The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.
We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies’ online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050.
In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied.
Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all.
Bill & Melinda Gates Foundation.
The COVID-19 pandemic has renewed interest in the past, present, and future of global health financing, in part because responding to the COVID-19 pandemic has been and continues to be tremendously costly. Governments around the world implemented restrictions on travel and mass gatherings; required masks and quarantines; and rolled out and ramped up access to COVID-19 testing, contact tracing, and, when possible, COVID-19 treatment.
Governments have fought to secure access to the first round of approved COVID-19 vaccines, with vaccination campaigns beginning in more than 30 countries in 2020, including China, Israel, Russia, Mexico, the USA, and the UK.
Evidence before this study
The Global Burden of Disease Health Financing Collaborator Network and WHO have each published annual estimates of global health spending, with the former also publishing estimates of future health spending. So far, few research efforts have provided estimates of health spending associated with the COVID-19 pandemic, and these vary in their scope and completeness. The Economist Intelligence Unit’s COVID-19 Health Funding Tracker provides visualisations of pledged and disbursed funding for pandemic response, although it does not include international commitments to individual countries or pledges less than US$2 million. The Kaiser Family Foundation Donor Funding for the Global Novel Coronavirus Response tracker is a tabulated database of funding pledged for the global response to COVID-19. This tracker has not been updated since April, 2020, and does not include resources for research and development or in-kind support. The Centre for Disaster Protection’s database tracks funding from multilateral agencies and regional development banks for global humanitarian and development needs, but does not capture bilateral or private contributions. Devex’s interactive website tracks funding committed toward addressing the health, social, economic, and environmental effects of the pandemic, but does not provide information on the disbursements of these funds. The COVID-19 Research Project tracker from the UK Collaborative on Development Research and the Global Research Collaboration for Infectious Disease Preparedness collates data on all research and development project commitments and maps these to WHO research priorities. Although these existing studies track various aspects of the funding targeted toward the pandemic response, none reports comprehensive tracking for the health sector.
Added value of this study
We track spending on health globally, providing estimates from 1990 to 2050. We focus mainly on novel estimates of development assistance for health for COVID-19 in 2020 and the ramifications that follow for funding other essential health areas. These estimates add value to trackers by focusing on 2020 disbursements, being as comprehensive as possible, and placing development assistance for health for COVID-19 in the context of past spending and projected future health spending.
Implications of all the available evidence
Since 1995, global health spending has increased constantly, but inequalities in spending remain. Our estimates suggest that although contributions have been forthcoming, there remains a gap in funding needed to fully address the effects of the pandemic in most low-income and middle-income countries, especially as vaccine roll-outs are initiated globally. Continued efforts are needed to raise the required resources to provide health care for the pandemic—prevention and treatment—for the most vulnerable. Beyond COVID-19, projected disparities in future health spending across income groups suggest an ongoing benefit of leveraging development assistance resources in promoting an equitable response to any future health emergencies.
It was estimated that the global economy shrank by 3·3% in 2020, and the economies of low-income and middle-income countries (excluding China) shrank by 4·3%.
Uncertainty is expected to linger as third and fourth waves sweep the globe and new COVID-19 variants spread with increasing speed.
Unemployment increased globally, and extreme poverty is estimated to have increased by between 88 and 115 million in 2020.
Moreover, the economic consequences of the health crisis are leading to long-standing reductions in economic development in some countries, and further indirect adverse effects on health.
Although some low-income countries have also borrowed resources (obtaining loans at market rates) to fund their responses to the 2020 crises, development assistance plays a unique role in funding health systems during emergencies in many countries and can be a catalyst for rapidly scaling up novel health services.
Comprehensive health spending estimates are important for examining potential gaps in resource needs versus available funding.
Health spending can be disaggregated into four key financing sources: government, out-of-pocket, and prepaid private health spending, which collectively make up domestic health spending; and development assistance for health, which includes international disbursements for health to low-income and middle-income countries. Government health spending includes social health insurance and government public health programmes. Out-of-pocket health spending includes health-care spending by a patient or their household but excludes insurance premiums. Prepaid private health spending includes private insurance spending and spending by non-governmental agencies on health.
Estimating domestic health spending, 1995–2018
We adjusted these estimates for inflation, converted to 2020 US$, modelled estimates to ensure consistency over time and comprehensiveness across countries and territories, and estimated uncertainty (appendix p 21). We also converted these estimates into 2020 purchasing-power parity-adjusted US$. We used deflator series and exchange rate data based on data from the IMF World Economic Outlook.
- Stanaway JD
- Afshin A
- Gakidou E
- et al.
Estimating development assistance for health, 1990–2020
We disaggregated the estimates into ten health focus areas and 53 programme areas. This disaggregation captures the main programmatic areas to which development assistance for health contributions have historically been provided, and facilitates comparison with 2020 contributions and the international funding for the ongoing pandemic. We defined relevant health focus areas and programme areas for projects on the basis of a keyword search of the project descriptions downloaded from international agencies’ online project databases. The specific keywords we used and their assigned health focus or programme area are detailed in the appendix (pp 35–46).
We leveraged information from available financial documents on revenue to remove double counting across disbursing agencies, so that each flow of funding is counted only once even if it was moved from one agency to another. Although OECD CRS completeness has improved over time, in earlier years (for this study, 1990 to 1996 especially) the data were less complete; thus, we used adjusted commitment data from the Development Assistance Committee tables to estimate disbursements. We also estimated the expenses associated with administering loans and grants.
Estimating development assistance for health for COVID-19
We developed a separate method for estimating development assistance for health for COVID-19 because much of the project-level data used as input for the historical development assistance for health estimates do not extend to 2020, and therefore do not include resources disbursed in response to COVID-19. Likewise, budget and commitment data made before 2020 do not include the response to the pandemic. To adjust our 2020 development assistance estimates and include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a diverse set of databases. Our primary focus was on the UN Office of Humanitarian Assistance financial tracking service (UNOCHA) and the International Aid Transparency Initiative (IATI). We relied on UNOCHA for data on non-governmental organisations; UNICEF; the UN Population Fund; and bilateral development agencies for the United Arab Emirates, Switzerland, Italy, and New Zealand. We relied on IATI for data on bilateral development agencies for Australia, Belgium, Canada, Denmark, Finland, France, Germany, Italy, the Netherlands, New Zealand, Norway, South Korea, Spain, Sweden, Switzerland, the UK, the USA, and the European Commission. We obtained data through correspondence for regional banks and other international agencies. For US foundations, we extracted commitment estimates from Candid. We extracted relevant data directly from organisations’ online databases for the Bill & Melinda Gates Foundation; the Global Fund; Gavi, the Vaccine Alliance; WHO; the Pan American Health Organization; the World Bank; and regional development banks. For each agency, we extracted data on all 2020 project commitments and disbursements, as available. Data on commitments captured the resource allocation committed towards project activities that were generally available in project budget documents. Disbursements captured the value of project resources that had been transferred to implementing agencies to finance project activities.
Finally, we reviewed the development agencies to identify any instances of double counting of the same resources across agencies. To do this, we reviewed income and recipient agency data for each of the disbursing channels that we tracked and excluded disbursements to recipient agencies that we tracked separately as disbursing agencies. We typically kept the disbursed resources with the development agency that was closest in the process to the final recipient country. This review ensured that we counted each disbursement from the source agency, to ultimate disbursing agency, to the final recipient only once.
Estimating future health spending, 2019–50
Because this research draws from a diverse set of underlying input data, updates to these data have cascading effects and affect all of the projections.
We aggregated total development assistance for health provided across sources and used a separate model to project the proportion of total development assistance for health that each recipient was expected to receive from 2019 to 2050 (as these retrospective data extend to 2018). We also modelled when countries are projected to transition to being high-income and are no longer eligible to receive development assistance for health. We projected government health spending as a share of general government spending, prepaid private health spending as a share of GDP, and out-of-pocket health spending as a share of GDP from 2019 to 2050 (as the retrospective data extend to 2018). To capture increased government spending in response to COVID-19, we checked whether our 2020 estimates of government health spending increased by at least the estimates made by the IMF October 2020 Fiscal Monitor of previously unanticipated government health spending. Countries that had year-over-year spending increases in 2020 that were less than estimated increase reported in the Fiscal Monitor were adjusted upward proportionally.
All projections incorporated several types of uncertainty. We used ensemble modelling techniques to propagate model uncertainty. We took draws of the variance-covariance matrix of each estimate’s model to propagate parameter uncertainty. Finally, we added a random walk residual to each projection to propagate fundamental uncertainty. We generated 95% UIs by taking the 2·5th and 97·5th percentile of the 1000 estimated random draws.
For these aggregates (and the global aggregate) the reported estimates provide information about a group as a whole, rather than the mean of the countries included in that group. For all tables and figures, the country income classifications were held constant at the 2020 reported level, irrespective of whether they changed groups. The time periods for each of the financing sources differs relative to the availability of the underlying data (development assistance for health, 1990–2020; domestic health spending, 1995–2018; and future health spending, 2019–50). These time periods provide a time series of health spending data that makes sure to leverage all available data. We completed all the analyses using Stata (versions 13 and 15), R (versions 3.6.0 and 3.6.1), and Python (version 3.7.0).
Role of the funding source
The funder of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Table 1Health spending and development assistance for health in 2019 and 2050 by region
Estimates in parentheses are 95% uncertainty intervals. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. GDP=gross domestic product.
Table 2Estimates of global COVID-19-related disbursements and commitments of health and non-health funds, 2020
In the case where a grant was allocated to multiple sectors (health, as well as one or more non-health sectors), we calculated the funds attributed to health spending by multiplying the total grant amount by 1 divided by the number of sectors represented. Proportions of global commitments and disbursements by type of spending (health and non-health) were multiplied by IHME’s estimate of health-related disbursements. IHME=Institute for Health Metrics and Evaluation.
Table 3Development assistance for health specific to COVID-19 in 2020, by channel and type of assistance (millions of 2020 US$)
Spending data are reported in millions of 2020 US$, where estimates were available. In-kind contributions such as personal protective equipment was assumed to be grants. $200·7 million in bilateral development agencies funds were not able to be identified as either grants or loans.
This research highlights how this inequality exists at the national level within the health sector. In 2019, national health spending ranged from $7 to $11 345 per person, with government health spending ranging from $2 to $6578 per person (table 1, appendix p 142). Development assistance for health reached $40·4 billion in 2019 and increased to $54·8 billion in 2020 because of the additional resources provided in response to COVID-19. Although development assistance for health makes up less than 1·0% of health spending in most middle-income countries, development assistance for health was 24·6% (95% UI 24·0–25·1) of total health spending in low-income countries. Health spending per person has grown almost universally between 1995 and 2019 and is expected to rise in 195 of 204 countries and territories to 2050, but expected spending remains highly unequal. The finding of rising global health spending before the onset of the pandemic is aligned with what is reported in the WHO 2020 Global Health Spending Report.
In both our study and WHO spending report, the pandemic is expected to perpetuate already existing vulnerabilities in global health spending, such as inequalities in spending across and within income groups.
Our estimates of development assistance for health for COVID-19 show that in 2020, a total of $13·7 billion was disbursed to aid the health response in low-income and middle-income countries. This figure constituted over a quarter of all development assistance for health, and is evidence of how resources can be scaled quickly when needed. Resources focused on country-level coordination, supply chain and logistics, case management and treatment, surveillance, rapid-response teams, case investigation, maintaining essential health services and systems, and infection prevention and control have received modest contributions.
As of Jan 20, 2021, the Centre for Disaster Protection online visualisation tool reported $100·7 billion had been committed in loans (concessional and non-concessional) and $14·24 billion had been committed in grants.
A key difference between these estimates and our own is that most of the other research on this topic has not estimated disbursements, and instead focused on commitments or pledges. In practice, disbursements are generally less than commitments. Moreover, in the case of unexpected crisis, disbursing resources can take much longer than the time span that we have predicted. As of Dec 13, 2020, the Devex database reported 987 programme announcements worth $193·1 billion, 810 grants worth $2·9 billion, 2171 tenders worth $4·7 billion, and 1133 contracts worth $1·7 billion.
Unlike our estimates, these have a much broader focus and include support for the humanitarian response (outside of the health sector).
Previously, the Commission on a Global Health Risk Framework for the Future, which was set up after the Ebola epidemic, estimated that annually $4·5 billion was needed globally for pandemic preparedness, by contrast with an expected annual loss of more than $60 billion from potential pandemics. One study
on a sample of 73 low-income and middle-income countries estimated that the additional cost of responding to the COVID-19 pandemic was between $33 billion and $62 billion.
In addition to this, Kobayashi and colleagues
suggest that the global scale of the COVID-19 pandemic might have weakened public sentiment about contributing public resources abroad, given the immense challenges at home. In the next decade, development assistance for health disbursements might grow at a substantially slower pace and could rely more heavily on private philanthropy and multilateral institutions.
Additionally, there are calls for debt repayment suspension and a repurposing of such resources towards bolstering struggling economies.
At the beginning of the pandemic, when some health-care systems were overwhelmed by the unfolding crisis, the complete refocus of resources seemed to be the most logical response. However, over time, this burden on the health system has made evident the importance of strong health systems worldwide in maintaining global health security, and made it even more obvious that targeting development assistance contributions to the strengthening of the broader health system is a crucial investment for global health security overall.
Although contributions toward health system strengthening have improved, the relative proportion of development assistance funds that are targeted toward such activities remains small, with an even smaller amount allocated toward pandemic preparedness.
The pandemic has shown how quickly a local epidemic can develop into a global crisis, and the need for global activity and cooperation to be commensurate with this challenge.
globally, progress has been insufficient and the pandemic has only worsened the precarious progress made on most of the goals. For instance, in several countries in sub-Saharan Africa it seemed the health toll of the pandemic was less than expected in 2020, but the economic fallout due to public health measures such as lockdowns might have had much more severe consequences and pushed an additional 23 million people into poverty.
The mitigation strategies used to reduce the impact of the pandemic have also led to a meaningful global response. So far, development assistance contribution that falls outside of the health sector has been much larger than health-related contributions ($125·4 billion vs $13·7 billion). This reflects how the effect of the COVID-19 pandemic has reverberated outside of the health sector, affecting the social, economic, and environmental sectors in most countries.
