The COVID-19 pandemic is only adding to a financial health care burden on the world’s poorest that existed prior to the crisis.

More than half a billion people were either pushed or pushed further into extreme poverty around the world before the pandemic due to out-of-pocket health care costs, according to two new reports the World Health Organization (WHO) and the World Bank released on Sunday.

The COVID-19 pandemic will likely exacerbate the situation and is expected to stop two decades of global progress toward achieving universal health coverage.

The two reports were launched on Universal Health Coverage Day to shine a light on the pandemic’s impact on access and affordability of health care. The WHO and the World Bank include warnings and guidelines to assist countries in recovering from the pandemic and protecting their populations. 

🆕 Report: More than 500M people are being pushed or further pushed into extreme poverty due to out-of-pocket health expenses.

Universal health coverage #UHC means making quality, affordable health services available for all. https://t.co/P79Addsktg#InvestInHealth#UHC2030pic.twitter.com/H7tpD9VoM9

— World Bank Health (@WBG_Health) December 12, 2021

“There is no time to spare,” Dr. Tedros Adhanom Ghebreyesus, WHO’s director-general, said in a statement. “All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.”

COVID-19 disrupted health services in 2020 and countries struggled to find the resources to address the public health crisis. Serious consequences of the limited bandwidth of health care systems included immunization dropping for the first time in two decades, and an increase in deaths from preventable diseases like tuberculosis and malaria. 

The pandemic also had an economic impact unlike any crisis since the 1930s, which added more stress to the estimated half a billion people who were already experiencing extreme poverty due to health care costs. Almost 1 billion people were spending more than 10% of their household budget on health care, explained Pablo Uribe, global director for health, nutrition, and population at the World Bank. 

Financial hardship will only worsen as poverty grows, incomes drop, and governments have tighter budgets, according to the reports. Uribe urged governments to stand up to protect and increase health budgets.

Around 68% of the world’s population had access to essential health services, immunization services, and disease treatments and diagnoses in 2019. However, ensuring affordability remained a challenge, leaving the poorest and most vulnerable people without access to health services that wouldn’t result in debt. 

As many as 90% of households who have to pay unaffordable out-of-pocket health expenses are at or below the poverty line. Maintaining policies that waive out-of-pocket health expenses for people living in poverty must be a priority, according to the World Bank. Improving data on access, services, and out-of-pocket health spending can also help countries meet the needs of all populations. 

“This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic, and stay on course toward universal health coverage,” Dr. Tedros said.