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SDG 3: Good Health and Well-Being

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SDG 3 at a Crossroads: Charting Progress, Pandemic Setbacks, and the Precarious Path to 2030



Executive Summary


The 2030 Agenda for Sustainable Development established Sustainable Development Goal 3 (SDG 3) as a comprehensive mandate to "ensure healthy lives and promote well-being for all at all ages." An analysis of the period from 2015 to 2019 reveals a global health landscape of uneven progress. While significant gains were achieved in areas such as child survival and the fight against HIV, driven by targeted interventions and global partnerships, the overall pace of improvement was insufficient to meet the 2030 targets. Progress had already begun to stall in critical domains requiring robust, integrated health systems, such as reducing maternal mortality and combating the rising tide of non-communicable diseases (NCDs). These pre-existing vulnerabilities set the stage for the unprecedented disruption caused by the COVID-19 pandemic.

The pandemic inflicted a dual shock on global health. The direct toll was catastrophic, with official figures vastly understating the true impact. The World Health Organization (WHO) estimates approximately 15 million excess deaths in 2020 and 2021, a figure that captures not only unrecorded COVID-19 fatalities but also a devastating wave of "collateral damage" deaths from other conditions as health systems buckled under the strain. This systemic fracture was pervasive, with over 90% of countries reporting disruptions to essential health services. The pandemic reversed years, and in some cases decades, of progress. Childhood immunization coverage suffered its largest decline in 30 years, and deaths from tuberculosis and malaria increased for the first time in over a decade. The crisis created a vicious cycle, where the pre-existing burden of NCDs amplified the severity of COVID-19, while the pandemic response decimated NCD care, portending a long-term surge in premature mortality.

The post-pandemic recovery has been fragile, slow, and deeply inequitable. While global life expectancy has begun to rebound, troubling trends have emerged, including rising mortality among young adults. Foundational elements of health systems remain severely weakened. Routine immunization has not fully recovered to pre-pandemic levels, leaving millions of children vulnerable and signaling a degradation of primary healthcare infrastructure. A projected global shortage of 11.1 million health workers by 2030 presents a fundamental obstacle to progress.

The world is now severely off track to meet the 2030 health targets. A return to the pre-pandemic trajectory is not only insufficient but impossible without transformative action. Salvaging the SDG 3 agenda requires urgent and ambitious strategic shifts. These imperatives include an unwavering recommitment to Universal Health Coverage (UHC) as the central organizing principle for health systems strengthening; closing the vast health financing gap through increased domestic investment and predictable international aid; and a massive, concerted effort to rebuild the global health and care workforce. Critically, the deep erosion of trust and multilateral cooperation, exposed by the profound inequities of the pandemic response, must be repaired. The establishment of a new, equitable, and legally binding international framework for pandemic prevention, preparedness, and response is not merely a technical necessity but a prerequisite for the global solidarity required to achieve a healthier, more secure, and sustainable future for all.


Section 1: The Global Health Mandate Before the Crisis: A Pre-Pandemic Baseline (2015-2019)


The adoption of the 2030 Agenda for Sustainable Development in 2015 marked a pivotal moment for global health. Building upon the legacy of the Millennium Development Goals (MDGs), SDG 3 established a far more ambitious and comprehensive vision for global health and well-being.1 This section details the architecture of this crucial goal and provides a data-driven assessment of the world's trajectory in the five years preceding the COVID-19 pandemic. The analysis reveals a period of significant, yet uneven, progress. While notable achievements were recorded, the overall pace of change was already insufficient to meet the 2030 targets, exposing foundational weaknesses and systemic vulnerabilities that the subsequent global crisis would tragically exploit and amplify.


1.1 Defining the Ambition: The Architecture of SDG 3


The overarching aim of SDG 3 is "to ensure healthy lives and promote well-being for all at all ages".1 This goal is underpinned by 13 distinct targets that cover a wide spectrum of global health priorities, moving beyond a narrow focus on disease to encompass the full life course and the broader determinants of health.1 These targets can be systematically categorized to understand their comprehensive scope:

  • Reproductive, Maternal, and Child Health: This cluster continues the unfinished agenda of the MDGs. Target 3.1 aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births.3 Target 3.2 seeks to end preventable deaths of newborns and children under five, with specific mortality rate goals.3 Target 3.7 focuses on ensuring universal access to sexual and reproductive healthcare services, including family planning and education.3