Another challenge associated with raising and disbursing record-setting amounts of development assistance is the crucial task of allocating these scarce resources. Despite the differences in the burden of the pandemic across geographical regions, the patterns in the allocation of development assistance for health for COVID-19 remain largely the same as development assistance for health in the past, with Latin America and the Caribbean receiving little support despite their high burden. In future, key contributions must be aligned with where they are needed the most.
Although the initial discussion in popular media and among policy makers focused on national interests, the Access to COVID-19 Tools (ACT) Accelerator partnership was launched in April, 2020, by WHO, the European Commission, and the French Government to ensure pooled and equitable distribution of tools to fight COVID-19. ACT-Accelerator was estimated to need $33 billion for its work. Of ACT-Accelerator’s four key pillars, the pillar that focuses on vaccines is the COVID-19 Vaccines Global Access Facility, which is led by Gavi, WHO, and CEPI. Leveraging its previous experience with managing advanced market commitment for immunisation, Gavi was tasked with facilitating the procurement of vaccines for 92 middle-income countries through the COVID advance market commitment. The objective was to raise $2 billion before the end of 2020 to enable it to support access to vaccines irrespective of income.
As of August, 2021, $17·9 billion had been committed to the ACT Accelerator partnership.
COVID-19 mortality rates have varied greatly across the globe, but there is little consensus on what is driving this variation, with key historical measures of pandemic preparedness highlighting capacity gaps, but not accurately predicting where the outcomes will be the best or worst.
To be successful in fighting the virus and preventing substantial loss, a constellation of characteristics that fall both inside and outside of the traditional health system is necessary. These characteristics include leadership, public health system capacity, social safety nets, and trust in the systems providing information and care.
A painful lesson of this pandemic is that global health security is only as strong as its weakest link. It is crucial that those working in the health sector ensure that the entire health system is in fact robust, and that policy makers outside of the health sector also be prepared for many potential crises that can accompany a pandemic.
This research highlights the context in which COVID-19 spread quickly across the globe—one of enormous variation in health-care spending. Robust health systems require more resources, and those working in government and advocacy outside of the health sector are encouraged to see COVID-19 and the staggering loss of life and broader setbacks in global development as indicators of the importance of investing in health in and outside the health system, and building governments and social systems that can also contribute towards health security.
This study has several limitations. The data were extracted from multiple sources with different reporting structures and components included. We kept definitions and methods as consistent as possible across data sources to ensure a reliable estimate of resources. Furthermore, given that the pandemic is ongoing and development projects take some time to reach implementation, disbursement could still be low even where commitments have been made. Moreover, global health resource tracking does not allow comparable tracking of how domestic resources are spent on health and does not allow for comprehensive estimates of domestic health spending on COVID-19. More information is needed to assess how governments, households, and private organisations are spending health resources, and what resources are available for responding to health emergencies. Health financing reporting, especially in many low-income and middle-income countries, but also in high-income countries, is constrained by how timely domestic health spending data are available. Health financing data are not collated in a manner that is shareable or comparable across time and country. As countries deliberate on ways to rebuild systems after the pandemic, the health financing architecture and equity are important aspects to consider. Finally, our quantification of uncertainty captures some types of uncertainty, but not all types of uncertainty. It is included here as a relative quantification of where we have the most confidence in our estimates.
Health spending in 2019, before the COVID-19 pandemic, ranged widely, and marks tremendous variation in the access to essential health services and universal health coverage. Much more money is needed to fully address the effects of the pandemic in most low-income and middle-income countries, along with access to key tools such as vaccines. Moreover, long-term projections suggest that health inequalities are likely to persist and that international efforts to invest in global public goods related to global pandemic preparedness are essential. Resources are needed urgently to mitigate the loss associated with the COVID-19 pandemic and fund systems that can prevent and respond quicker to the next global health crisis.
Global Burden of Disease 2020 Health Financing Collaborator Network
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Christine Mpundu-Kaambwa, Moses K Muriithi, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Mukhammad David Naimzada, Vinay Nangia, Atta Abbas Naqvi, Aparna Ichalangod Narayana, Bruno Ramos Nascimento, Muhammad Naveed, Biswa Prakash Nayak, Javad Nazari, Rawlance Ndejjo, Ionut Negoi, Sandhya Neupane Kandel, Trang Huyen Nguyen, Justice Nonvignon, Jean Jacques Noubiap, Vincent Ebuka Nwatah, Bogdan Oancea, Foluke Adetola Ogunyemi Ojelabi, Andrew T Olagunju, Babayemi Oluwaseun Olakunde, Stefano Olgiati, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Adrian Otoiu, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Jagadish Rao Padubidri, Raffaele Palladino, Songhomitra Panda-Jonas, Eun-Cheol Park, Fatemeh Pashazadeh Kan, Shrikant Pawar, Hamidreza Pazoki Toroudi, David M Pereira, Arokiasamy Perianayagam, Konrad Pesudovs, Cristiano Piccinelli, Maarten J Postma, Sergio I Prada, Mohammad Rabiee, Navid Rabiee, Fakher Rahim, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Mosiur Rahman, Amir Masoud Rahmani, Usha Ram, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Priya Rathi, David Laith Rawaf, Salman Rawaf, Lal Rawal, Reza Rawassizadeh, Robert C Reiner Jr, Andre M N Renzaho, Bhageerathy Reshmi, Mavra A Riaz, Rezaul Karim Ripon, Anas M Saad, Mohammad Ali Sahraian, Maitreyi Sahu, Joseph S Salama, Sana Salehi, Abdallah M Samy, Juan Sanabria, Francesco Sanmarchi, João Vasco Santos, Milena M Santric-Milicevic, Brijesh Sathian, Miloje Savic, Deepak Saxena, Mehdi Sayyah, Falk Schwendicke, Subramanian Senthilkumaran, Sadaf G Sepanlou, Allen Seylani, Saeed Shahabi, Masood Ali Shaikh, Aziz Sheikh, Adithi Shetty, Pavanchand H Shetty, Kenji Shibuya, Mark G Shrime, Kanwar Hamza Shuja, Jasvinder A Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Shahin Soltani, Moslem Soofi, Emma Elizabeth Spurlock, Simona Cătălina Ștefan, Viktória Szerencsés, Miklós Szócska, Rafael Tabarés-Seisdedos, Biruk Wogayehu Taddele, Yonas Getaye Tefera, Aravind Thavamani, Ruoyan Tobe-Gai, Roman Topor-Madry, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Lorainne Tudor Car, Anayat Ullah, Saif Ullah, Nasir Umar, Eduardo A Undurraga, Pascual R Valdez, Tommi Juhani Vasankari, Jorge Hugo Villafañe, Francesco S Violante, Vasily Vlassov, Bay Vo, Sebastian Vollmer, Theo Vos, Giang Thu Vu, Linh Gia Vu, Richard G Wamai, Andrea Werdecker, Mesfin Agachew Woldekidan, Befikadu Legesse Wubishet, Gelin Xu, Sanni Yaya, Vahid Yazdi-Feyzabadi, Vahit Yiğit, Paul Yip, Birhanu Wubale Yirdaw, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Ismaeel Yunusa, Telma Zahirian Moghadam, Hamed Zandian, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Arash Ziapour, Yves Miel H Zuniga, Simon I Hay, Christopher J L Murray, Joseph L Dieleman.
