Advancing towards a worldwide healthcare system in the post-COVID-19 era: benefits and barriers to international collaboration in healthcare

Introduction

The coronavirus disease 2019 (COVID-19) has posed serious challenges to healthcare, demonstrating weakness of healthcare systems worldwide¹. Notable among these issues are a shortage of staff, equipment and access to healthcare. Hospitals have had difficulty keeping up with an influx of patients needing medical care - leading to multiple issues¹.

Hospitals and clinics needed to expand their capacity, which required additional staff, equipment, and resources. Unfortunately, many healthcare systems could not keep up with demand for medical supplies such as personal protective equipment (PPE), ventilators, and other critical care items. This shortage placed healthcare workers at risk while driving up prices due to increased demand^1,2.

Furthermore, the pandemic has led to a decrease in healthcare revenue as patients postpone elective procedures and routine check-ups to reduce their exposure to virus^2,3. This financial loss had an immense effect on healthcare systems, leading to layoffs and furloughs of staff members³. Furthermore, its economic consequences extended beyond healthcare alone; businesses closed and unemployment rates spiked^1,2. Many people lost health insurance coverage, making accessing healthcare even more challenging. Moreover, decreased funding for public health programs made it harder to contain and manage outbreaks³.

The COVID-19 pandemic has revealed stark disparities in response across countries and regions. Countries like Taiwan, South Korea, and New Zealand were able to contain the virus with swift and effective measures like rigorous testing, contact tracing, and mandatory quarantine for those infected or exposed⁴. On the other hand, countries like the United States, Brazil, and India had limited capabilities for testing or contact tracing capabilities; limited healthcare resources; and political and public resistance against enforcing public health regulations^3,5.

Italy was among the countries hardest-hit by the early stages of the pandemic, and its healthcare system struggled to cope with an unprecedented influx of COVID-19 patients⁶. Hospitals became overwhelmed, leading to shortages in medical supplies⁶. Furthermore, healthcare workers such as doctors and nurses became infected while treating patients, creating an extremely challenging scenario for Italian healthcare systems⁶. This can be explained by poor protection due to a shortage of personal protective equipment.

These differences in responses can be observed in the varying death rates and economic effects. For example, the US economy suffered a severe recession due to the pandemic, with a 3.5% decline in GDP for 2020; conversely, Taiwan’s GDP increased by 3.11% during that same time frame^7,8.

Given these difficulties faced by healthcare systems during the pandemic, a coordinated and unified global health response is necessary. This editorial examines both the advantages and potential drawbacks of global healthcare collaboration in responding to pandemics in order to make progress towards creating a truly global healthcare system.

Discussion

Our editorial offers novel perspectives into the global health response to pandemics. Not only does it explore potential for international collaboration during pandemics, but it also suggests practical solutions for overcoming any obstacles that might hinder such collaboration.

One of the most remarkable examples of global collaboration during COVID-19 is the COVAX initiative⁹. Led by WHO, Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, The Vaccine Alliance, COVAX seeks to accelerate development and distribution of COVID-19 vaccines across all countries. Since its founding, COVAX has delivered more than 329 million doses of vaccines to 141 countries and territories as of September 2021⁹.

COVAX not only provided COVID-19 vaccines to countries, but they also offered technical and financial support to help them prepare for the launch of the vaccine⁹. This includes training healthcare workers, strengthening supply chains, and monitoring vaccine safety and efficacy. Thanks to COVAX's assistance many countries have made significant strides in their vaccination campaigns, an essential step in slowing down COVID-19's global spread.

Collaboration among countries can significantly deepen our comprehension of pandemics by encouraging knowledge sharing and expertise^10,11. This, in turn, can spur research efforts to create diagnostic tools, drugs, and vaccines to combat the pandemic. By pooling resources, expertise and data, countries can expedite the development of effective interventions and minimize pandemic impacts. Furthermore, sharing information and expertise leads to best practices for dealing with pandemics or disasters. By learning from each other’s successes and failures, countries improve their preparedness and response capabilities – ultimately saving lives while reducing economic and social effects associated with pandemics.

An impressive example of global health collaboration during the COVID-19 pandemic was the WHO's solidarity trial, which involved 14,200 patients, 600 hospitals and over 30 countries to evaluate potential drugs to treat SARS-CoV-2¹². This initiative brought together scientists, researchers, healthcare workers and governments from around the world with one common purpose: finding effective treatments for COVID-19. The trial played a vital role in determining drug safety and efficacy, including Remdesivir and Hydroxychloroquine – while providing guidance on treatment protocols for COVID-19 patients worldwide¹².

