- Brendan Shaw
Access Accelerated: NCDs and the pharmaceutical industry’s coming of age
“Premature death from noncommunicable diseases (NCDs) continues to be one of the major development challenges in the 21st century”
- Dr Tedros Adhanom Ghebreyesus, Director General, WHO
Next week’s United Nations High Level Meeting on Non-Communicable Diseases (NCDs) in New York comes at just the right time for the global pharmaceutical industry’s major NCD initiative, Access Accelerated.
Or perhaps Access Accelerated has come at just the right time for the High Level Meeting.
Where once communicable and infectious diseases were the only game in town when people talked about health care in low- and lower-middle income countries (LMICs), today there is a growing realisation that these countries are facing major challenges with NCDs. NCDs, sometimes referred as chronic diseases, include heart disease, stroke, cancer, diabetes, chronic lung disease and mental health conditions.
And the figures are sobering.
Forty-one million people die from NCDs in the world each year which accounts for 71% of all deaths worldwide.
But the staggering statistic is that more than 85% – almost all – of the 15 million people in the world who die pre-maturely from NCDs each year in the world (those aged between 30 and 70) are people living in LMICs.
Source: Source: World Health Organization, "Non-communicable diseases: key facts", 1 June 2018, http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases, accessed 18/9/2018
So basically most of the people dying earlier from NCDs than they should are people living in low- and middle-income countries.
And, finally, earlier this year the WHO reported that adults in low- and lower-middle income countries have more than double the risk of dying pre-maturely from an NCD than adults in high-income countries.
In this day and age, that’s just not fair.
At the end of the day, treating NCDs is first and foremost about peoples’ lives.
But it doesn’t make economic sense either.
It is projected that the economic loss to LMICs from such diseases will exceed US$ 7 trillion over the period 2011-2025, averaging about US$ 500 billion per year.
That’s roughly equivalent to 4% of these countries’ annual income that will need to be paid due to people dying early from NCDs.
The problems of NCDs in LMICs were recognised in the UN Sustainable Development Goals agreed by the world leaders in 2015 which included an explicit goal:
3.4 - By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
The trends in the current data suggest that unless action is taken to do more, the world is not going to achieve this goal by 2030.
If you do some basic projections from the current figures, essentially we're going to have to do twice as better than we're doing at the moment if we are going to reach the 2030 target we have set ourselves.
So, it’s a big deal that the pharmaceutical industry has taken the initiative to drive new private-public partnerships to combat NCDs by coming together and investing in Access Accelerated.
Access Accelerated (AA) is a cross-biopharmaceutical industry collaboration launched in 2017 that works to reduce barriers to prevention, treatment and care for NCDs in lower- and middle-income countries (LMICs) through health systems strengthening and alignment with Universal Health Coverage objectives and priorities.
To date 24 pharmaceutical companies have come together in partnership with countries, civil society, international organizations, multilaterals and NGOs to drive on-the-ground implementation and sustainable action to address NCDs.
The initiative is unique for a variety of reasons. Not least because it is the first substantial set of industry programs to address NCDs, backed by commitment from the CEOs of so many global companies.
It works to create new partnerships between the industry, international organisations, national governments, NGOs and academics in ways that are ground-breaking.
It also provides a platform for companies’ own NCD access programs in LMICs.
From the start, Access Accelerated has been an ambitious, multi-faceted and multi-sectoral, initiative designed to be a game-changer in how NCDs are addressed.
The pharmaceutical industry has helped set the agenda on this at a time when other private industry sectors, international organisations and governments are still considering how to practically engage in this space.
For all these reasons, the pharmaceutical industry has been a leader here and deserves recognition for that.
For all the same reasons, it was never going to be easy to make it all work up front.
If private-public sector collaboration in health was a diving competition, Access Accelerated would be a reverse four-and-a-half somersault with a pike off a 10 metre board …. while the diving pool is still being filled with water.
Getting 24 pharmaceutical companies, the World Bank, the World Health Organization, numerous patient NGOs, academics and supporting agencies to agree on strategy, key actions and have complementary initiatives is such a difficult job it makes negotiating nuclear arms reductions between governments look like a walk in the park.
However, Access Accelerated’s first year report shows the initiative’s progress since launch. This includes:
27 new or expanded individual company programs announced since the launch of AA to help patient access to NCD care in low- and middle-income countries
a World Bank pilot commenced in Kenya, another planned for Vietnam, and an African regulatory harmonisation project in a major partnership with the World Bank
four C/Can 2025 cancer city projects launched in Kali, Asuncion, Yangon and Kumasi
several other partnerships with international health NGOs in the NCD space, and
an arm’s-length academic evaluation and data collection process commissioned with the School of Public Health at Boston University, including the publication of an Access Observatory with data on 62 company AA programs in 88 LMICs.
Ultimately, how successful Access Accelerated is will be judged on how tangibly it achieves even some of its goals.
Another potential benefit of Access Accelerated will be to help companies develop their own new programs that help poorer people get better treatment for NCDs and are sustainable from a public health and business perspective, identifying what is ‘best practice’ in the process.
Access Accelerated is not without its problems, and there are a few issues that ideally need to be rectified if it is going to truly deliver on its potential.
A longer-term strategic plan would help both companies and external stakeholders understand how Access Accelerated is going to contribute to the longer term NCD agenda.
A better integration of the rigorous data collection, monitoring and evaluation work with the practical programs the companies and partners are developing is going to be critical if industry is to demonstrate the contribution it makes to tackling NCDs.
And the World Health Organization is going to have to be convinced to partner with industry – something that has been almost heresy for it in the past.
Given the long term, chronic nature of non-communicable diseases, it is critical to develop innovative, sustainable programs that treat patients and make good economic sense for both the public sector and private industry.
This is one of the radical elements of Access Accelerated that may not be welcomed by those who just in principle oppose the private sector being involved in healthcare at all.
But given the size of humanity’s task, the need for long-term sustainable systems, and the level of innovative thinking required if the world is going to even try to achieve the UN Sustainable Development Goals on NCDs, the private sector will have to be a key resource for treating the patients of the world.
The important thing for companies is to ensure they do this in the best, most effective, and most ethical way possible.
And Access Accelerated can be a path to achieve that.
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