Institute for Health Metrics and Evaluation (A E Micah PhD, I E Cogswell BS, B Cunningham MA, A C Harle BA, E R Maddison BS, D McCracken PhD, K E Simpson BS, H N Stutzman BA, G Tsakalos MS, L E Wallace MPA, R R Zende BTech, C M Antony MA, G S Azhar PhD, X Dai PhD, Prof L Dandona MD, Prof R Dandona PhD, Prof S D Dharmaratne MD, N Fullman MPH, A Haakenstad ScD, Prof S S Lim PhD, Prof R Lozano MD, M Moitra MPH, Prof A H Mokdad PhD, R C Reiner Jr PhD, M Sahu MS, E E Spurlock BA, Prof T Vos PhD, Prof S I Hay FMedSci, Prof C J L Murray DPhil, J L Dieleman PhD), Department of Health Metrics Sciences, School of Medicine (Prof R Dandona PhD, Prof S D Dharmaratne MD, Prof S S Lim PhD, Prof R Lozano MD, Prof A H Mokdad PhD, R C Reiner Jr PhD, Prof T Vos PhD, Prof S I Hay FMedSci, Prof C J L Murray DPhil, J L Dieleman PhD), University of Washington, Seattle, WA, USA; Department of Global Health Policy (S Ezoe MD, S Nomura PhD), University of Tokyo, Tokyo, Japan; Department of Health Policy and Management (S Nomura PhD), Keio University, Tokyo, Japan; Nuffield Department of Medicine (Y Zhao MPH), Centre for Tropical Medicine and Global Health (R J Maude PhD), The George Institute for Global Health (Prof S Yaya PhD), University of Oxford, Oxford, UK; Department of Juridical and Economic Studies (C Abbafati PhD), La Sapienza University, Rome, Italy; Department of Surgery (M Abdelmasseh MD, Prof J Sanabria MD), Marshall University, Huntington, WV, USA; Department of Orthopaedic Surgery (A Abedi MD, M K Mesregah MSc), Radiology (A Gholamrezanezhad MD), Department of Radiology (S Salehi MD), University of Southern California, Los Angeles, CA, USA; Department of Biostatistics (K H Abegaz MSc), Near East University, Nicosia, Cyprus; Department of Biostatistics and Health Informatics (K H Abegaz MSc), Madda Walabu University, Bale Robe, Ethiopia; Department of Botany (E S Abhilash PhD), Sree Narayana Guru College Chelannur, Kozhikode, India; Department of Laboratory Medicine (H Abolhassani PhD), Karolinska University Hospital, Huddinge, Sweden; Research Center for Immunodeficiencies (H Abolhassani PhD), Department of Health Management and Economics (M Anjomshoa PhD), National Institute of Health Research (E Ehsani-Chimeh PhD), Multiple Sclerosis Research Center (S Eskandarieh PhD, Prof M Sahraian MD), Non-communicable Diseases Research Center (Prof F Farzadfar DSc, B Mohajer MD), Department of Environmental Health Engineering (Prof A Maleki PhD), Digestive Diseases Research Institute (Prof R Malekzadeh MD, S G Sepanlou MD), Department of Epidemiology and Biostatistics (M Mansournia PhD), Metabolomics and Genomics Research Center (F Rahim PhD), Sina Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD), Tehran University of Medical Sciences, Tehran, Iran; Department of Research (M R M Abrigo PhD), Philippine Institute for Development Studies, Quezon City, Philippines; Department of Public Health (T Adhikari MPH), Aarhus University, Aarhus, Denmark; Nepal Health Frontiers, Kathmandu, Nepal (T Adhikari MPH), Kathmandu, Nepal; Department of Community Medicine (Prof S Afzal PhD), King Edward Memorial Hospital, Lahore, Pakistan; Department of Public Health (Prof S Afzal PhD), Public Health Institute, Lahore, Pakistan; The Australian Centre for Public and Population Health Research (B O Ahinkorah MPH), University of Technology Sydney, Sydney, NSW, Australia; School of Advanced Technologies in Medicine (S Ahmadi PhD), National Nutrition and Food Technology Research Institute (M Ajami PhD), Virtual School of Medical Education & Management (N Jahanmehr PhD), Prevention of Cardiovascular Disease Research Center (N Jahanmehr PhD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biosciences (H Ahmed PhD), COMSATS Institute of Information Technology, Islamabad, Pakistan; Department of Epidemiology (M B Ahmed MPH), Jimma University, Jimma, Ethiopia; Australian Center for Precision Health (M B Ahmed MPH), University of South Australia, Adelaide, SA, Australia; Department of Computer Science and Engineering (T Ahmed Rashid PhD), University of Kurdistan Hewler, Erbil, Iraq; Department of Food and Nutrition Policy and Planning Research (M Ajami PhD), National Institute of Nutrition, Tehran, Iran; Faculty of Medicine and Public Health (B Aji DrPH), Jenderal Soedirman University, Purwokerto, Indonesia; Department of Medical Physiology (Y Akalu MSc), Department of Clinical Pharmacy (Y G Tefera MSc), Department of Midwifery (B W Yirdaw MSc), University of Gondar, Gondar, Ethiopia; Department of Public Health (C J Akunna DMD), The Intercountry Centre for Oral Health for Africa, Jos, Nigeria; Department of Public Health (C J Akunna DMD), Federal Ministry of Health, Garki, Nigeria; Geriatric and Long Term Care Department (H Al Hamad MD, B Sathian PhD), Rumailah Hospital (H Al Hamad MD), Hamad Medical Corporation, Doha, Qatar; Murdoch Business School (K Alam PhD), Murdoch University, Perth, WA, Australia; Health Information Management and Technology Department (T M Alanzi PhD), Environmental Health Department (S M A Dahlawi PhD), Forensic Medicine Division (Prof R G Menezes MD), Department of Pharmacy Practice (A Naqvi PhD), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (F M Alanezi PhD); Department of Midwifery (Y Alemayehu MSc), Arba Minch University, Arba Minch, Ethiopia; Institute of Health Research (R K Alhassan PhD), Department of Population and Behavioural Sciences (H Amu PhD), Department of Health Policy Planning and Management (M A Ayanore PhD), University of Health and Allied Sciences, Ho, Ghana; Department of Health Care Management and Economics (C Alinia PhD), Urmia University of Medical Science, Urmia, Iran; Department of Health Policy and Management (Prof S M Aljunid PhD), Kuwait University, Safat, Kuwait; International Centre for Casemix and Clinical Coding (Prof S M Aljunid PhD), National University of Malaysia, Bandar Tun Razak, Malaysia; College of Medicine (S A Almustanyir MD), Alfaisal University, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia (S A Almustanyir MD); Research Group in Hospital Management and Health Policies (Prof N Alvis-Guzman PhD), Department of Economic Sciences (N J Alvis-Zakzuk MSc), Universidad de la Costa (University of the Coast), Barranquilla, Colombia; Research Group in Health Economics (Prof N Alvis-Guzman PhD, Prof C A Marrugo Arnedo MSc), University of Cartagena, Cartagena, Colombia; National Health Observatory (N J Alvis-Zakzuk MSc), Colombian National Health Observatory (C A Castañeda-Orjuela MD), National Institute of Health, Bogota, Colombia; Department of Health Services Management (S Amini PhD), Department of Pediatrics (J Nazari MD), Arak University of Medical Sciences, Arak, Iran; Health Management and Economics Reasearch Center (M Amini-Rarani PhD), Isfahan University of Medical Sciences, Isfahan, Iran; Pharmacy Department (Prof R Ancuceanu PhD), Cardiology Department (C Andrei PhD), Department of General Surgery (D V Davitoiu PhD, A Manda MD, I Negoi PhD), Department of Legal Medicine