WHO news

The 2024 Global Heath Expenditure Report by the World Health Organization (WHO) shows that the average per capita government spending on health in all country income groups fell in 2022 from 2021 after a surge in the early pandemic years. The report entitled, “Global spending on health Emerging from the pandemic” has been published in alignment with the Universal Health Coverage (UHC) Day campaign marked annually on 12 December. The campaign’s focus for 2024 is on improving financial protection for people everywhere to access health services they need.

Government spending on health is crucial to delivering UHC. Its deprioritization can have dire consequences in a context where 4.5 billion people worldwide lack access to basic health services and 2 billion people face financial hardship due to health costs.

“While access to health services has been improving globally, using those services is driving more and more people into financial hardship or poverty. Universal Health Coverage Day is a reminder that health for all means everyone can access the health services they need, without financial hardship,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Protecting people from financial hardship due to out-of-pocket health costs is fundamental to achieving health for all. Yet, WHO’s report shows that out-of-pocket spending remained the main source of health financing in 30 low- and lower middle-income countries. In 20 of these countries, more than half of total health spending in the country was paid for by patients out of their pocket, which contributes to the cycle of poverty and vulnerability.

The challenges posed by the lack of financial protection for health are not limited to lower-income countries. Even in high-income countries, out-of-pocket payments lead to financial hardship and unmet need, particularly among the poorest households. Most recent health accounts data show that in over a third of high-income countries, more than 20% of total health spending was paid out-of-pocket.

On the occasion of UHC Day, WHO is calling on leaders to make UHC a national priority and eliminate impoverishment due to health-related expenses by 2030. Effective strategies to strengthen financial protection include minimizing or removing user charges for those most in need, including people with low incomes or chronic conditions, adopting legislation to protect people from impoverishing health costs and establishing health financing mechanisms through public funding to cover the full population.

Public funding needs to budget for an affordable package of essential health services – from health promotion to prevention, treatment, rehabilitation and palliative care – using a primary health care approach.

During the COVID-19 pandemic in 2020–2022, public spending on health – mainly via government health budgets –enabled health systems to respond quickly to the emergency. This reflects the advantage of government budgets in financing public health functions, in particular population-based public health interventions, versus other health financing schemes, during times of health emergencies. Government funding ensured that more people were protected and more lives were saved.  

Emerging from the pandemic, countries are at a crossroads. Governments face difficult decisions as they work to strengthen the resilience of health systems against future health threats while addressing their populations' healthcare needs in a challenging economic environment.

The key to making better choices on future health investments is timely and reliable evidence on the level and pattern of health spending. For 25 years the WHO Health Expenditure Tracking programme  has had a major influence on how critical information on health spending is compiled and reported at the country level and globally.

Among its most notable achievements are the establishment of the Global Health Expenditure Database – the world’s richest source of health expenditure data covering more than 190 countries since 2000--and the Global Health Expenditure Report, which has been published annually since 2017. These global public goods drive informed policymaking, transparency and accountability worldwide.

This year’s UHC Day also provides a platform for a milestone discussion in WHO’s efforts to advance support and collaboration with countries in reorienting their health systems to advance UHC and achieve health security in countries, regions and globally. From 11–13 December, national health representatives, heads of WHO country offices, and health policy advisers from over 125 countries are meeting in Lyon, France to take stock of progress and challenges, agree on priority areas and working methods, and set the agenda for the next phase of the UHC Partnership from 2025-2027.

The UHC Partnership is WHO’s flagship initiative on international cooperation for UHC, which brings WHO and partners together to support concrete actions to achieve UHC. It is funded by the European Union, Belgium, Canada, the French Ministry for Europe and Foreign Affairs, Germany, Irish Aid, the Government of Japan, and the United Kingdom - Foreign, Commonwealth & Development Office.

Around 846 million people aged between 15 and 49 are living with genital herpes infections – more than 1 in 5 of this age-group globally – according to new estimates released today. At least 1 person each second – 42 million people annually – is estimated to acquire a new genital herpes infection.

Most of the time, these infections cause no or few symptoms. However, for some people they lead to painful genital sores and blisters that can recur throughout life, causing significant discomfort and often requiring multiple healthcare visits. According to the estimates, more than 200 million people aged 15 to 49 suffered at least one such symptomatic episode in 2020.

The authors of the study, published in the journal Sexually Transmitted Infections, say that new treatments and vaccines are needed to reduce adverse health effects of the herpes virus and control its spread.

“While most people with a genital herpes infection experience few symptoms, with so many infections genital herpes still causes pain and distress for millions globally and strains already overburdened health systems,” said Dr Meg Doherty, Director of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes at WHO. “Better prevention and treatment options are urgently needed to reduce herpes transmission and will also contribute to reducing the transmission of HIV.”

Currently, there is no cure for herpes, although treatments can relieve symptoms. In addition to sores, genital herpes can also on occasion lead to serious complications, including neonatal herpes – a rare condition most likely to occur when a mother acquires the infection for the first time in late pregnancy and then transmits the virus to her baby during childbirth.

There are two types of the herpes simplex virus (HSV), known as HSV-1 and HSV-2, both of which can lead to genital herpes. According to the estimates, 520 million people in 2020 had genital HSV-2, which is transmitted during sexual activity. From a public health perspective, genital HSV-2 is more serious since it is substantially more likely to cause recurrent outbreaks, accounts for around 90% of symptomatic episodes, and is linked to a three-fold increased risk of getting HIV.

