Ten years is long enough to forget what the starting line looked like. In 2016, there was no licensed vaccine against malaria in use, no licensed Ebola vaccine, and the idea that a weekly injection for obesity would become one of the most in-demand medicines on earth would have sounded like a pitch deck. The word “pandemic” was something epidemiologists warned about in reports that governments filed away.
This is a then-vs-now look at the last decade in health, restricted to things we could verify. It is not a complete list. It is a set of before-and-after snapshots, and several of them do not point in the direction people expect.
Life expectancy: a decade that went backwards before it went forwards
Then: Global life expectancy was rising steadily, as it had for decades.
Now: The WHO’s World Health Statistics 2025 report found that between 2019 and 2021, global life expectancy fell by 1.8 years to 71.4 years, the largest drop in recent history and a return to the level of 2012. The report also described a longer-running slowdown in progress that began before the pandemic, followed by a slow recovery.
The lesson is uncomfortable. A decade that brought extraordinary medical innovation also delivered the biggest reversal in global life expectancy in living memory. Progress is not automatic, and shocks can erase years of gains in a very short time.
Child survival: still improving, but more slowly
Then: The Millennium Development Goals had just ended in 2015 with child mortality dramatically lower than in 1990.
Now: According to the UN Inter-agency Group for Child Mortality Estimation, an estimated 4.8 million children died before their fifth birthday in 2023. But its report also found that the annual rate of reduction in under-five mortality in the SDG era (2015 to 2023) was 42% lower than in the MDG era (2000 to 2015). Sixty countries are projected to miss the 2030 target if current trends continue.
The number is better. The speed is worse.
Malaria vaccines: from none to two
Then: No malaria vaccine was recommended for widespread use. Pilots of the RTS,S vaccine were still being planned.
Now: The WHO recommended RTS,S/AS01 for broader use among children in malaria-endemic regions in October 2021, and recommended a second vaccine, R21/Matrix-M, in October 2023. Both are now being rolled out in routine childhood immunisation in several African countries.
These vaccines are not silver bullets; their protection is partial and requires multiple doses. But going from zero to two recommended vaccines against the parasite that causes malaria is one of the genuine landmarks of the decade.
Ebola: from outbreak response to a vaccine
Then: West Africa was emerging from the 2014-2016 Ebola epidemic, the largest in history, which was fought without a licensed vaccine.
Now: Ervebo, a vaccine against the Zaire strain of Ebola, was approved by the US FDA in December 2019 after being deployed under emergency protocols in earlier outbreaks. Ebola outbreaks still happen, but responders now arrive with a vaccine.
Obesity drugs: from niche to mass market
Then: Semaglutide was not yet approved for any indication. Obesity pharmacotherapy was a small, disappointing field.
Now: Semaglutide was approved by the FDA for chronic weight management, as Wegovy, in June 2021. GLP-1 based drugs have since reshaped conversations about obesity, diabetes, cardiovascular risk and health budgets. In 2026, core semaglutide patents expired in several large markets, including India and China, and generic versions launched in India in the first quarter of the year.
The then-vs-now contrast here is less about the science than about cost. The question has shifted from “does this work?” to “who can afford it, and for how long?”
AI in medical devices: from curiosity to routine
Then: Artificial intelligence in regulated medical devices was a small and mostly experimental category.
Now: The US FDA’s public list of AI-enabled medical devices has passed 1,000 authorisations, with the large majority granted in the past decade. Most are in radiology. Whether these tools are improving patient outcomes at scale is a separate, and much less settled, question.
HPV vaccination: one dose instead of several
Then: HPV vaccine schedules required two or three doses, a major barrier in low-income settings.
Now: In 2022 the WHO updated its guidance to say a single dose could be used for girls and young women in certain age groups. That change simplified delivery and stretched limited supply further, which matters for a vaccine that prevents cervical cancer.
Paying for value: a threshold that finally moved
Then: NICE in England used a cost-effectiveness threshold of £20,000 to £30,000 per quality-adjusted life year, as it had for years.
Now: From April 2026, the threshold is £25,000 to £35,000 per QALY, the first change in more than two decades, following an announcement made in the context of a US-UK agreement on pharmaceuticals in December 2025.
Global health governance: a different map
Then: The United States was the WHO’s largest single funder and a founding member.
Now: The US government gave notice in January 2025 that it would withdraw from the WHO, with the withdrawal taking effect in January 2026. The financial and political consequences for global health cooperation are still unfolding.
Pandemic rules: from paper to a treaty
Then: The International Health Regulations were the main legal framework for outbreaks, and there was no global treaty on pandemic preparedness.