  • Infectious and Non-Communicable Diseases: This category addresses the dual burden of disease affecting countries worldwide. Target 3.3 aims to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and to combat hepatitis and other communicable diseases.3 Target 3.4 confronts the growing global crisis of NCDs, aiming to reduce by one-third premature mortality from conditions like cardiovascular disease, cancer, diabetes, and chronic respiratory disease, while also promoting mental health and well-being.3 Target 3.5 focuses on strengthening the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.5

  • External Causes and Environmental Health: This group acknowledges the impact of the external environment on health. Target 3.6 set an ambitious (and now passed) goal to halve the number of global deaths and injuries from road traffic accidents by 2020.3 Target 3.9 aims to substantially reduce deaths and illnesses from hazardous chemicals and air, water, and soil pollution.5

  • Health Systems and Access: These targets, often referred to as the "means of implementation," are crucial for achieving all other health outcomes. Target 3.8, achieving Universal Health Coverage (UHC), is arguably the cornerstone of SDG 3, encompassing financial risk protection and access to quality essential healthcare services, medicines, and vaccines for all.3 The remaining targets support this overarching goal: Target 3.a on strengthening tobacco control; Target 3.b on supporting research, development, and access to affordable vaccines and medicines; Target 3.c on increasing health financing and the health workforce in developing countries; and Target 3.d on improving early warning systems for global health risks.3

Crucially, SDG 3 is designed to be integrated and indivisible from the other 16 SDGs.2 The enjoyment of the highest attainable standard of health is recognized as a fundamental human right and is inextricably linked to progress on poverty reduction (SDG 1), nutrition (SDG 2), education (SDG 4), gender equality (SDG 5), and clean water and sanitation (SDG 6).1 Health is determined not just by access to healthcare but by the social, economic, and environmental conditions in which people are born, grow, live, and work.6 Therefore, progress on SDG 3 is both a prerequisite for and an outcome of broader sustainable development.


1.2 A Story of Uneven Progress: Global Health Trajectory (2015-2019)


The initial years of the SDG era were characterized by continued, albeit slowing, momentum from the MDG period. An examination of key indicators reveals a complex picture of both laudable achievements and concerning stagnation, painting a portrait of a world making progress but not at the speed or scale required.10


Positive Trends


Significant gains were made, particularly in areas that had been the focus of concerted global efforts, demonstrating that progress was possible when backed by political will, financing, and technological innovation.1

  • Child Survival (Target 3.2): The world made remarkable progress in reducing child mortality. The global under-5 mortality rate fell by 49% between 2000 and 2017, from 77 deaths per 1,000 live births to 39. By 2019, the rate had fallen further to 38 deaths per 1,000 live births.12 This translated into millions of young lives saved and stood as a testament to the success of interventions like vaccination, improved nutrition, and treatment for common childhood illnesses.3

  • Immunization (Target 3.b): Routine immunization, one of the most cost-effective public health interventions, saw expanded coverage. The proportion of children receiving the required three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine, a key indicator of health system performance, increased from 72% in 2000 to an impressive 86% in 2018.10 This achievement was a cornerstone of the progress in child survival.

  • HIV/AIDS (Target 3.3): The global response to HIV continued to yield positive results. Between 2010 and 2018, the incidence of new HIV infections among adults declined by 18%, with the steepest reductions (37%) occurring in the heavily burdened region of sub-Saharan Africa.10 These advances were fueled by strong international and domestic commitment to prevention, testing, and the scale-up of life-saving antiretroviral therapy.12

  • Universal Health Coverage (Target 3.8): On the crucial front of UHC, there was clear forward movement. The global UHC Service Coverage Index (SCI), which measures coverage of essential health services, improved from a score of 45 (out of 100) in 2000 to 67 in 2019. This progress was largely driven by significant gains in services for infectious diseases and newborn care.14


Stagnating or Insufficient Progress


Despite these successes, a closer look at the data reveals that in several critical areas, progress was either too slow or had begun to stall, signaling deep-seated structural challenges that would require more than targeted interventions to overcome.10

  • Maternal Mortality (Target 3.1): The global maternal mortality ratio (MMR) declined by 38% between 2000 and 2017, from 342 to 211 deaths per 100,000 live births.10 While a significant reduction, the average annual rate of decline of 2.9% was less than half the 6.4% annual rate needed to achieve the 2030 target of fewer than 70 deaths.10 This persistent and tragic loss of life pointed to enduring weaknesses in access to skilled birth attendance, antenatal care, and emergency obstetric services, particularly in sub-Saharan Africa and Southern Asia.12

