This blog was first published on Diplomatic Courier on 21 April 2018.
“Business as usual will not work any longer regarding NCDs. The global burden and challenge of NCDs is of such a scale and magnitude that it requires thinking out of the box and new partnerships and financing mechanisms”. We all, some 300 of us from inter alia governments, development and United Nations agencies, NGOs and from business, applauded when Denmark’s Minister for Development Cooperation, Ulla Tørnæs, issued this call to action. We were gathered at the three-day Global Dialogue on Partnerships for Sustainable Financing of Noncommunicable Disease (NCD) Prevention and Control organised by the World Health Organization and the Danish government and we were tasked with breaking the logjam in finding and financing new ways for governments to combat these serious illnesses and life-long conditions.
This Copenhagen meeting was the penultimate stop before the September UN High-level Meeting on NCDs, and provided, the opportunity to galvanize one and all to take stock of the progress made in protecting people from dying too young from heart and lung diseases, cancers and diabetes, as well a chance to share best practices. Action, not words, now more than ever is what matters. Chronic diseases, called NCDs, account for 70% of all health-related deaths and it is estimated that, left unchecked, they will cost the world and eye-watering $47 trillion by 2030. As many as four-fifths of the 15 million NCD deaths among the economically active aged 30-69 are in low- and middle-income countries – this is truly an epidemic.
The burden of NCDs is huge and tackling this burden is top of the priority list of global health leaders as well as of many national governments. Yet, top of the priority list does not translate in budget allocation. At present, little more than 1% of global health development assistance target NCDs, and national spending is similarly insignificant in relation to the size of the challenge. An explanation I offered at the Copenhagen meeting was that NCDs are “silent killers”. In contrast to the comparatively small number of deaths in outbreaks of Swine Flu, Zika, or Ebola, which often make the headlines, scores more people die every day from cardiovascular disease, diabetes, cancer, or respiratory disease, without a word in the media.
Putting NCDs on the agenda of world leaders as at the United Nations in September will hopefully help to break the financing deadlock.The Copenhagen meeting provided a platform for representatives from international organizations, governments, civil society, and the private sector to present innovative ideas for new financing streams to help in the fight against NCDs. As the representative of a not-for-profit organization representing the biopharmaceutical industry and accredited to engage in the United Nations process (IFPMA), we put on the table solutions that could contribute to finding larger, sustainable and long-term financing to tackle chronic diseases. Some of our ideas are listed below. These proposals were favourably received by most participants who also agreed that the private sector can make an important contribution through service delivery and products, expertise in management, insurance and can be a source of “disruptive innovation”, something I believe is much needed in the health sector.
Four innovative solutions that are worthy of consideration at the UN General Assembly:
- Building on new modes of cooperation and partnerships offer clear promise as a way forwards. For example, over 20 biopharmaceutical companies are working together as peers, rather than competitors, to identify and break down barriers to prevention, treatment and care. Together, these companies are scaling-up existing programs and developing new programs with partners such as UICC and the World Bank to support health system strengthening. This project called Access Accelerated was launched last year, and pools companies’ expertise making sure what the companies do on the ground is streamlined and where possible economies of scale are achieved. Projects are being rolled out in some of the world’s fastest growing cities: Cali, Asuncion, Yangon and Kumasi together with the UICC C/Can 2025. Access Accelerated is joining forces with the World Bank and the Ministry of Health from Kenya are cooperating to strengthen the health systems across the country. Such a wide-ranging cooperation is new – and all are involved for the long haul and others are welcome to join forces with us or learn from us and set up similar cross sector, cross institution endeavours.
- Another idea is to scale up the use of social or development investment bonds. Here private sector investors invest the initial up-front amounts to put the infrastructure and systems in place to develop the health system. Governments then pay a steady return to the private investor in social investment bonds, or an international development agency takes on that role with development investment bonds. Such long-term approaches to funding may be appropriate for treatment of long-term chronic NCDs in countries.
- The recently launched Defeat NCDs Partnership offers a supplies, procurement and distribution facility and a financing facility. Through the first facility a marketplace aims to make the provision of medicines, diagnostics, and equipment more cost-effective for poorer countries. It includes pooling the purchasing power of small countries who do not get value-for-money in their procurement and ensuring continuity of supplies. Pharma companies have expressed interest. The approach chosen by the Defeat NCDs partnership highlights that the quest for efficiency gains in cutting procurement costs or tackling inefficiencies in the supply chain is one way of making drugs more accessible and affordable for patients in developing countries.
- Tapping into additional financing through new insurance models offers promise. For example, based on cooperation with several provinces and 16 insurance companies, millions of middle-class Chinese have signed up to private insurance to get coverage for innovative cancer drugs, and new insurance schemes for cancer coverage are being introduced in countries such as the United Arab Emirates and Ghana. Another approach is the partnership between manufacturers (R&D-based and generics) and charities aiming at providing cheaper access to 16 essential cancer treatments for African governments, allowing substantial savings.
The innovative pharmaceutical industry is determined to live up to its name by bringing forward and sharing viable ideas to tackle the critical funding gap in national NCD responses. Industry seeks to innovate – challenge the status quo, imagine, connect ideas and people, take risks, test and try again – to prompt new discoveries and approaches. To go further, faster, we will need partnerships of all kinds. Through listening, learning and acting together with our partners, we aim to make a meaningful difference to people’s lives.