Pre- and post-pandemic health and wellness cooperation FIGURE 11 0.601.202022-23 average1.00 0.95 0.90 0.85 0.80 0.650.700.751.051.101.15Most metrics are in line with pre-pandemic trends – except assistance and pharma R&D Index averages 2018-19 average0.45 0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90 0.95 1.00 1.05 1.10 1.15 1.20 45° line, where 2022-23 average = 2018-19 averageMaternal mortalityHigher post-2020 Lower post-2020Cross-border ﬂows of pharma R&D/intellectual property (IP)Health development assistanceTrade in health goodsInternational health regulationsChild mortalityDALYs Life expectancy Sources: United Nations (UN), Institute for Health Metrics and Evaluation (IHME), Policy Cures Research, World Health Organization (WHO), UN Comtrade, McKinsey & Company analysis.There were other indications of flagging advancement in cooperation actions. For instance, trade in health-related goods, like most goods trade, fell this past year. International Health Regulations scores also declined, a sign that public health capacity was stagnating or falling around the world. Furthermore, the World Health Assembly (WHA) failed to align on a Pandemic Agreement (a comprehensive, binding framework under the WHO constitution to better prevent, prepare for and respond to future pandemics). The latter is a stark example of challenges in post-pandemic global cooperation on health and particularly concerning given the recent re-emergence of Mpox. Additionally, the growing number and protracted nature of conflicts around the world could have a major negative effect on global health outcomes, both from the physical impacts of conflict and the cascading disruptions to health systems.46 Looking ahead, actors will need to build cooperative mechanisms to protect against global health threats so that they bolster their own health systems. Over the next 25 years, the global population aged 60 and over is projected to double. This means that many economies will need to share best practices for developing health systems that are sustainable and can support this burgeoning ageing population while they collaborate on addressing near-term global health risks.47 The Global Cooperation Barometer 2025 Second Edition 19