  • Tuberculosis and Malaria (Target 3.3): The UN's 2019 progress report sounded an alarm that the fight against some major infectious diseases had lost momentum. Global efforts to combat malaria and tuberculosis had slowed or stalled, a worrying sign that could be attributed to a combination of factors including funding gaps, emerging drug resistance, and a potential decline in political focus.12

  • Non-Communicable Diseases (NCDs) (Target 3.4): The world was grappling with a massive, ongoing epidemiological transition that many health systems were ill-equipped to handle. While the probability of dying from one of the four main NCDs between the ages of 30 and 70 declined slightly from 22% in 2000 to 18% in 2016, this modest improvement belied the scale of the crisis.10 By 2019, NCDs accounted for over 70% of all global deaths.13 Critically, 85% of the 15 million premature NCD deaths (before age 70) occurred in low- and middle-income countries (LMICs), where health systems were often focused on infectious diseases and lacked the capacity for prevention, screening, and long-term management of chronic conditions.10

A critical analysis of these pre-pandemic trends reveals a fundamental dichotomy in global health progress. The most significant gains were concentrated in areas supported by established, often vertically-funded global health initiatives and characterized by the availability of specific technological solutions, such as vaccines provided through Gavi or antiretroviral drugs supported by The Global Fund.10 In contrast, progress was markedly slower in areas that depend on the existence of robust, integrated, and resilient health systems. Reducing maternal mortality, for instance, requires a functional continuum of care, from community-level health education to well-equipped facilities capable of performing emergency surgery.10 Similarly, managing NCDs necessitates a strong primary healthcare platform for prevention, early detection, and chronic care management.10

The faster progress in these "siloed" programs compared to the slower progress in "system-dependent" areas was not a coincidence; it was a clear indicator of a pre-existing structural weakness in the global health architecture. The world had become proficient at deploying specific tools to fight specific diseases but had underinvested in building the foundational, horizontal health systems needed to deliver holistic, comprehensive care for all. This inherent fragility meant that the global health ecosystem was dangerously vulnerable to a systemic shock. When the COVID-19 pandemic arrived, it did not merely disrupt individual programs; it fractured the entire weak foundation upon which global health progress was built, precipitating the catastrophic and multi-faceted reversals that would follow.


Section 2: The Unprecedented Shock: COVID-19's Direct and Indirect Assault on Global Health


The emergence of the novel coronavirus SARS-CoV-2 in late 2019 and its rapid global spread in 2020 unleashed an unprecedented public health crisis, the likes of which had not been seen in a century.11 The COVID-19 pandemic acted as a dual crisis: an acute infectious disease emergency that caused immense mortality and morbidity, and a chronic, systemic disruptor that crippled health services, shattered economies, and exacerbated pre-existing inequalities.9 This section analyzes the scale of this shock, first by quantifying its direct toll and then by detailing the far-reaching indirect impacts that led to a global fracture in essential healthcare delivery.


2.1 The Direct Toll: Quantifying the Mortality and Morbidity Crisis


The direct impact of the COVID-19 pandemic, measured in lives lost and people infected, was staggering. By May 2022, official records tallied over 516 million confirmed cases and 6.3 million deaths globally.17 While these figures are immense, they represent a significant undercount of the true scale of the catastrophe. From the outset, the reliability of official data was compromised by vast disparities in testing capacity, variations in how deaths were classified and reported, and the fact that many infections, particularly asymptomatic ones, were never identified.18

To capture the full scope of the pandemic's lethality, the concept of "excess mortality" is indispensable. This metric compares the total number of deaths from all causes during the pandemic period with the number of deaths that would have been expected based on historical trends.18 It is the single most important measure of the pandemic's impact, as it transcends the political and logistical limitations of official COVID-19 death counts. The World Health Organization (WHO) calculated that in 2020 and 2021 combined, there were approximately 15 million excess deaths globally.20 This figure is more than double the official reported COVID-19 death toll for that period and reveals the true, devastating cost of the crisis.

Crucially, this excess mortality figure comprises two components: deaths directly caused by COVID-19 that went unreported, and deaths indirectly caused by the pandemic's overwhelming effect on health systems and society.20 This reveals that the pandemic's deadliest effect was not just the virus itself, but its ability to trigger a total system collapse, leading to a massive wave of "collateral damage" deaths from otherwise treatable and preventable conditions.

The burden of this crisis was not borne equally. The virus disproportionately affected the most vulnerable populations. In the United States, for example, adults over the age of 65 accounted for more than 81% of COVID-19 deaths.21 Individuals with underlying non-communicable diseases (NCDs)—such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer—were at a much higher risk of developing severe illness and dying from the virus.13 The geographic distribution of the impact was also highly uneven. While the pandemic was global, the excess death rate—a relative measure of deaths per 100,000 people—was highest in countries in Latin America and Eastern Europe, including Peru, Bulgaria, and Bolivia, highlighting significant regional disparities in health system resilience and response capacity.20


2.2 The Systemic Fracture: Widespread Disruption of Essential Health Services


Beyond the direct toll of the virus, the pandemic's most insidious impact was the profound and prolonged disruption of essential health services worldwide. This systemic fracture reversed hard-won gains and threatened the health and well-being of millions who were not infected with COVID-19.

The scope of this disruption was nearly universal. WHO pulse surveys conducted throughout the pandemic consistently revealed a grim picture. In the first quarter of 2021, over a year into the crisis, about 90% of countries were still reporting one or more disruptions to their essential health services, a figure that showed no substantial global improvement from the first survey in 2020.22 A subsequent survey at the end of 2021 confirmed that these severe impacts persisted, with little to no recovery observed.23 This demonstrates the chronic and pervasive nature of the crisis, which extended far beyond the initial emergency phase.

The mechanisms driving this disruption were multifaceted and interconnected:

  • Resource Diversion: Health systems globally were forced into an emergency footing, diverting immense resources to the COVID-19 response. In 94% of countries, ministry of health staff working on NCDs were reassigned to support the pandemic effort.24 Hospital beds were converted to COVID-19 wards, and vital supplies like personal protective equipment (PPE) and ventilators were rerouted, creating shortages for non-COVID care.25

  • Access Barriers: Public health measures designed to curb transmission, such as lockdowns and restrictions on movement, created significant barriers to care. Patients were often unable or afraid to visit healthcare facilities due to transport cancellations or the fear of contracting the virus in a clinical setting.10 This led to a dramatic drop in utilization of services; for example, during the initial surges in the U.S., emergency department visits for heart attacks fell by 23% and for strokes by 20%.29

  • Financial Collapse: The pandemic inflicted a catastrophic financial blow on hospitals and health systems. The cancellation of non-emergency and elective procedures, a primary source of revenue, combined with the soaring costs of treating COVID-19 patients and procuring supplies, created a perfect financial storm.30 Hospitals in the United States, for instance, were estimated to have lost a staggering $202.6 billion between March and June 2020 alone.30 This financial instability threatened the very viability of healthcare providers, particularly in rural and underserved areas.32

The disruptions were felt across all levels of the healthcare system. More than half of countries surveyed in late 2021 reported that many people were still unable to access care at the primary and community levels.23 Even critical emergency care was compromised, with 36% of countries reporting disruptions to ambulance services and 23% to emergency surgeries.23

This evidence reframes the nature of the pandemic. It was not simply a communicable disease crisis; it was a profound health systems resilience crisis. The massive strain placed on hospitals and public health infrastructure directly led to a decline in care for a host of other life-threatening conditions. A significant portion of the 15 million excess deaths were people who died from heart attacks, strokes, diabetic complications, untreated cancers, and other preventable causes because the system designed to save them was overwhelmed and unable to function.24 This reality has critical implications for recovery and future preparedness, demanding a focus that extends beyond disease surveillance to the strengthening of the foundational pillars of healthcare delivery, as envisioned in SDG targets 3.8 (UHC), 3.c (health workforce), and 3.d (emergency preparedness).


Section 3: A Target-by-Target Analysis of Pandemic-Induced Regression


The systemic shock of the COVID-19 pandemic reverberated across every facet of global health, causing significant regression on nearly all key targets of SDG 3. The crisis not only halted progress but actively reversed years of hard-won gains, pushing the 2030 goals further out of reach. This section provides a granular, evidence-based assessment of the damage inflicted across the core pillars of SDG 3, using a comparative pre- versus post-pandemic framework to quantify the scale of the setbacks.

The following dashboard provides a high-level summary of the pandemic's impact on key SDG 3 indicators, illustrating the stark contrast between the pre-pandemic trajectory, the acute disruption phase, and the current state of recovery.

