Prologue of a Pandemic – COVID-19

“… Since Word War 2, there hasn’t been in our country a similar challenge where everything depended so much upon our joint solidarity action …”

Angela Merkel, March 2020 – Chancellor of Germany

Many things can and will be said on how the pandemic was managed by international leaders, it is not in the scope of this text to analyze them. Aftermaths cannot be measured only after the storm has passed, and even time is required to asses – “fairly” – the cost of such a global event; it is also not in the scope of this text to predict them.

If the present (- from the beginning of the pandemic) will not be judged and the future is irrelevant at this point, what is left to asses is the past. Decisions in the past that took us to the point where we are.

For that purpose, the beginning of a previous pandemic has been set as parameter. Since that point in time, expenditure of OECD countries (% of GDP) in healthcare systems will be tracked across time to see if there was a significant change up to the closest point when a new pandemic changed the way we behave as a global society.

AH1N1 – also: H1N1pdm09

“In the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in the United States and spread quickly across the United States and the world.” (1)

Quick facts:

  • From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the AH1N1 virus (1)
  • Additionally, CDC estimated that 151,700-575,400 people worldwide died from AH1N1 virus infection during the first year the virus circulated.
  • Globally, 80 percent of AH1N1 virus-related deaths were estimated to have occurred in people younger than 65 years of age. This differs greatly from typical seasonal influenza epidemics, during which about 70 percent to 90 percent of deaths are estimated to occur in people 65 years and older (1)

Important to notice that all numbers are estimations and ranges!

In healthcare, the variables are sometimes – literally – impossible to control and only some numbers can be estimated. E.g.; “CDC estimated that 151,700-575,400 people worldwide died from AH1N1 virus infection” and they must remain the same way.

Opposite to estimated cases and ranges, finances can be quantified. If we narrow the players and metrics to specifically OECD countries and % of their GDP spent in healthcare, numbers can be easily tracked.

Must be disclosed beforehand, I will not exhaustively dig in other factors (internals or externals) that might have influenced the expenditure. All those variables are left to the reader to search for and apply upon each case.

% of GDP to Healthcare of some OECD Countries
Expenditure per country in healthcare (% of GDP) from 2010 (-End of AH1N1 Pandemic) to 2018 (Latest available data)

The compound annual growth rate per country, looks as follow:


Between the eleven countries together, there was only a raise of 0.56% in expenditure (% of GDPs combined) in the healthcare system after the AH1N1 pandemic.

In the gates of this new pandemic, which countries are -and even had – tackling better the challenge and which are facing bigger problems to contain it?

What are the day-to-day numbers of the COVID-19 telling us about national healthcare systems?

Who are the ones needing for a bigger financial rescue package?


Eleven years passed between the last pandemic and the current one.

Considering the first warning that we received – now we know it was a warning – none of the countries increased “significantly” the expenditure in their healthcare systems

Some of the countries above, and they have been selected for a reason, currently show some challenges against COVID-19. Since many of them are still in the peak of efforts and countermeasures – I wish them all only the best – no numbers or statistics will be shown here. The reader itself must asses and apply critical thinking of/ if we as a society understood where the main problems lie in a new globalized world.

Now that in the face of a second challenge… with bigger proportions and (soon to be confirmed) worst outcomes, should the countries raise to the a new world where healthcare must receive a first role instead of everything else that pushes for a consumerism life? Where lies the line of what is more important for a country to invest in …


(1) 2009 H1N1 Pandemic (H1N1pdm09 virus). Centers for disease control and prevention – CDC. June 2019. Retrieved from:

(2) Health expenditure and financing. OECD. Data extracted on the 21.03.2020. Retrieved from:

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