Now: In May 2025, the World Health Assembly adopted the WHO Pandemic Agreement, after more than three years of negotiation prompted by COVID-19. Some of the hardest questions, including how countries share pathogen samples and the benefits that flow from them, were left to a further annex to be negotiated afterwards. Meanwhile, the WHO declared mpox a public health emergency of international concern twice in the decade, in 2022 and again in 2024.
The contrast with 2016 is striking. Then, a pandemic was a scenario. Now, the world has lived through one, written a treaty in response, and discovered how difficult it is to agree on the details that decide whether the treaty changes anything.
Why tools raced ahead of systems
The pattern in these snapshots is not an accident, and it is worth understanding the mechanism rather than just observing it.
New tools have concentrated backers. A vaccine or drug has a developer with a strong financial reason to push it through regulators, and often a global funder with a clear, countable goal. Its success can be measured in a trial with a start and an end. Its approval is a single event that makes headlines.
Systems have no equivalent champion. Nobody holds a patent on a functioning primary care network, a reliable supply chain or a well-paid rural workforce. Their benefits are diffuse and slow, and they compete for money every year against everything else a government funds. When budgets tighten, as they did after the pandemic in many countries, systems are what get cut, because the damage takes years to show.
The malaria vaccines illustrate the gap well. The science took decades, and the WHO recommendations in 2021 and 2023 were landmarks. But a vaccine given in multiple doses across the first years of life depends on the routine immunisation system being able to reach the same child several times. Cameroon became the first country to add a malaria vaccine to its routine childhood schedule in January 2024, and other African countries have followed. How many children actually complete the schedule will depend less on the vaccine than on the clinics delivering it.
The same logic applies to semaglutide. The approval of Wegovy in 2021 was the tool. What happens now that generics are arriving in large markets is a question for systems: who prescribes, who pays, who monitors people over years of treatment, and what happens when they stop.
The strongest objection to our reading
It would be fair to push back on the framing that systems failed. Several things on this list are system achievements, not just tool achievements. The single-dose HPV recommendation was a policy decision that made an existing tool far easier to deliver. The change to NICE’s threshold, whatever one thinks of it, was a change in how a system values tools. The pandemic agreement is an attempt, however incomplete, to build global system capacity.
It is also true that the pandemic distorts any comparison with 2016. Some of the reversal in life expectancy was a one-off shock rather than a sign of systemic decline, and part of it has since been recovered. A decade that includes a once-in-a-century pandemic is not a fair test of whether systems were improving.
Both points are reasonable. But they sharpen the conclusion rather than overturn it. The most useful changes of the decade were often the ones that made tools easier for systems to use, such as fewer doses or clearer rules for paying. The least successful were the ones that assumed a tool would find its own way to patients.
What this means for the next ten years
For a health ministry, the lesson is that the arrival of a new product is the start of the work, not the end. Every major tool on this list created a delivery problem that needed financing, staff and data to solve.
For funders, it is that the returns from making existing tools easier to deliver, such as simpler schedules, cheaper versions and better supply chains, may now be higher than the returns from the next breakthrough.
For clinicians and managers, it is that many of the most important changes of the past decade arrived as decisions made far away, by regulators, advisory committees and trade negotiators. Understanding how those decisions are made is now part of the job.
What to watch
The comparison we would most like to make in 2036 is whether the next decade reverses the pattern. The signals to watch are domestic health spending in low- and middle-income countries as external aid shifts, completion rates for multi-dose vaccines such as those for malaria, and whether the arrival of cheap GLP-1 generics turns into organised public programmes or simply a larger private market.
What the comparison tells us
Put these snapshots side by side and a pattern emerges. The last decade was extraordinary for tools: vaccines, drugs, diagnostics, algorithms. It was much weaker for systems: the financing, governance and delivery that decide whether tools reach people. Life expectancy fell. Child survival progress slowed. Health cooperation fractured.
Innovation outran implementation. That may be the defining feature of healthcare between 2016 and 2026.
One caveat about this whole exercise. Then-vs-now comparisons flatter change that can be counted, such as approvals, recommendations and devices on a list. They undercount change that is harder to date, such as the gradual thinning of a workforce or the slow erosion of trust in public health advice. Some of the most important shifts of the decade will only become obvious in hindsight, which is one reason we want your own before-and-after examples below. Official statistics catch up with those shifts years late; the people working inside the system usually notice them first.
Your then vs now
What is the biggest change you have seen in your own practice or system over the last ten years? Something that got better, or something that quietly got worse? Share your then vs now in the comments, with numbers if you have them.