Table 1: SDG 3 Key Indicator Dashboard: Pre-Pandemic vs. Post-Pandemic Status


SDG Target

Indicator

Pre-Pandemic Status (c. 2019)

Pandemic-Era Low (c. 2020-21)

Current Status (2023-24 Data)

2030 Target

3.1

Maternal Mortality Ratio (per 100,000 live births)

211 (2017) 10

223 (2020) 7

197 (2023) 7

<70

3.2

Under-5 Mortality Rate (per 1,000 live births)

39 (2017) 12

37 (2020) 7

37 (2023) 7

≤25

3.3

TB Deaths (millions)

1.2 (2019) 7

1.3 (2020) 7

1.25 (2023) 33

End Epidemic

3.3

Malaria Cases (millions)

232 (2019) 20

247 (2021) 20

263 (2023) 33

End Epidemic

3.4

Premature NCD Mortality (% probability)

18% (2016) 10

Stalled/Worsened 34

Off-track 34

Reduce by 1/3

3.8

UHC Service Coverage Index

67 (2019) 14

Stalled/Reversed 7

Stagnated 34

Universal Coverage

3.b

DTP3 Immunization Coverage (%)

86% (2019) 10

81% (2021) 38

84% (2023) 33

≥90%


3.1 Maternal, Newborn, and Child Health (Targets 3.1, 3.2): A Decade of Gains Erased


Early in the pandemic, global health bodies issued stark warnings that disruptions to routine health care and decreased access to food could be devastating for maternal and child health.10 Models predicted that in 118 low- and middle-income countries, even moderate disruptions could lead to hundreds of thousands of additional under-5 deaths and tens of thousands of additional maternal deaths in 2020 alone.10

These fears were realized. Progress in reducing maternal mortality, already lagging, came to a near standstill. The global maternal mortality ratio, which stood at 227 per 100,000 live births in 2015, barely moved to 223 in 2020.7 While the latest data for 2023 shows a welcome decline to 197, the pace of progress remains critically insufficient.7 To reach the 2030 target of less than 70, the world now needs to achieve an annual rate of reduction of 11.6%—a rate that is historically unprecedented and far exceeds the pre-pandemic trend.7 Similarly, disruptions to family planning services threatened to cause millions of unintended pregnancies, further increasing risks for maternal health.10

For child health, while the overall under-5 mortality rate did not see a sharp global increase, the pandemic effectively erased years of progress by slowing the rate of decline.7 In 2020 alone, 5 million children died before their fifth birthday, a stark reminder of the fragility of the gains made over the previous two decades.7


3.2 The Resurgence of Epidemics (Target 3.3): A Setback for Global Health Security


The pandemic's disruption of health services had a catastrophic effect on the control of other major infectious diseases, leading to a resurgence that threatens global health security.

  • Tuberculosis (TB): For the first time in over a decade, global deaths from TB increased, rising from 1.2 million in 2019 to 1.3 million in 2020.7 By 2023, TB had likely returned to its status as the world's leading cause of death from a single infectious agent.33 The number of people newly diagnosed with TB hit a record high of 8.2 million in 2023, a 15% increase from 2019.7 This surge reflects a combination of infections that went undiagnosed during the pandemic lockdowns and a backlog of cases now entering a strained healthcare system.

  • Malaria: The fight against malaria suffered a significant blow. In 2020, there were an estimated 14 million more malaria cases and 69,000 more deaths compared to 2019, with approximately two-thirds of these additional deaths directly linked to disruptions in prevention, diagnosis, and treatment services.7 The situation has not improved; by 2023, the number of malaria cases had risen to 263 million, an increase from the 226 million cases reported in the 2015 baseline year.33

  • HIV: While the long-term trend of declining new HIV infections continued, the pandemic posed a grave threat. Models indicated that a six-month complete disruption in access to antiretroviral therapy in sub-Saharan Africa could lead to over 500,000 additional AIDS-related deaths in 2020–2021.10 This highlighted the precarious situation of millions of people dependent on uninterrupted access to life-saving treatment.