and Bioethics (S Hostiuc PhD), Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Statistics and Econometrics (Prof T Andrei PhD, Prof M Ausloos PhD, I Glăvan PhD, Prof C Herteliu PhD, A Mirica PhD, Prof A Otoiu PhD), Management Department (S Ştefan PhD), Bucharest University of Economic Studies, Bucharest, Romania; Institute of Global Health (B Angell PhD), University College London, London, UK; Health System Science Program (B Angell PhD), The George Institute for Global Health, Newtown, NSW, Australia; Department of Health Policy and Administration (C T Antonio MD), University of the Philippines Manila, Manila, Philippines; Department of Applied Social Sciences (C T Antonio MD), Hong Kong Polytechnic University, Hong Kong, China; Department of Psychology (M Aqeel PhD, M Aqeel PhD), Foundation University Islamabad, Rawalpandi, Pakistan; Health Management and Economics Research Center (J Arabloo PhD, S Azari PhD, A Ghashghaee BSc, M Hosseinzadeh PhD), Student Research Committee (A Ghashghaee BSc), Preventive Medicine and Public Health Research Center (S Goharinezhad PhD), Department of Physiology (H Pazoki Toroudi PhD), Physiology Research Center (H Pazoki Toroudi PhD), Iran University of Medical Sciences, Tehran, Iran (F Pashazadeh Kan BSN); Social Determinants of Health Research Center (M Arab-Zozani PhD), Birjand University of Medical Sciences, Birjand, Iran; Public Health and Healthcare Management (T Aripov PhD), Tashkent Institute of Postgraduate Medical Education, Tashkent, Uzbekistan; Boston Children’s Hospital, Boston, MA, USA (T Aripov PhD); Scientific Institute San Raffaele Hospital (A Arrigo MD), Vita-Salute University, Milan, Italy; University Institute of Radiological Sciences and Medical Imaging Technology (T Ashraf MS), Faculty of Allied Health Sciences (Prof S Gilani PhD), University Institute of Public Health (A Hanif PhD), The University of Lahore, Lahore, Pakistan; Department of Health System and Health Economics (D D Atnafu MPH), Bahir Dar University, Bahir Dar, Ethiopia; School of Business (Prof M Ausloos PhD), University of Leicester, Leicester, UK; Center for Health Systems Research (L Avila-Burgos ScD, Prof I Heredia-Pi DipSocSc), Center for Nutrition and Health Research (E Denova-Gutiérrez DSc), National Institute of Public Health, Cuernavaca, Mexico; School of Nursing and Health Sciences (A T Awan DrPH), Capella University, Minneapolis, MN, USA; Continuing Education-Grant Writing Academy (A T Awan DrPH), University of Nevada, Las Vegas, NV, USA; School of Public Health (G Ayano MSc, D Hendrie PhD, T R Miller PhD), Curtin University, Perth, WA, Australia; Badan Pusat Statistik (Central Bureau of Statistics) (G S Azhar PhD), The RAND Corporation, Santa Monica, CA, USA; Discipline of Public Health Medicine (T K Babalola MSc), University of KwaZulu-Natal, Durban, South Africa; Department of Community Health and Primary Care (T K Babalola MSc), Department of Psychiatry (A T Olagunju MD), University of Lagos, Lagos, Nigeria; Department of Healthcare Management and Education (M Bahrami PhD), Health Human Resources Research Center (M Bayati PhD), Non-communicable Disease Research Center (Prof R Malekzadeh MD, S G Sepanlou MD), Health Policy Research Center (S Shahabi PhD), Shiraz University of Medical Sciences, Shiraz, Iran; Unit of Biochemistry (A A Baig PhD), Faculty of Business and Management (M A Riaz Mcom), Universiti Sultan Zainal Abidin (Sultan Zainal Abidin University), Kuala Terengganu, Malaysia; Department of Hypertension (Prof M Banach PhD), Medical University of Lodz, Lodz, Poland; Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland (Prof M Banach PhD); Deputy of Research and Technology (N Barati PhD), Hamedan University of Medical Sciences, Hamedan, Iran; Heidelberg Institute of Global Health (Prof T W Bärnighausen MD, S Chen DSc, J De Neve MD, S Kohler MD, S Mohammed PhD), Department of Ophthalmology (Prof J B Jonas MD, S Panda-Jonas MD), Heidelberg University, Heidelberg, Germany; T H Chan School of Public Health (Prof T W Bärnighausen MD, I Yunusa PhD), Center for Primary Care (S Basu PhD), Division of General Internal Medicine (Prof A Sheikh MD), Harvard University, Boston, MA, USA; Department of Public & Environmental Health (A Barrow MPH), University of The Gambia, Brikama, The Gambia; Epidemiology and Disease Control Unit (A Barrow MPH), Ministry of Health, Kotu, The Gambia; School of Public Health (S Basu PhD), Imperial College Business School (D Kusuma DSc), Department of Primary Care and Public Health (Prof A Majeed MD, R Palladino MD, Prof S Rawaf MD), WHO Collaborating Centre for Public Health Education and Training (D L Rawaf MD), Imperial College London, London, UK; Department of Psychiatry (Prof B T Baune PhD), University of Münster, Münster, Germany; Department of Psychiatry (Prof B T Baune PhD), Melbourne Medical School, Melbourne, VIC, Australia; Department of Epidemiology and Health Promotion (Prof H Benzian PhD), School of Global Public Health (S D Friedman BA), New York University, New York, NY, USA; Department of Medicine (A E Berman MD), Medical College of Georgia at Augusta University, Augusta, GA, USA; Department of Social and Clinical Pharmacy (A S Bhagavathula PharmD), Charles University, Hradec Kralova, Czech Republic; Institute of Public Health (A S Bhagavathula PharmD), United Arab Emirates University, Al Ain, United Arab Emirates; Department of Anatomy (Prof N Bhardwaj MD), Government Medical College Pali, Pali, India; Department of Community Medicine and Family Medicine (P Bhardwaj MD), School of Public Health (P Bhardwaj MD), Department of Pharmacology (J Charan MD), Department of Forensic Medicine and Toxicology (T Kanchan MD), All India Institute of Medical Sciences, Jodhpur, India; Neurovascular Imaging Laboratory (S Bhaskar PhD), NSW Brain Clot Bank, Sydney, NSW, Australia; Department of Neurology and Neurophysiology (S Bhaskar PhD), South West Sydney Local Heath District and Liverpool Hospital, Sydney, NSW, Australia; Institute of Soil and Environmental Sciences (S Bibi PhD, S Ullah PhD), University of Agriculture, Faisalabad, Faisalabad, Pakistan; Social Determinants of Health Research Center (A Bijani PhD, M A Jahani PhD), Babol University of Medical Sciences, Babol, Iran; School of Business Administration (Prof V Bodolica PhD), American University of Sharjah, Sharjah, United Arab Emirates; University of Genoa, Genoa, Italy (N L Bragazzi PhD); Department of Epidemiology (D Braithwaite PhD), University of Florida, Gainesville, FL, USA; Cancer Population Sciences Program (D Braithwaite PhD), University of Florida Health Cancer Center, Gainesville, FL, USA; Psychiatry and Behavioral Health Department (Prof N J K Breitborde PhD), Department of Psychology (Prof N J K Breitborde PhD), Division of Cardiovascular Medicine (A Guha MD), Ohio State University, Columbus, OH, USA; Institute of Medicine (Prof A V Breusov DSc), RUDN University, Moscow, Russia; Department of Epidemiology and Evidence-Based Medicine (Prof N I Briko DSc, E V Glushkova