Health systems in the ACT-A.

The attention to health systems in the headline of Ann Usher's World Report about the Access to COVID-19 Tools Accelerator (ACT-A) is most welcome. However, we were disappointed that the World Report focused on medical oxygen and personal protective equipment (PPE), interventions that, although important, are better described as components of clinical care. Unlimited medical oxygen and PPE will not benefit populations that are affected by COVID-19 if health facilities do not have enough staff or funding for other equipment, drugs, utilities, and transport, or if they have lost most supplies to pilfering. Additionally, populations will not benefit if health managers cannot effectively prepare budgets, use most of their recurrent budget on salaries, or do not reliably collect or use local data for outbreak identification, priority setting, and resource allocation.

COVID-19 and the ACT-A provide an enormous opportunity for strengthening health systems. There has arguably never been such an obvious, globally applicable rationale for universal coverage of and access (ie, financial and physical) to basic health services, essential public health functions, and advanced health care that is affordable for people who are very sick. The observed collapse in essential basic services, delayed management of illnesses other than COVID-19, and the inability of many countries' health systems to mount an effective response to the pandemic have exposed the fragility of the global health sector. Had this pandemic involved a more lethal virus than SARS-CoV-2, then the consequences would have been even more dire.

The diagnostics, treatments, and vaccines that are being developed with ACT-A funding all depend on strong health systems for their efficient and effective introduction. A WHO–UNICEF operational framework described a health-systems approach to universal coverage of quality primary care and essential public health functions and provided related guidance for governments, donors, and partners. Funding this approach, in addition to medical oxygen and PPE, should be prioritised by the ACT-A.

We declare no competing interests.