Learning from the OECD Strategic Joint Evaluation of the Collective International Development and Humanitarian Assistance Response to the COVID-19 Pandemic

To promote the use of evaluation findings in future global health emergencies, the Independent Evaluation Department of Norwegian Development Cooperation (Eval), the Norwegian Agency for Development Cooperation (Norad), and the Norwegian Institute of Public Health (NIPH) jointly hosted a seminar on Global Health Security in April 2026. The in-person seminar was held in parallel with the ongoing development of the Norwegian Global Health Security (GHS) strategy, led by the Ministry of Foreign Affairs and the Ministry of Health and Care Services.

Participants comprised a small, selected group of representatives from Norwegian ministries, development cooperation administration, and academia, as well as Norwegian civil society organisations and think tanks. This summary highlights key lessons from the evaluation and the COVID-19 pandemic, and identifies perspectives, tensions, and unresolved questions that emerged during the seminar discussions.

Discussions repeatedly returned to the interplay between national interests and the promotion of global public goods as underlying goals of the emerging GHS strategy, and why conceptual clarity between the two matters. Seminar discussions on efforts to promote access to vaccines during the COVID-19 pandemic brought this tension to the fore.

While mechanisms such as the COVID-19 Vaccines Global Access Facility (COVAX) — funded by Norway and other countries — aimed to promote vaccine equity, many of the same countries, Norway included, secured early access through pre-purchase agreements, sometimes procuring many times the doses needed to cover their entire populations.

The resulting disparities were stark: by the end of 2022, low-income countries had received approximately 34 vaccine doses per 100 people, compared with 212 doses per 100 people in high-income countries. Some participants argued that this approach not only undermined Norwegian development cooperation during the pandemic but ultimately backfired from a national interest perspective by prolonging the global crisis.

Others contended that early domestic access was critical to Norway’s interests and reduced severe illness and mortality. These discussions revealed nuances in what “national interests” imply and entail, and how their conceptualisation may vary across ministries, agencies, civil society, and private-sector actors.

Despite divergent views, there was broad agreement on the need for clearer definitions of core concepts and greater transparency around trade-offs, as prerequisites for trust, policy coherence, and legitimacy in the emerging GHS strategy and in future global health emergencies.

Questions for further consideration

• How should Norway conceptualise and balance national interests and global solidarity in its GHS strategy?
• How should the costs and benefits of development assistance be assessed and weighed from a national interest perspective, beyond its humanitarian objectives?

Participants echoed OECD findings that preparedness is essential and cannot be improvised during crises. The difficulty of sustaining political and financial attention between crises and during “peacetime” was highlighted and linked to recurring cycles of panic and neglect.

OECD findings reinforce this concern: despite record-high assistance to developing countries in 2020 (USD 289 billion), health-sector support in many countries declined to pre-pandemic levels or below by 2023. Discussions highlighted system-level investments as central to strengthening prevention, preparedness, and crisis management.

Suggested approaches included embedding crisis-relevant monitoring within routine health and system-building efforts, rather than relying on ad hoc emergency responses. Strengthening absorption capacity, to ensure effective reach and uptake during emergencies, was also emphasised. In addition to pandemic-related preparedness, others stressed broader system-building, pointing to investments in healthy and resilient communities as a means of preventing and mitigating health emergencies.

Some participants also questioned whether the notion of “peacetime” adequately reflects the realities of partner countries facing multiple and overlapping crises, where sustaining health systems and strengthening preparedness are particularly challenging.

Question for further consideration

• How can the GHS strategy support sustained investment in prevention and preparedness, including in settings affected by chronic and overlapping emergencies?

Global health emergencies were understood not only as epidemiological crises but also as geopolitical events requiring leadership and international coordination.

While the central role of the World Health Organization (WHO) was recognised, participants noted limitations in its response, including its political authority and convening capacity, both before and during the COVID-19 pandemic and today.

The OECD evaluation highlights findings related to the speed, effectiveness, and reach of international assistance during the pandemic. While bilateral delivery of supplies and vaccines could enhance speed through existing channels, it may also risk fragmentation and inefficient delivery arrangements when not well aligned with multilateral and partner responses.

Concerns about effective reach were also raised in discussions of multilateral initiatives such as the Access to COVID-19 Tools Accelerator (ACT-A) and COVAX, which were explicitly designed to address inequities within the global health architecture. Participants questioned whether these initiatives succeeded in countering existing structural dynamics, noting how funding and delivery delays undermined trust and credibility in international cooperation.

As such, discussions surfaced broader questions about expectations and benchmarks for “success” and “failure” in international crisis responses, particularly with regard to timeliness and solidarity in delivery and support. Participants also reflected on leadership and coordination at regional and national levels.

New coordination arrangements introduced since COVID-19 were seen as having the potential to strengthen preparedness and response, while also risking greater complexity within the international institutional landscape. At the domestic level in Norway, interministerial coherence and political pressure were highlighted as key factors shaping response choices, echoing earlier discussions on what national interests entail.

Question for further consideration

• How should Norway engage with the WHO and other partners to support effective leadership and coordination in ways that promote effective delivery while building solidarity and trust?

Discussions highlighted unresolved questions regarding the role, influence, and governance of the private sector in GHS, including public — private partnerships. Participants debated whether market-shaping tools such as COVAX can deliver equitable access under conditions of scarcity and uneven competition, or whether they are more likely to function as distribution mechanisms once demand from high-income countries has been met.

Concerns were also raised about the large volumes of public financing flowing to for-profit entities, for example to support manufacturing, and whether the public returns on these investments are sufficiently defined, transparent, and accountable. Some participants also noted that the private sector remains largely absent from political negotiation and coordination arenas. In fact, no private-sector actors were invited to this seminar.

Future discussions should consider these perspectives to shed further light on questions of governance, equity, and responsibility, particularly in contexts where public financing is substantial but public control remains limited.

Question for further consideration

• How should Norway approach private-sector engagement, regulation, and market-based tools in relation to GHS?

The principle that evidence and lessons from past health emergencies should inform the emerging GHS strategy was uncontested, and participants welcomed the structured learning opportunity provided by the seminar.

Two critical challenges were highlighted: ensuring that existing knowledge is mobilised and translated quickly enough to inform decision-making during crises, and designing strategies that remain sufficiently flexible to respond to emergencies that differ in nature, scale, and trajectory. Several participants cautioned against preparing for future crises as if they were repetitions of COVID-19, particularly against assuming a vaccine-centric response pathway.

Discussions underscored that, while the specific characteristics of crises may vary, certain dilemmas, trade-offs, and vulnerabilities tend to recur across contexts.

In many instances, participants noted that the core challenge is not a lack of evidence, but the difficulty of translating existing knowledge into timely and context-appropriate action under conditions of uncertainty.

Question for further consideration

• How can the GHS strategy be designed to support adaptive, evidence-informed responses across diverse crisis scenarios?