PhD), IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Health Care Management (Prof R Busse PhD), Technical University of Berlin, Berlin, Germany; School of Public Health and Administration (L Cahuana-Hurtado PhD), Peruvian University Cayetano Heredia, Lima, Peru; School of Public Health and Preventive Medicine (E J Callander PhD), Monash University, Melbourne, VIC, Australia; Internal Medicine Department (Prof L A Cámera MD), Hospital Italiano de Buenos Aires (Italian Hospital of Buenos Aires), Buenos Aires, Argentina; Board of Directors (Prof L A Cámera MD), Argentine Society of Medicine, Buenos Aires, Argentina (Prof P R Valdez MEd); Epidemiology and Public Health Evaluation Group (C A Castañeda-Orjuela MD), National University of Colombia, Bogota, Colombia; National School of Public Health (F Catalá-López PhD), Institute of Health Carlos III, Madrid, Spain; Clinical Epidemiology Program (F Catalá-López PhD), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Microbiology & Infection Control (S Chatterjee MD), Medanta Medicity, Gurugram, India; Department of Public Health (S Chattu PhD), Texila American University, Georgetown, Guyana; Department of Medicine (V Chattu MD), University of Toronto, Toronto, ON, Canada; Global Institute of Public Health, Thiruvananthapuram, India (V Chattu MD); Department of Medical and Surgical Sciences (Prof A F G Cicero PhD, Prof F S Violante MD), Department of Biomedical and Neuromotor Sciences (F Sanmarchi MD), University of Bologna, Bologna, Italy; Department of Health Informatics (O Dadras DrPH), Graduate School of Medicine (O Dadras DrPH), Kyoto University, Kyoto, Japan; Division of Public Health Science (Prof K Dalal PhD), Mid Sweden University, Sundsvall, Sweden; Higher School of Public Health (Prof K Dalal PhD), Al Farabi Kazakh National University, Almaty, Kazakhstan; Public Health Foundation of India, Gurugram, India (Prof L Dandona MD, Prof R Dandona PhD, G Kumar PhD); Indian Council of Medical Research, New Delhi, India (Prof L Dandona MD); Department of Surgery (D V Davitoiu PhD), Clinical Emergency Hospital Sf Pantelimon, Bucharest, Romania; Department of Medical Clinic (Prof A R de Sá-Junior PhD), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Community Medicine (D Dhamnetiya MD), Dr Baba Sahib Ambedkar Medical College and Hospital, Delhi, India; Department of Community Medicine (Prof S D Dharmaratne MD), University of Peradeniya, Peradeniya, Sri Lanka; Department of Health Policy and Management (L Doshmangir PhD), Department of Medical Surgical Nursing (M Ghafourifard PhD), Social Determinants of Health Research Center (S Karimi PhD), Tabriz University of Medical Sciences, Tabriz, Iran; Office of Institutional Analysis (J Dube MA), University of Windsor, Windsor, ON, Canada; Reference Laboratory of Egyptian Universities-Cairo (Prof M El Sayed Zaki PhD), Ministry of Higher Education and Scientific Research, Cairo, Egypt; Pediatric Dentistry and Dental Public Health Department (Prof M El Tantawi PhD), Alexandria University, Alexandria, Egypt; School of Nursing (T Y Ferede MSc), School of Midwifery (G Kassahun MSc), Hawassa University, Hawassa, Ethiopia; Institute of Gerontological Health Services and Nursing Research (F Fischer PhD), Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany; Institute of Gerontology (N A Foigt PhD), National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; Department of Community Medicine, Information and Health Decision Sciences (A Freitas PhD), Associated Laboratory for Green Chemistry (Prof D M Pereira PhD), Center for Health Technology and Services Research (J V Santos MD), University of Porto, Porto, Portugal; Center for Health Technology and Services Research, Porto, Portugal (A Freitas PhD); Department of Dermatology (T Fukumoto PhD), Kobe University, Kobe, Japan; Health Services Management Training Centre (P A Gaal PhD, T Joo MSc, V Szerencsés MA), Faculty of Health and Public Administration (M Szócska PhD), Semmelweis University, Budapest, Hungary; Department of Applied Social Sciences (P A Gaal PhD), Sapientia Hungarian University of Transylvania, Târgu-Mureş, Romania; Department of Cardiovascular Medicine (M M Gad MD), Department of Nephrology and Hypertension (M H Hassanein MD), Heart and Vascular Institute (A M Saad MD), Cleveland Clinic, Cleveland, OH, USA; Gillings School of Global Public Health (M M Gad MD), University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Faculty of Business and Management (M Garcia-Gordillo PhD), Universidad Autonóma de Chile (Autonomous University of Chile), Talca, Chile; Department of Radiology (T Garg MBBS), King Edward Memorial Hospital, Mumbai, India; Young Researchers and Elite Club (A Gholamian MSc), Islamic Azad University, Rasht, Iran; Department of Biology (A Gholamian MSc), Islamic Azad University, Tehran, Iran; Department of Public Health (G Ghozali PhD), University of Muhammadiyah Kalimantan Timur, Samarinda, Indonesia; Afro-Asian Institute, Lahore, Pakistan (Prof S Gilani PhD); Health Systems and Policy Research (M Golechha PhD), Department of Epidemiology (Prof D Saxena PhD), Indian Institute of Public Health, Gandhinagar, India; Australia India Institute New Generation Network (S Goli PhD), UWA Public Policy Institute (S Goli PhD), University of Western Australia, Perth, WA, Australia; Harrington Heart and Vascular Institute (A Guha MD), Department of Nutrition and Preventive Medicine (Prof J Sanabria MD), Division of Pediatric Gastroenterology (A Thavamani MD), Case Western Reserve University, Cleveland, OH, USA; School of Medicine (V Gupta PhD), Deakin University, Geelong, VIC, Australia; Department of Clinical Medicine (Prof V K Gupta PhD), Macquarie University, Sydney, NSW, Australia; Department of Global Health and Population (A Haakenstad ScD), TH Chan School of Public Health, Boston, MA, USA; Department of Social and Public Health (M Haider PhD), Ohio University, Athens, OH, USA; Department of Global Public Health and Primary Care (A Hailu PhD), Center for International Health (S Hassan MPhil), Bergen Center for Ethics and Priority Setting (S Hassan MPhil), University of Bergen, Bergen, Norway; School of Health and Environmental Studies (Prof S Hamidi DrPH), Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates; Medical Research Unit (H Harapan PhD), Universitas Syiah Kuala (Syiah Kuala University), Banda Aceh, Indonesia; Sekolah Tinggi Ilmu Kesehatan Indonesia Maju [Indonesian Advanced College of Health Sciences] (R K Hartono MPH), Institution of Public Health Sciences, Jakarta, Indonesia; Department of Zoology and Entomology (A I Hasaballah PhD), Al Azhar University, Cairo, Egypt; Institute of Pharmaceutical Sciences (K Hayat MS), University of Veterinary and Animal Sciences, Lahore, Pakistan; Department of Pharmacy Administration and Clinical Pharmacy (K Hayat MS), Xian Jiaotong University, Xian, China; Department of Neurology (M I Hegazy PhD), Cairo University, Cairo, Egypt; Independent Consultant, Santa Clara, CA, USA (G Heidari