The COVID-19 pandemic has had a profound effect on global healthcare partnerships, leading to the continuation of several agreements and plans long after its end. A noteworthy development is the establishment of a global early alert system which allows rapid detection of potential outbreaks and forecasting risk levels. This information will inform prevention and containment strategies as well as assist in mitigating future pandemic outbreaks. On September 20, 2021, the WHO unveiled the Hub for Pandemic Intelligence and Epidemic Intelligence. This hub provides a promising framework for global health surveillance and response by facilitating early detection and management of emerging threats as well as sharing best practices in pandemic management.

In addition to medical benefits, global collaboration in healthcare during pandemics can have positive effects on the economy and job market, particularly within the healthcare sector. Such collaboration encourages new technologies and manufacturing of healthcare products which then leads to increased international trade and investment into this sector, spurring economic growth and job creation.

International health collaboration can be highly successful in improving global health outcomes, but several obstacles can stand in its way. Political and economic tensions between countries can make it difficult to build trust and form partnerships; for instance, ongoing trade disputes between the US and China could impede their capacity for cooperation on a pressing global health crisis like COVID-19 pandemic.

Another challenge when collaborating across countries is the distinct legal and regulatory health frameworks. These distinctions can make it challenging to coordinate efforts and share information, as companies need to adhere to different regulatory requirements in each place, leading to increased costs and logistical problems. For instance, in Europe there are differing regulations on medical devices and pharmaceuticals which make distribution across borders challenging.

Social and cultural differences can impede international health collaboration. Disparate cultural norms and beliefs about health may lead to differing approaches when providing healthcare or implementing public health interventions. For instance, some cultures may be reluctant to receive vaccinations while others favor traditional medicine over modern healthcare practices.

Delivering medical equipment and personnel to war zones or isolated areas can present a major barrier for international health collaboration. For instance, in Syria’s conflict, medical supplies and personnel have been severely hindered due to ongoing violence and displacement of populations.

International health services during pandemics must contend with the free movement of individuals, both for tourist purposes and as part of medical tourism, due to the potential risk of spreading the virus across borders. Pandemics like COVID-19 could easily spread from country to country through infected individuals moving between them; this could overwhelm their healthcare systems in receiving nations by leading to shortages in medical supplies and personnel. Furthermore, this movement could create new variants of the virus which may be more transmissible or resistant to treatment. Furthermore, the movement of individuals for medical tourism purposes can present a challenge to healthcare systems during pandemics. The additional demand placed on destinations’ healthcare systems may add an additional strain to those already stretched by demands from their own populations. Furthermore, cross-border movement increases the potential risk for virus transmission and new variants emerging. Conversely, medical tourism can contribute to the economic recovery of countries affected by the pandemic. But this requires meticulous planning and coordination so that patients’ movements remain secure and healthcare systems are able to accommodate an increased demand.

Finally, the absence of a global vision for healthcare delivery and access can hinder collaboration¹³. Specifically, each country has its own healthcare objectives, which makes it difficult to align priorities and reach consensus on certain health outcomes.

To overcome these barriers, countries must take practical steps towards building a global framework for healthcare collaboration. First, effective communication and constant coordination between countries is essential to ensure efficient resource allocation and utilization. Second, there is a necessity for creating and activating mechanisms for equitable distribution and sharing of essential medical supplies, vaccines, and expertise¹⁴. Third, harmonization of legal and regulatory frameworks can further promote collaboration, as well as enable sharing medical data and research findings. One successful example of collaboration in action occurred during the Ebola outbreak response between 2014 and 2016. African countries joined forces under a joint framework to contain the virus spread and provide essential medical supplies and expertise to affected regions¹⁵. Europe-African research collaborations that assessed vaccine safety in West Africa were established, underscoring the value of international health collaboration when responding to pandemics and providing a model for future cooperation^15,16.

Furthermore, developing trust between countries is paramount for successful international health collaboration. This can be accomplished through long-term partnerships, joint funding mechanisms and shared decision-making processes. Effective leadership and governance are essential to breaking down barriers to international health collaboration¹⁴, while investing in technology and innovation can help remove logistical hurdles that stand in the way. For instance, the use of telemedicine and digital health technologies can enable healthcare professionals to share knowledge and expertise across borders, offering remote access to medical care for underserved communities. Lastly, public education and awareness campaigns can help break down cultural barriers to international healthcare collaboration¹⁷.

Conclusion

International collaboration in healthcare during pandemics can have numerous advantages across various sectors, such as medical, economic and job opportunities. Unfortunately, several obstacles stand in the way of effective collaboration and efficient management of pandemics globally. By addressing these issues head-on, countries will be able to address political and economic tensions between them, disparities in regulatory frameworks, social and cultural differences and logistical difficulties effectively.

Transparency

Declaration of funding

No funding was received to produce this article.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

AZAM conceptualized the study design, extracted data, analyzed data, and drafted the manuscript.

Acknowledgement

None reported.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The data that support the findings of this study are available on reasonable request from the corresponding author (AZM).