The CVIOD-19 pandemic exposed major weaknesses in global health systems, particularly in surveillance, prevention, and response capacity, highlighting longstanding gaps in financing for health systems and pandemic preparedness. This analysis by the Global Burden of Disease 2021 Health Financing Collaborator Network assessed global health spending trends across 204 countries and territories, examining development assistance for health (DAH), government expenditure, out-of-pocket spending, and private prepaid spending from 1990 to 2021, with projections through 2026. The study also evaluated funding directed specifically toward pandemic preparedness and COVID-19 response in relation to estimated global needs.

In 2019, global health spending reached approximately US$9.2 trillion, with substantial inequities across income groups. High-income countries accounted for $7.3 trillion of this total, while low-income countries spent only $24.8 billion, reflecting a nearly 300-fold disparity. During the COVID-19 pandemic, development assistance for health increased substantially, with $37.8 billion allocated to COVID-19 response efforts in 2020–2021. However, only $1.8 billion was directed toward pandemic preparedness in low- and middle-income countries, representing just 12.2% of the estimated need, while COVID-19 response funding exceeded recommended targets by over 250%.

These findings emphasize a critical imbalance between reactive and preventive global health financing. Although the pandemic prompted an unprecedented surge in development assistance, investments in preparedness systems remained far below recommended levels. The study underscores the need for sustained and strategically directed funding to strengthen global health infrastructure, particularly in low-resource settings, to ensure better preparedness for future pandemics and to reduce inequities in global health system capacity.