MD); School of Business (Prof C Herteliu PhD), London South Bank University, London, UK; Department of Applied Microbiology (K Hezam PhD), Taiz University, Taiz, Yemen; Department of Microbiology (K Hezam PhD), Nankai University, Tianjin, China; Kasturba Medical College, Mangalore (R Holla MD, J Padubidri MD, P Rathi MD), Manipal College of Pharmaceutical Sciences (Prof M D Janodia PhD), Manipal College of Dental Sciences, Manipal (Prof A I Narayana PhD), Department of Community Medicine (C R Rao MD), Department of Health Information Management (B Reshmi PhD), Manipal Academy of Higher Education, Manipal, India (B Reshmi PhD); Maternal and Child Health Division (S J Hossain MPH, T M Huda PhD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Clinical Legal Medicine Department (S Hostiuc PhD), National Institute of Legal Medicine Mina Minovici, Bucharest, Romania; School of Public Health (T M Huda PhD), Sydney Medical School (S Islam PhD), Save Sight Institute (H Kandel PhD), University of Sydney, Sydney, NSW, Australia; Department of Occupational Safety and Health (Prof B Hwang PhD), China Medical University, Taichung, Taiwan; Department of Public Health (Prof I Iavicoli PhD, R Palladino MD), University of Naples Federico II, Naples, Italy; Infectious Diseases Department (B Idrisov MD), Bashkir State Medical University, Ufa, Russia; Laboratory of Public Health Indicators Analysis and Health Digitalization (B Idrisov MD), Moscow Institute of Physics and Technology, Moscow, Russia; Department of Community Medicine (O S Ilesanmi PhD), Department of Medicine (Prof M O Owolabi DrM), University of Ibadan, Ibadan, Nigeria; Department of Community Medicine (O S Ilesanmi PhD), Department of Medicine (Prof M O Owolabi DrM), University College Hospital, Ibadan, Ibadan, Nigeria; Independent Consultant, Tabriz, Iran (S N Irvani MD); Institute for Physical Activity and Nutrition (S Islam PhD), Department of Economics (L K D Le PhD), Deakin University, Burwood, VIC, Australia; Department of Clinical Pharmacy (Prof N Ismail PhD), MAHSA University, Bandar Saujana Putra, Malaysia; Department of General Surgery and Surgical-Medical Specialties (Prof G Isola PhD), University of Catania, Catania, Italy; Institute of Comparative Economic Studies (Prof M Jakovljevic PhD), Hosei University, Tokyo, Japan; Department of Global Health, Economics and Policy (Prof M Jakovljevic PhD), University of Kragujevac, Kragujevac, Serbia; Health Informatic Lab (T Javaheri PhD), Department of Computer Science (R Rawassizadeh PhD), Boston University, Boston, MA, USA; Centre of Studies and Research (S Jayapal PhD), Ministry of Health, Muscat, Oman; Department of Physiology (R Jayawardena PhD), Department of Pharmacology (P Ranasinghe PhD), University of Colombo, Colombo, Sri Lanka; School of Exercise and Nutrition Sciences (R Jayawardena PhD), Queensland University of Technology, Brisbane, QLD, Australia; Urology Department (S Jazayeri MD), University of Florida, Jacksonville, FL, USA; Department of Community Medicine (R P Jha MSc), Dr Baba Saheb Ambedkar Medical College & Hospital, Delhi, India; Department of Community Medicine (R P Jha MSc), Banaras Hindu University, Varanasi, India; Beijing Institute of Ophthalmology (Prof J B Jonas MD), Beijing Tongren Hospital, Beijing, China; Gastrointestinal and Liver Diseases Research Center (F Joukar PhD, Prof F Mansour-Ghanaei MD), Caspian Digestive Disease Research Center (F Joukar PhD, Prof F Mansour-Ghanaei MD), Guilan University of Medical Sciences, Rasht, Iran; Institute of Family Medicine and Public Health (M Jürisson PhD), University of Tartu, Tartu, Estonia; Health Economics Unit (B Kaambwa PhD), College of Medicine and Public Health (B Kaambwa PhD), Health and Social Care Economics Group (C Mpundu-Kaambwa PhD), Flinders University, Adelaide, SA, Australia; Institute for Prevention of Non-communicable Diseases (R Kalhor PhD), Health Services Management Department (R Kalhor PhD), Qazvin University of Medical Sciences, Qazvin, Iran; Sydney Eye Hospital (H Kandel PhD), South Eastern Sydney Local Health District, Sydney, NSW, Australia; Research Center for Environmental Determinants of Health (Prof B Karami Matin PhD, A Kazemi Karyani PhD, S Soltani PhD), Department of Public Health (N Kianipour MA), Social Development and Health Promotion Research Center (M Soofi PhD), Department of Health Education and Health Promotion (A Ziapour PhD), Kermanshah University of Medical Sciences, Kermanshah, Iran; International Research Center of Excellence (G A Kayode PhD), Institute of Human Virology Nigeria, Abuja, Nigeria; Julius Centre for Health Sciences and Primary Care (G A Kayode PhD), Utrecht University, Utrecht, Netherlands; School of Health (L Keikavoosi-Arani PhD), Alborz University of Medical Sciences, Karaj, Iran; Department of Public Health (Prof Y S Khader PhD), Jordan University of Science and Technology, Irbid, Jordan; Amity Institute of Forensic Sciences (H Khajuria PhD, B P Nayak PhD), Amity University, Noida, India; Department of Biophysics and Biochemistry (Prof R Khalilov PhD), Baku State University, Baku, Azerbaijan; Russian Institute for Advanced Study (Prof R Khalilov PhD), Moscow State Pedagogical University, Moscow, Russia; Health Promotion Research Center (M Khammarnia PhD), Zahedan University of Medical Sciences, Zahedan, Iran; Department of Population Studies (J Khan MPhil), Department of Development Studies (Prof A Perianayagam PhD), Department of Public Health & Mortality Studies (Prof U Ram PhD), International Institute for Population Sciences, Mumbai, India; Department of Public Health (Prof J Khubchandani PhD), New Mexico State University, Las Cruces, NM, USA; Department of Preventive Medicine (G Kim PhD, Prof E Park PhD), Institute of Health Services Research (Prof E Park PhD), Yonsei University, Seoul, South Korea; School of Traditional Chinese Medicine (Y Kim PhD), Xiamen University Malaysia, Sepang, Malaysia; School of Health Sciences (Prof A Kisa PhD), Kristiania University College, Oslo, Norway; Department of Global Community Health and Behavioral Sciences (Prof A Kisa PhD), Tulane University, New Orleans, LA, USA; Department of Nursing and Health Promotion (S Kisa PhD), Oslo Metropolitan University, Oslo, Norway; Independent Consultant, Jakarta, Indonesia (S Kosen MD); Microbiology & Molecular Cell Biology Department (R Koteeswaran MD), Eastern Virginia Medical School, Norfolk, VA, USA; Kasturba Medical College, Udupi, India (S Koulmane Laxminarayana MD); CIBERSAM (A Koyanagi MD), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain; 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School of Medicine (Prof G Xu MD), Nanjing University, Nanjing, China; School of International Development and Global Studies (Prof S Yaya PhD), University of Ottawa, Ottawa, ON, Canada; Department of Health Management (V Yiğit PhD), Süleyman Demirel Üniversitesi (Süleyman Demirel University), Isparta, Turkey; Centre for Suicide Research and Prevention (Prof P Yip PhD), Department of Social Work