3.3 The Silent Pandemic: Non-Communicable Diseases & Mental Health (Target 3.4)


The COVID-19 pandemic severely impacted the prevention and treatment of NCDs, a crisis often termed the "silent pandemic." Health services for these chronic conditions were among the most severely disrupted. A WHO survey found that services for hypertension were disrupted in 53% of countries, for diabetes and its complications in 49%, and for cancer treatment in 42%.24

This disruption has dire long-term consequences. The world is unequivocally not on track to meet the SDG target of reducing premature NCD mortality by one-third by 2030.34 In 2021, an estimated 18 million people under the age of 70 died from NCDs, accounting for more than half of all premature deaths globally.34

Furthermore, the pandemic triggered a profound global mental health crisis. The unprecedented stress from social isolation, fear of illness, and economic turmoil led to a 25% increase in the global prevalence of anxiety and depression in the first year of the pandemic alone.40 This surge has placed immense strain on already under-resourced mental health services and has had a particularly severe impact on the well-being of young people.40


3.4 Universal Health Coverage (Target 3.8): Progress Halted, Inequities Deepened


Progress towards UHC, the cornerstone of SDG 3, had already slowed before 2020, and the pandemic brought it to a grinding halt, and in many cases, reversed it.34 The crisis exposed the fragility of health systems and deepened existing inequalities.

The financial protection aspect of UHC was severely undermined. The economic shock of the pandemic pushed tens of millions of people into extreme poverty, while out-of-pocket health expenditures continued to drive financial hardship.16 Even before the pandemic, in 2019, an estimated 344 million people were pushed or further pushed into extreme poverty due to health costs.34 The pandemic exacerbated this, as individuals faced the dual burden of income loss and the potential for catastrophic health spending.43

The pandemic also laid bare the deep inequities in access to care. Service coverage for reproductive, maternal, and child health services consistently remains lower among poorer, less educated, and rural populations, especially in low-income countries.34 The inequitable distribution of COVID-19 vaccines and treatments was a stark global manifestation of this challenge, demonstrating that without a deliberate focus on equity, UHC remains an elusive goal.45

The pandemic's impact created a devastating feedback loop between communicable and non-communicable diseases. The high global prevalence of NCDs acted as a major risk amplifier, as individuals with these underlying conditions were far more vulnerable to severe illness and death from COVID-19.13 This reality meant that the NCD crisis (Target 3.4) significantly worsened the mortality of the COVID-19 crisis (Target 3.3). In turn, the global response to the pandemic, with its necessary focus on the acute infectious threat, led to the widespread and prolonged disruption of NCD prevention and treatment services.13 This interruption in care is projected to fuel higher rates of advanced disease, more complications, and increased premature mortality from NCDs for years to come. This vicious cycle underscores the fallacy of a disease-specific, vertical approach to health security. A resilient health system must be capable of managing both acute infectious threats and the chronic burden of NCDs simultaneously. Future pandemic preparedness strategies (Target 3.d) must therefore explicitly include robust plans for maintaining the continuity of essential NCD services; otherwise, this destructive cycle will inevitably repeat itself with even more tragic consequences.


Section 4: The State of Recovery and the Lingering Scars (2022-Present)


As the world moves beyond the acute phase of the COVID-19 pandemic, the global health landscape is defined by a fragile, uneven, and incomplete recovery. While some top-line indicators have begun to rebound, a closer examination reveals deep and persistent scars on health systems, a depleted workforce, and the emergence of new, troubling health trends. The progress lost during the pandemic has not been fully regained, and the long-term consequences continue to unfold, posing significant challenges to the achievement of SDG 3.


4.1 A Fragile Rebound: Life Expectancy and Mortality Trends


One of the most dramatic impacts of the pandemic was on global life expectancy. Between 2019 and 2021, global life expectancy at birth fell by 1.8 years, plummeting to 71.4 years—a level last seen in 2012 and the largest drop in recent history.39 This single metric encapsulates the reversal of nearly a decade of health gains. Since the end of the pandemic's acute phase, life expectancy has begun to rebound, reaching an estimated 73.3 years in 2024.39

However, this aggregate recovery masks a deeply concerning new trend: a reversal in mortality improvements among teenagers and young adults (approximately ages 10-29).41 For decades, this demographic had seen some of the fastest declines in mortality. Now, in many parts of the world, death rates for this group are falling more slowly than for older cohorts, and in some regions, they are actively rising. The drivers of this trend vary by region. In North America and parts of Latin America, the increase is strongly linked to a worsening mental health crisis, manifesting in rising deaths from suicide, drug overdoses, and alcohol misuse. In contrast, in low-income settings, particularly sub-Saharan Africa, the leading causes remain preventable infectious diseases, unintentional injuries, and gaps in health systems, such as inadequate access to emergency care and maternal health services.41 This emerging crisis among the world's youth represents a significant long-term threat to human capital and sustainable development.


