By Agnès Soucat and Rajat Khosla
The COVID-19 crisis has shed a brutal light on the weaknesses caused by a chronic lack of investment in health systems worldwide. Investment in institutions critical to producing global health commons have been persistently neglected—particularly national and regional institutions responsible for the prevention, preparedness, and response to health threats. Health commons are functions or interventions to improve health that require collective financing, usually from governments.1 These common goods for health are fundamental to protecting and promoting health and wellbeing. They tend to have broad benefits, affecting multiple sectors.2 Strategic action in this domain by government or donors is therefore essential.
A “global common” is what everyone shares on the one hand, but towards which everyone has responsibilities on the other. Unfortunately, when it comes to health, the concept of “global commons” can increasingly be summed up in the now proverbial Hardin “tragedy of the commons,”3 with shared claims, but little effort to shoulder the common responsibilities we share and to tackle them systematically. Everybody desires freedom from infectious diseases, but we fail to invest adequately in centres for disease control, national institutes of public health, medicines and approval agencies, or in animal and environmental health programmes.
Common goods for health generally encompass five categories of responsibilities: policy and coordination (for example, disease control policies and strategies), taxes and subsidies (for example, taxes on products that have an impact on health in order to shift market dynamics, and change behaviour), regulations and legislation (for example, environmental regulations and guidelines), information, analysis, and communication (for example, surveillance systems), and population services (for example, medical and solid waste management, vaccination, or animal health).4