The alarm has rightly been sounded on a silent killer. Faced with the staggering figure that 40 million people lose their lives each year to non-communicable diseases (NCDs), it is time to leave our comfort zones and consider how to best pool expertise to make sure that the right treatments are reaching the right patients, at the right time.
Singling out the cost of treatment as the main barrier to access, as was the case again during the UN NCD hearing in July, does little to address the multiple barriers to access. Yes, we cannot fudge the affordability question and the price of insulin or cancer drugs does matter, but if we want to make progress we need a holistic approach. Why is it that in spite of companies’ tiered pricing policies and partnership efforts, access to these treatments still remains a challenge, in particular in low-income settings?
The fact is that there are multiple factors that come into the equation, and most relate to weak health systems. For instance, in many countries, diabetes is still not seen as a priority for action. Funding is thus not properly allocated to train or equip healthcare workers to detect the symptoms or advise on the course of treatment. This opens the door to costlier, yet avoidable interventions down the road. People who are unaware they have the disease are at risk of suffering from heart attack, blindness, amputation, kidney failure.
Additionally, secure and efficient distribution of medicines to treat NCDs, including insulin that requires cold chain specifications, is far from guaranteed in developing countries. Non-functioning supply chains can influence the availability of medicines as hefty mark-ups along the way are common, and the circulation of falsified medicines is substantial. As more tools and technologies emerge, it will be essential to put in place supply chains that are less fragmented, with fewer intermediaries, that will enable lower retail prices, better forecasting, higher availability, better monitoring of quality, and better adherence to standard treatment guidelines.
According to the IMS Institute for Health Informatics, USD 269 billion per year could be saved if health systems worldwide tackled patient adherence to treatment. A proper monitoring and follow up with patients will lead to improved adherence to prescribed medicines, overall medication uses and prevention of adverse events, and achieve major therapeutic gains.
In the absence of a robust primary care system, NCDs go unnoticed until complications arise, adequate treatment is not initiated, and treatment effect is not consistently monitored. While we mustn’t gloss over the affordability question, we just can’t afford not to address these health systems failures.
One of the learnings of the multiple factors influencing access is that it does not suffice for our industry to be a mere transactional player in the health care system, i.e. a supplier of medicines. Discovering and developing new medicines and vaccines is our bread and butter, but we actually do much more than that: we foster innovation across the continuum of medical education, prevention, treatment and care. We share expertise and experience in strengthening supply chains, but also in training of health care workers, human resources management, treatment adherence, and health literacy. Additionally, by participating in multi-sectoral partnerships, we contribute to creating innovative finance models and build the bodies of evidence that will be crucial to meet the NCD targets.
A case in point is our work with Access Accelerated, a first-of-its-kind collaboration led by more than 20 pharmaceutical companies who are all pooling their efforts together with IFPMA, the World Bank and the Union of International Cancer Control to focus on improving access to treatment and care for NCDs in low- and middle-income countries. Concretely, this translates to on-the-ground support to integrate NCD services into primary healthcare, like in Kenya. In March, a pilot programme was launched to help the Kenyan Ministry of Health meet their ambitious goal to achieve universal healthcare coverage by 2022 and to contribute to the global target to reduce NCD deaths by two-thirds by 2030 set in the Sustainable Development Goals.
Critical to Access Accelerated is our ability to track progress and continuously adapt our approach. We have put independent measurement at our core by working with Boston University’s School of Public Health to develop a framework that rigorously measures and evaluates our programs. Our industry, whether it is about R&D or complying with regulatory requirements, strongly supports evidence-based approaches, and it strives to apply the same approach to investments in health partnerships. This will show us what’s working, what’s not and how we can adapt and scale-up our work to develop other pilot programs. We owe it to the beneficiary populations and to our partners on the ground.
As NCDs are sweeping the entire globe, addressing health system failures is becoming ever more apparent, and it will be essential to tap into the private sector experience. Our industry brings extensive knowledge, expertise, and resources to develop innovative solutions. We can accelerate progress by pooling resources, leveraging tried and tested solutions, trying new, innovative pilot programs, and working with expert partners to support health systems with the management of life-long conditions. We’re committed for the long-haul to help ensure our life-changing therapies we work so hard to develop reach the remaining millions of people suffering from NCDs.
About the author: Thomas Cueni is Director General of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA).