There are two sides to every story. One, that India’s healthcare system is not in great shape, and that there is a dearth of hospital beds, doctors and paramedic staffs to react to a health emergency like the Covid pandemic. But turn to the other side, and one finds that merely spending more on health may not necessarily lead to a desired health outcome.The US government spent almost double the amount on medical care compared to 11 other wealthier nations. The higher amount spent by the US — and this excludes money spent by private insurers — was mostly on account of high costs of labour, pharmaceuticals and administrative costs, and this did not translate to having better health outcomes. Compared to the 11 developed Organisation for Economic Cooperation and Development (OECD) countries, life expectancy is still lowest and infant mortality rates still the highest in the US.To understand how vulnerable a country is to a pandemic, it is necessary to create an index that not only considers the existing level of health infrastructure but also the ability of a country to spend to create more healthcare assets. This is the health infrastructure index (HII).HII ranks countries based on availability of physicians, dentists, nursing and midwifery personnel, pharmacists, hospital beds, number of hospitals and skilled healthcare professionals such as anaesthesiologists, radiologists, etc, all of which are normalised with respect to the population. Additionally, HII accounts for variables such as money spent on account of healthcare activities by governments. India gets a lower rank — 113th out of 184 countries.HII highlights critical areas where domestic or multilateral interventions are required. For instance, multilateral organisations such as the World Health Organisation (WHO), International Monetary Fund (IMF) and World Bank may want to give more funding to the countries more vulnerable on HII. Even within a country, HII showcases the areas where a government, or multilateral organisations, should intervene, and how they may prioritise such interventions.While Covid-19 is equally likely to affect all low-, middle- and high-income countries in terms of spread, lower-income households within a given country are more likely to be severely affected so far. Evidence suggests 5% of poor income households residing in low- and middle-income countries spend disproportionately more than the rich as a percentage of household income on healthcare.For a rich nation, like the US, life expectancy for the bottom 5% of poor people did not change between 2001 and 2014. However, during the same period, the life expectancy of people in the high-income bracket showed improvement. Poor health outcomes for individuals with lower income directly result from exposure to harmful environments. In Europe, unmet need for medical care tended to be higher for the disadvantaged in countries with larger income inequalities, regardless of the average economic standard in terms of GDP per capita.Irrespective of what HII suggests in terms of disbursement of Covid-19 funds, some world leaders are demanding that China should pay the price. China’s actions in combating Covid-19 are in violation of Article 6 and 7 of the International Health Regulation (IHR). If any government wants to sue China, it must do so by identifying the jurisdictional basis for such action. Article 56 of IHR allows such punitive action, but it can only be executed when China agrees to the wrongdoing on its part.Similarly, to protect their economic and tourist activities, some countries such as Turkey, Indonesia and Russia have under-reported their Covid cases. Governments of ‘affected’ countries can also ask for compensation. There can be a spill-over effect. Many governments are imposing sanitary and phytosanitary sanctions, and imposing restrictions on goods originating from China. This has seen increase in the number of lawsuits, especially under Article 11 of the World Trade Organisation dealing with quantitative restrictions.Investment arbitration to settle disputes between foreign investors and host states can come in handy. International investment tribunals and other such bodies can be asked to review the states’ guidelines against the pandemic, thereby addressing many disputes. Peru, for example, has developed an online digital platform aimed at providing public access to key pieces of information about arbitration. With more countries following suit and Covid-19 fatality waning, we may be heading for a better time.Banik is professor, School of Management, Bennett University, Greater Noida, and Chaisse is professor, School of Law, City University of Hong Kong.