4.2 The Immunization Gap: A Persistent Threat


The pandemic delivered a devastating blow to routine childhood immunization programs, causing the largest sustained decline in vaccinations in three decades.37 This backsliding left millions of children vulnerable to deadly but preventable diseases like measles, polio, and meningitis.37

Critically, immunization coverage has not fully recovered to pre-pandemic levels. The coverage of the third dose of the DTP vaccine (DTP3), a key barometer of routine immunization system performance, fell from a high of 86% in 2019 to a low of 81% in 2021.37 By 2023, it had only recovered to 84%.33 This persistent 2-percentage-point gap means that in 2023, there were 2.7 million more unvaccinated or under-vaccinated children than there were in 2019.39 This "immunization gap" has already had predictable and tragic consequences, fueling a resurgence of vaccine-preventable diseases. Serious and deadly measles outbreaks have been reported in countries such as the Democratic Republic of the Congo, Pakistan, and Yemen, with health agencies warning of further outbreaks as the number of susceptible children grows.49

The failure of routine immunization to fully recover is a leading indicator of deep and persistent health system scarring. Unlike acute care metrics, which can rebound more quickly as patient volumes return to normal, immunization coverage is a measure of the health system's proactive reach, its logistical capacity, and its relationship of trust with the community. Its continued deficit is not merely a technical problem but a symptom of a much larger issue: a degradation of primary healthcare (PHC) infrastructure and a potential erosion of public trust in health services. This single lagging indicator is a bellwether for the overall health of the system. A system that cannot consistently deliver a basic, life-saving intervention like a vaccine is a system that will struggle to provide quality maternal care, manage chronic diseases, or respond effectively to the next health emergency. The recovery of this indicator is thus a critical test for the recovery of SDG 3 as a whole.


4.3 A Depleted Health Workforce and Strained Systems


The foundation of any resilient health system is its workforce, and the pandemic pushed health and care workers to their limits and beyond. The crisis exacerbated pre-existing shortages through immense physical and mental strain, leading to burnout, illness, and death.30 Health workers left the profession in significant numbers, citing burnout, anxiety, and depression as primary reasons.30

The global health workforce now faces a severe and growing crisis. A global shortage of 14.7 million health workers was recorded in 2023, a figure that is projected to decline only gradually to 11.1 million by 2030.33 This shortfall is not evenly distributed; over half of the projected 2030 gap will be in the African and Eastern Mediterranean regions, precisely where the health needs are greatest.7 This massive human resource deficit represents a fundamental structural barrier to achieving UHC and nearly every other target within SDG 3.

Health systems that are understaffed and under-resourced are now facing a dual burden. They must contend with the immense backlog of deferred care from the pandemic years—including delayed cancer screenings, postponed surgeries, and interrupted management of chronic diseases—which is leading to patients presenting with more advanced and complex conditions.30 Simultaneously, they must manage the long-term health consequences of COVID-19 itself. "Long COVID," a condition with a wide range of debilitating symptoms that can persist for months or years, is placing a new and significant demand on health services, requiring multidisciplinary care for which many systems are unprepared.30 This combination of a depleted workforce and increased demand creates a perilous situation that threatens the sustainability of health systems and further impedes the recovery of SDG 3 progress.


Section 5: The Path to 2030: An Outlook Under Duress


As the 2030 deadline for the Sustainable Development Goals approaches, the global health community confronts a sobering reality. The COVID-19 pandemic has inflicted a severe and lasting setback, derailing progress and exposing the profound fragility of global health systems. A "business-as-usual" recovery will be wholly inadequate to reclaim the lost ground. The final years of the 2030 Agenda demand a radical acceleration of effort, backed by transformative shifts in policy, financing, and international cooperation. This final section synthesizes the report's findings to provide a clear-eyed assessment of the future and outlines the strategic imperatives required to navigate the arduous path ahead.


