US President Donald Trump (Republican), who, during his first term from 2017-2021, pulled the US out of the WHO and made efforts to reduce funding to the Global Fund and PEPFAR, has concerned global health advocates, particularly in light of upcoming WHO and Gavi replenishment rounds and significant US funding to these organizations.

Which global health sub-sectors receive the largest funding?

32% of donor countries' bilateral global health spending in 2022 was focused on COVID-19 control. STD control, including HIV/AIDS, is the second largest sub-sector of global health spending, accounting for 26% of DAC donor countries’ total bilateral ODA for health. Spending on reproductive health care has notably decreased in absolute terms since 2017, and relative terms since 2019.

What are the key debates and topics surrounding global health?

Ensuring global commitments: Global health financing is at a critical crossroads as donor countries face budget constraints, yet the need to replenish essential global health funds remains urgent, underscoring the importance of sustained financing for mechanisms like the Global Fund and Gavi. These organizations are not only central to achieving SDG #3, but they are also crucial for global health security. With upcoming replenishment cycles for the WHO, Gavi, and the Pandemic Fund involving significant financial asks, these health funds face an uphill battle, especially amidst dwindling ODA streams.

Both donor countries and the private sector must step up their contributions to ensure life-saving vaccines and treatments reach the most vulnerable populations. Despite fiscal challenges, these high-impact investments are essential to safeguarding global health and securing a healthier future for all. The sharp decline in donor funding for global health also has the potential to drive much-needed reforms within global health institutions, as well as necessitate the creation of sustainable health systems less dependent on volatile global funding.

Climate - Health: The convergence of climate change and health system resilience emerged as a key topic at WHS 2024, underscoring the increasingly evident links between environmental sustainability and global health. With rising temperatures and more frequent extreme weather events threatening to overwhelm health systems, the need for climate resilience is more urgent than ever. As climate-induced health risks grow, scaling up climate finance remains a top priority for protecting the most vulnerable populations from the compounded impacts of health and environmental crises.

The power of impact investments: Bridging the gaps in healthcare accessibility, particularly in low-income regions, requires innovative financing approaches, which are crucial to developing high-impact health technologies that can improve healthcare delivery in underserved areas. By mobilizing more resources toward these innovations, the health sector can accelerate progress toward universal health coverage and better access to life-saving treatments.

In September 2024, the WHO, EIB, and other MDBs launched the Health Impact Investment Platform to strengthen PHC in LMICs by unlocking US$1.5 billion in loans and grants to improve PHC services, starting with health investment plans in 15 countries

Pandemic Preparedness: The COVID-19 pandemic underscored the critical need for robust systems to detect, prevent, and respond to global health threats. Pandemic preparedness requires sustained investment in public health infrastructure, research, and workforce development.

The Pandemic Fund announced its third round of funding in December 2024.