and Social Administration (Prof P Yip PhD), University of Hong Kong, Hong Kong, China; Department of Neuropsychopharmacology (N Yonemoto MPH), National Center of Neurology and Psychiatry, Kodaira, Japan; Department of Public Health (N Yonemoto MPH), Juntendo University, Tokyo, Japan; Department of Health Policy and Management (Prof M Z Younis PhD), Jackson State University, Jackson, MS, USA; School of Medicine (Prof M Z Younis PhD), Tsinghua University, Beijing, China; Department of Epidemiology and Biostatistics (Prof C Yu PhD), School of Medicine (Z Zhang PhD), Wuhan University, Wuhan, China; Department of Clinical Pharmacy and Outcomes Sciences (I Yunusa PhD), University of South Carolina, Columbia, SC, USA; Social Determinants of Health Research Center (T Zahirian Moghadam PhD, H Zandian PhD), Department of Community Medicine (H Zandian PhD), Ardabil University of Medical Science, Ardabil, Iran; Addictology Department (Prof M S Zastrozhin PhD), Pediatrics Department (A Zastrozhina PhD), Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Health Technology Assessment Unit (Y H Zuniga BS), Department of Health Philippines, Manila, Philippines; #MentalHealthPH, Quezon City, Philippines (Y H Zuniga BS).
Declaration of interests
D McCracken’s position was supported in part through the Wellcome Trust, and by the Department of Health and Social Care using UK aid funding managed by the Fleming Fund. R Ancuceanu reports consulting fees from AbbVie and AstraZeneca; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sandoz, AbbVie, and Braun Medical; and support for attending meetings or travel from AbbVie and AstraZeneca, all outside the submitted work. M Ausloos and C Herteliu report grants or contracts from the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI), project number PN-III-P4-ID-PCCF-2016-0084, outside the submitted work. C Herteliu reports grants or contracts from CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351, outside the submitted work. S Bhaskar reports an unpaid leadership or fiduciary role in a board, society, committee or advocacy group, with the Rotary Club of Sydney Board of Directors, outside the submitted work. R Busse reports grants or contracts from Berlin University Alliance (COVID pre-exploration project), outside the submitted work. S M S Islam reports grants or contracts from National Health and Medical Research Council (NHMRC) and the National Heart Foundation of Australia, all outside the submitted work. K Krishan reports non-financial support from UGC Centre of Advanced Study phase II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. M J Postma reports grants or contacts from Merck Sharp & DDohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Bayer, Bristol Myers Squibb, AstraZeneca, Sanofi, IQVIA, BioMerieux, WHO, EU, Seqirus, FIND, Antilope, DIKTI, LPDP, and Budi; consulting fees from Merk Sharp & Dohme, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Novavax, Quintiles, Bristol Myers Squibb, Astra Zeneca, Sanofi, Novartis, Pharmerit, IQVIA, and Seqirus; participation on a Data Safety Monitoring Board or Advisory Board to Asc Academics as Advisor; and stock or stock options in Health-Ecore and PAG, all outside the submitted work. M G Shrime reports grants or contracts from the Iris O’Brien Foundation; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Brightsight speakers; and leadership or fiduciary role in board, society, committee or advocacy group, paid or unpaid with Pharos Global Health Advisors as a board member. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, Two labs, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, and Practice Point communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings and travel from OMERACT; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the US Food and Drug Administration Arthritis Advisory Committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a Director and Editor; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, and Charlotte’s Web Holdings; and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals, all outside the submitted work. All other authors declare no competing interests.
J L Dieleman reports support for the current manuscript from the Bill & Melinda Gates Foundation. This research was funded in part by the Wellcome Trust (grant number 220211). S Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). S Afzal acknowledges support from King Edward Medical University by facilitating qualified human resource to work on this research and complete it in a timely manner. S M Aljunid would like to acknowledge the Department of Health Policy and Management, Faculty of Public Health, Kuwait University; and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. S Bhaskar acknowledges funding support from the NSW Ministry of Health. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. J-W De Neve was supported by the Alexander von Humboldt Foundation. M Golechha acknowledges being a project lead of NITI Aayog, Government of India funded project “Impact of the National Health Mission on Governance, Health System, and Human Resources for Health” and being a project lead of a Department of Science and Technology-funded project on the development and implementation of Heat Action Plan in Indian Cities under the National Mission on Strategic Knowledge for Climate Change. V K Gupta acknowledges funding support from NHMRC Australia. S M S Islam is supported by the NHMRC and the National Heart Foundation of Australia. M Jakovljevic was co-funded through Grant OI 175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia (number XMUMRF/2020-C6/ITCM/0004). S L Koulmane Laxminarayana acknowledges institutional support provided by Manipal Academy of Higher Education. K Krishan is supported by the UGC Centre of Advanced Study (phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. L K D Le acknowledges support from the Alfred Deakin Postdoctoral Research Fellowship and funding from the NHMRC PREMISE. R J Maude is supported by a grant from the Research Council of Norway (285188). B R Nascimento was supported in part by CNPq (Bolsa de produtividade em pesquisa, 312382/2019-7), by the Edwards Lifesciences Foundation (Every Heartbeat Matters Program 2020) and by FAPEMIG (grant APQ-000627-20). M D Naimzada, N Otstavnov, and S S Otstavnov acknowledge the support by a grant from the Russian Science Foundation (project number 20-78-10157). J R Padubidri acknowledges the Manipal Academy of Higher Education, Manipal for their support in research publications. B Reshmi acknowledges Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India. A M Samy acknowledges the support from the Fellowship of the Egyptian Fulbright Mission program. A Sheikh is supported by the Health Data Research UK BREATHE Hub. A Shetty acknowledges support from Manipal Academy of Higher Education, Manipal.
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Published: September 22, 2021
© 2021 The Author(s). Published by Elsevier Ltd.