5.1 The Sobering Reality: Projections for 2030


The world is severely off track to achieve the health-related goals set for 2030. Midpoint assessments conducted in 2023 painted a stark picture: only about 15% of the health-related SDG targets were on track, with less than a third considered likely to be achieved by the deadline.35 The UN's 2025 progress report, covering all SDGs, found that only 35% of assessable targets are on track or making moderate progress, while nearly half show significant deviation from the desired trajectory.53 For health, the pandemic has not just slowed progress; it has caused a regression that will take years, and in some cases more than a decade, to reverse, making the 2030 targets "almost unlikely to reach" without a fundamental change in approach and investment.13

The economic scarring from the pandemic presents a formidable barrier. The global recession shrank government revenues and constrained fiscal space, particularly in low- and lower-middle-income countries (LMICs).55 This has created massive financing gaps for health and other essential services. Projections indicate that in 41 countries, government spending is expected to remain below pre-COVID-19 levels until at least 2027, severely restricting their ability to invest in health system recovery and expansion.56 This fiscal constraint, coupled with rising debt burdens, threatens to lock in the inequalities exacerbated by the pandemic and leave the most vulnerable populations even further behind.55


5.2 Strategic Imperatives for a Resilient and Equitable Recovery


Navigating this challenging landscape requires a decisive shift from short-term crisis response to long-term strategic investment in building resilient and equitable health systems. Four key imperatives must guide this effort:

  1. Recommit to Universal Health Coverage as the North Star: The pandemic was a brutal lesson in the importance of UHC. Countries with stronger, more equitable health systems were better able to withstand the shock. UHC (Target 3.8) must be treated not as just one target among many, but as the central organizing principle for achieving all of SDG 3.13 This requires a renewed and intensified focus on strengthening Primary Health Care (PHC) as the accessible, people-centered foundation of the entire health system. A robust PHC platform is essential for everything from routine immunization and maternal care to NCD management and early detection of disease outbreaks.34

  2. Close the Health Financing Gap: Achieving UHC and the broader SDG 3 targets is impossible without a massive increase in health financing. This requires a dual approach. Domestically, governments must increase public spending on health, improve the efficiency of that spending, and explore innovative financing reforms.56 Internationally, development partners must provide sustained, predictable, and better-aligned financial support, particularly for the poorest countries.55 The pandemic demonstrated that underinvestment in health is not a saving but a catastrophic economic and social liability. Investing in health systems is a fundamental investment in economic productivity, stability, and shared prosperity.56

  3. Invest in the Health and Care Workforce: The projected shortfall of 11.1 million health workers by 2030 is a crisis that must be addressed with the utmost urgency.7 This is the human infrastructure upon which all health services depend. A massive, coordinated global effort is needed to increase investment in the education, training, recruitment, and retention of health professionals. This must include ensuring decent working conditions, fair pay, and adequate occupational safety and mental health support to stop the exodus of workers from the profession.26

  4. Build a New Architecture for Global Health Security: The pandemic exposed a global health security system that was not fit for purpose. The catastrophic inequities in access to vaccines, diagnostics, and therapeutics were a moral and strategic failure that prolonged the pandemic and deepened global divisions.45 The greatest long-term threat to achieving SDG 3 is not the direct epidemiological legacy of COVID-19, but the erosion of multilateralism and trust that resulted from this inequitable response. Rebuilding this trust is a prerequisite for the global cooperation needed to tackle all other transboundary health challenges, from climate change to antimicrobial resistance. The ongoing negotiations for a new international Pandemic Agreement represent a critical opportunity to forge a new framework based on solidarity, equity, and enforceable commitments to ensure that the tragic failures of the COVID-19 response are "never again" repeated.33 The success of this process—in creating a truly equitable system for sharing pathogens and the benefits derived from them, including life-saving countermeasures—is a political test of whether the world can repair its broken trust. It is the primary mechanism for rebuilding the intangible infrastructure of cooperation essential for achieving the entirety of the SDG 3 agenda.


5.3 Conclusion: From Crisis to Catalyst


The COVID-19 pandemic was a devastating setback for Sustainable Development Goal 3. It reversed hard-won progress, claimed millions of lives, and exposed deep-seated vulnerabilities in the world's health systems and its mechanisms for global cooperation. The path to 2030 is now steeper and more fraught with challenges than ever before.

However, a crisis of this magnitude can also serve as a powerful catalyst for transformative change.45 The pandemic provided undeniable, painful proof that health is the bedrock of stable, prosperous, and resilient societies. It demonstrated that underinvestment in public health is an unaffordable risk and that global health security is only as strong as its weakest link. The final five years of the 2030 Agenda demand a level of political will, financial investment, and multilateral collaboration that has thus far been lacking. The choice facing the global community is not between recovery and inaction, but between a return to a fragile and inequitable status quo and the collective resolve to build the resilient, equitable, and people-centered health systems required to ensure health and well-being for all and to prepare for the inevitable crises yet to come. The 2030 Agenda remains the best blueprint for this future, but its promise can only be realized if the lessons of the pandemic are translated into a decade of truly transformative action.45

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