By April 2022, the coronavirus causing COVID-19 had infected more than 500 million people and killed more than 6.2 million worldwide. However, the most recent estimates suggest that the global number of excess deaths, directly and indirectly, attributable to COVID-19 could be as high as three times this figure. The pandemic has severely disrupted essential health services, shortened life expectancy, and exacerbated inequities in access to basic health services between countries and people, threatening to undo years of progress in some health areas. Furthermore, immunization coverage dropped for the first time in 10 years and deaths from tuberculosis and malaria increased.
Reproductive, Maternal, and Child Health
Based on data from 2015-2021, 84 percent of births worldwide were assisted by skilled health professionals, including medical doctors, nurses, and midwives, an increase from 77% in 2008-2014. In sub-Saharan Africa, coverage is 20 percentage points lower. Available data do not reflect the impact of the COVID-19 pandemic on the disruption of services, which may reverse gains made over the past decades.
The global under-5 mortality rate fell by 14 percent, from 43 deaths per 1,000 live births in 2015 to 37 deaths per 1,000 live births in 2020, while the global neonatal mortality rate fell to 17 deaths per 1,000 live births in 2020 from 19 deaths per 1,000 live births in 2015, a 12 percent reduction. Even with that progress, 5 million children died before reaching their fifth birthday in 2020 alone, down from 5.9 million in 2015. Almost half of those deaths, 2.4 million, occurred in the first month of life.
The proportion of women of reproductive age (15-49 years) whose need for family planning was satisfied through the use of modern contraceptive methods stagnated at about 77 percent between 2015 and 2022, while sub-Saharan Africa has seen the largest increase - almost 5 percentage points. The ongoing COVID-19 pandemic may lead to a reversal of this trend because of supply chain disruptions and decreased access to family planning services.
The adolescent birth rate has fallen worldwide from 56 births per 1,000 adolescents aged 15-19 years in 2000 to 45 births in 2015 and 41 births in 2020. The largest declines are occurring in Central and Southern Asia, from 70 births per 1,000 adolescent women in 2000 to 24 births in 2020. Early adolescent childbearing, occurring in the 10–14 age group, is much more common in countries in sub-Saharan Africa and Latin America, and the Caribbean than in other parts of the world.
An estimated 1.5 million new HIV infections and 680,000 deaths from AIDS-related causes occurred in 2020. The incidence of HIV infections globally declined by 39 percent between 2010 and 2020, far less than the 75 percent target agreed upon by the General Assembly in 2016. Measures to slow the spread of the COVID-19 pandemic and the additional strain the new pandemic has placed on health systems have disrupted HIV-related services.
In 2020, an estimated 10 million people fell ill with tuberculosis worldwide. There was a rise in tuberculosis deaths for the first time in a decade, caused by the COVID-19 pandemic, from 1.2 million in 2019 to 1.3 million in 2020 (excluding tuberculosis deaths in people with HIV). Tuberculosis incidence is falling at a rate of about 2 percent per year, which is much slower than the 4–5 percent annual decline which was required to achieve the 2020 milestones of the End Tuberculosis Strategy. Between 2018 and 2020, tuberculosis treatment reached 20 million people, only half of the global target.
There were an estimated 241 million malaria cases and 627,000 malaria deaths worldwide in 2020. This represents about 14 million more cases in 2020 compared with 2019 and 69,000 more deaths. About two-thirds of the additional deaths were linked to disruptions in the provision of malaria services during the pandemic. Africa was home to 95 percent of malaria cases and 96 percent of malaria deaths.
Despite significant disruptions to health services caused by the COVID-19 pandemic, the global number of people requiring treatment and care for neglected tropical diseases decreased from 2.19 billion in 2010 to 1.73 billion in 2020. Notably, 48 percent of the total population of least developed countries, required treatment and care for neglected tropical diseases in 2020, down from 79 percent in 2010.
Non-communicable Diseases, Mental Health, and Environmental Risks
Globally, 74 percent of all deaths in 2019 were caused by non-communicable diseases. The probability of dying from any of the four main non-communicable diseases (cardiovascular disease, cancer, diabetes, or chronic respiratory disease) between 30 and 70 tears of age declined from 19.9 percent in 2010 to 17.8 percent in 2019. This rate of decline is insufficient to meet the Sustainable Development Goal target.
Tobacco use rates have declined in 150 countries, contributing to the decline of the global average prevalence rate from 24.4 percent in 2015 to 22.3 percent in 2020. In 15 countries, tobacco use rates are either steady or still going up.
The global suicide death rate declined by 29 percent from 13.0 deaths per 100,000 population in 2000 to 9.2 deaths per 100,000 in 2019. Although the available data do not show an increase in suicide rates during the first months of the COVID-19 crisis, the pandemic has had a severe impact on the mental health and well-being of people around the world. In 2020, there was a 25 percent increase in the prevalence of anxiety and depression worldwide.
Health Systems and Funding
Infant immunization coverage dropped to 83 percent in 2020 from 86 percent in 2019. The COVID-19 pandemic and associated disruptions have resulted in the missing out on vaccinations of 22.7 million children, 3.7 million more than in 2019 and the highest number since 2005. Moreover, 17.1 million children did not receive vaccines through the routine immunization program, an increase from 13.6 million. Measles is a highly contagious disease and the current coverage levels of 70 percent with 2 doses of the vaccine are insufficient to prevent measles outbreaks and illness, disability, and deaths caused by complications associated with the disease. Targeting girls 9-14 years of age, the human papillomavirus (HPV) vaccine to prevent cervical cancer was offered in 111 countries in 2020 but is still yet to reach the poorest countries.
Improvements in essential health services, as measured by the universal health coverage service index, increased from a global average of 45 out of 100 in 2000 to 67 out of 100 in 2019, with the highest score in Europe and Northern America (81), and the lowest in sub-Saharan Africa (45). The pandemic is likely to halt the continuous progress made in service coverage expansion over the past 20 years, as health systems face challenges with respect to ensuring the continuity of essential health services.
Even before the pandemic, the global proportion of the population with out-of-pocket health spending exceeding 10 percent of their household budget was on the rise, exceeding 13 percent. With the combined health and economic impacts of the COVID-19 pandemic, people are likely to face greater financial constraints on access to care and among those paying out of pocket for health, financial hardship is likely to worsen further, particularly among already disadvantaged populations.
Health and care workers remain at the forefront of the COVID-19 pandemic response. In the period between January 2020 and May 2021, the pandemic may have claimed the lives of 115,500 health and care workers globally.
Data for 2014-2020 show that the density of nursing and midwifery personnel remains highest in Northern America, at over 152 per 10,000 population, which is close to 4 times the global average of 40 per 10,000 and over 15 times the figure for sub-Saharan Africa and 8 times that for Northern Africa and Southern Asia. Despite a steady increase in the density of medical doctors per 10,000 population globally, the disparities between regions remain high, with, for example, an estimated 40 medical doctors per 10,000 population in Europe compared with only 2 per 10,000 population in sub-Saharan Africa.