Unlike HSV-2, HSV-1 primarily spreads during childhood through saliva or skin to skin contact around the mouth to cause oral herpes, with cold sores or mouth ulcers the most common symptoms. In those without previous infection, however, HSV-1 can be acquired through sexual contact to cause genital infection in adolescence or adulthood. Some 376 million people are estimated to have had genital HSV-1 infections in 2020. Of these, 50 million are estimated also to have HSV-2 as it is possible to have both types at the same time.

While the 2020 estimates show virtually no difference in the prevalence of genital HSV-2 compared to 2016, estimated genital HSV-1 infections are higher. Over recent years, several countries have observed changing patterns of transmission in HSV-1, with adult genital infections increasing as childhood oral infections decline. Reduced oral spread during childhood may be linked to factors like less crowded living conditions and improved hygiene, which then increases susceptibility to the virus at older ages. The authors note that these increases may also partially reflect changes in methods and additional data sources.

“Stigma around genital herpes means it has been discussed too little, despite affecting millions of people globally. Not enough has been done to address this common infection,” said Dr Sami Gottlieb, an author of the report and Medical Officer within WHO’s Department of Sexual and Reproductive Health and Research including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). “Expanded research and investment in developing new herpes vaccines and therapies, and their equitable use, could play a critical role in improving quality of life for people around the world.”

While they are not fully effective at stopping its spread, correct and consistent use of condoms reduces risks of herpes transmission. People with active symptoms should avoid sexual contact with other people, since herpes is most contagious when sores are present. WHO recommends that people with symptoms of genital herpes should be offered HIV testing and if needed, pre-exposure prophylaxis for HIV prevention.

In line with its Global Health Sector Strategy on HIV, viral hepatitis and sexually transmitted infections for 2022-2030, WHO works to increase awareness about genital herpes infections and related symptoms, improve access to antiviral medications, and promote related HIV prevention efforts. It is also working to advance research and development of new tools for the prevention and control of herpes infections, such as vaccines, treatments and topical microbicides.

Earlier this year, a new study showed that genital herpes infections not only cause significant health impacts but also major economic costs – amounting to an estimated US $35 billion a year worldwide – through health care expenditures and productivity loss.
 

The study, Estimated global and regional incidence and prevalence of herpes simplex virus infections and genital ulcer disease in 2020: Mathematical modeling analyses, updates the 2012 and 2016 WHO estimates. It was authored by experts from WHO, HRP, the WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis at Weill Cornell Medicine-Qatar as well as the University of Bristol.

Based on comprehensive regional systematic reviews and meta-analyses of HSV-1 and HSV-2 prevalence for all WHO regions, the study estimates the prevalence and incidence of genital HSV infection and HSV related genital ulcer disease in 2020 globally and by region.

The World Health Organization (WHO) has granted prequalification to the molecular diagnostic test for tuberculosis (TB) called Xpert® MTB/RIF Ultra. It is the first test for TB diagnosis and antibiotic susceptibility testing that meets WHO's prequalification standards.

Tuberculosis is one of the world’s leading infectious disease killers, causing over a million deaths annually and imposing immense socioeconomic burdens, especially in low- and middle-income countries. Accurate and early detection of TB, especially drug-resistant strains, remains a critical and challenging global health priority.

“This first prequalification of a diagnostic test for tuberculosis marks a critical milestone in WHO’s efforts to support countries in scaling up and accelerating access to high-quality TB assays that meet both WHO recommendations and its stringent quality, safety and performance standards,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. “It underscores the importance of such groundbreaking diagnostic tools in addressing one of the world's deadliest infectious diseases.”

WHO prequalification of this test is expected to assure quality of diagnostic tests used to improve access to early diagnosis and treatment. It complements WHO’s endorsement approach, which is grounded in emerging evidence, diagnostic accuracy, and patient outcomes alongside considerations for accessibility and equity, with prequalification requirements on quality, safety, and performance.

WHO’s assessment for prequalification is based on information submitted by the manufacturer, Cepheid Inc., and the review by Singapore’s Health Sciences Authority (HSA), the regulatory agency of record for this product.  

Designed for use on the GeneXpert® Instrument System, this nucleic acid amplification test (NAAT) Xpert® MTB/RIF Ultra detects the genetic material of Mycobacterium tuberculosis, the bacterium that causes TB, in sputum samples, and provides accurate results within hours. Simultaneously, the test identifies mutations associated with rifampicin resistance, a key indicator of multidrug-resistant TB.
It is intended for patients who screen positive for pulmonary TB and who have either not started anti-tuberculosis treatment or received less than three days of therapy in the past six months.

“High-quality diagnostic tests are the cornerstone of effective TB care and prevention,” said Dr Rogerio Gaspar, WHO Director for Regulation and Prequalification. “Prequalification paves the way for equitable access to cutting-edge technologies, empowering countries to address the dual burden of TB and drug-resistant TB.”

In a joint effort by WHO Global TB Programme and the Department of Regulation and Prequalification to improve access to quality-assured TB tests and expand diagnostic options for countries, WHO is currently assessing seven additional TB tests.