This blog was originally published on Pharma Boardroom on 12 November 2019
Last week I had the pleasure of moderating a panel discussion on access to medicines at the World Health Summit (WHS) in Berlin. The session brought together a panel of public health leaders from diverse sectors, specialities and geographies to discuss challenges and opportunities for partnerships to support better access to medicines. Our panellists; Dr. Eva Njenga, Chair of the NCD Alliance in Kenya; Dr Cary Adams, CEO of the Union for International Cancer Control (UICC); Dr Manica Balasegaram, Executive Director of the Global Antibiotic Research and Development Partnership; Martin Berhardt, Head of Global Public Affairs at Sanofi and Access Accelerated Steering Committee member; and, Dr Catherine Boehme, CEO of the Foundation for Innovative New Diagnostics, and; Thoko Elphick-Pooley, Director of Uniting to Combat NTDs, shared diverse views and experiences on how partnerships are helping to increase access to care and treatment across disease areas in hard to reach population.
2020 marks the 10-year countdown until the SDG deadline. The global goals were launched five years ago as the blueprint for dignity, peace and prosperity for people and our planet. Though some progress has been made, new challenges continue to emerge – the World Health Organization (WHO) estimates that nearly 2 billion people have no access to basic medicines, causing preventable suffering, mortality and morbidity.[1] While the majority of essential medicines are no longer covered under patents[2], their distribution and availability in many low- and- middle-income countries (LMICs) is complex and they are not reaching the populations that need them the most. SDG 17, partnership for the goals, highlights the collective responsibility of both public and private actors to tackle access challenges in underserved populations.
Last year’s WHS panel had focused on the numerous hurdles to access caused by inadequate health systems and the need for holistic approach. A year on, we have made great progress to foster new, and deepen existing partnerships to increase access to medicines. The examples the panel discussed highlighted the innovative approaches that we are adopting to increase access.
We can achieve more when we engage with diverse partners. Collaborating across bilateral and multilateral development organizations, governments, civil society, academia and other private sector helps to establish new approaches. We are seeing a growth in new and different types of collaborations to tackle the biggest challenges in health.
Martin Berhardt discussed the Access Accelerated initiative which brings together over 20 biopharmaceutical companies committed to addressing the growing burden of non-communicable diseases (NCDs). This is an important collaborative approach to address NCDs, as a global funding mechanism would not be fit-for-purpose to address the rising and chronic nature of these disease. The cross-industry collaboration is working to define what is needed to address NCDs, identify gaps in care and treatment, develop solutions, collaboratively build programs and rigorously monitor and evaluate programs. Access Accelerated is partnering with Boston University on program monitoring and evaluation which has supported the development of the Access Observatory, a framework and data repository to capture the combined impact of industry’s initiatives. Such solutions are developed in partnership with patients, an example of which is UICC’s City Cancer Challenge (C/CAN). Cary Adams described this initiative as “an innovative approach to tackling a public health challenge which has not been able to be addressed before”. C/Can 2025 is a multi-sectoral initiative supporting cities to take the lead in designing, planning and implementing cancer treatment solutions to reduce premature deaths from NCDs by 25% by 2025. The initiative goes beyond providing access to cancer treatment, and develops interventions which consider the whole patient journey, including pathologists, diagnostics, radiotherapy and surgery.
Cross-sectoral partnerships are also helping to address emerging global health challenges such as anti-microbial resistance (AMR), which is currently responsible for more than 700,000 deaths a year and expected to result in 10 million deaths per year by 2050.[3] Dr. Manica Balasegaram shared insights on the Global Antibiotic Research and Development Partnership (GARDP) which brings together unlikely actors to try and solve this complex challenge. They recently facilitated a workshop on delivering on the sustainable access of antibiotics to develop a roadmap that fosters access to appropriate use of antibiotics. The workshop brought together partners, including start-ups, technology companies, FMCGs and supply chain experts, to develop practical access and stewardship approaches to tackle AMR, leveraging their insights and expertise from outside of global health which could help to breakdown silos and develop a collaborative approach to address AMR, including engaging citizens to become AMR stewards.
The diversity of the programs the panel discussed demonstrates that the innovative biopharmaceutical industry’s role is no longer solely about developing new drugs. The industry has a role to play in increasing access to care and treatment through collaborating on holistic public health programs. To develop effective, holistic programs we need to understand the local context and population’s needs. A ‘one size fits all’ approach does not effectively address access challenges, and local government and civil society engagement is essential during programmatic design and implementation to ensure effective program design, local ownership and sustainability. Dr Eva Njenga commented that “Advocacy groups are important, but we need to hold people accountable within these partnerships. Partnering with the Ministries of Health and Government helps to develop sustainable partnerships.”
Similarly, civil society, patient and carer engagement is also crucial to build fit-for-purpose programs. Incorporating the perspectives from these groups into programs helps to ensure a patient centred approach is adopted which effectively responds to patients’ values and preferences, and empowers patients to actively participate in their health and wellbeing, which in turn improves health outcomes.
Patient engagement also helps to better understand on-the-ground roadblocks to accessing medicines. Dr Eva Njenga noted that “We need to move towards the people living with NCDs to understand specific community issues.” Once we understand roadblocks, we then need to make sure we share learnings and challenges with relevant stakeholders, course correcting programs when necessary. However, a frequent roadblock for patients is mis-diagnostics, Dr Catherine Boehme from FIND highlighted “Every patient’s road begins with diagnosis but the majority of NCD patients in LMICs are mis-diagnosed. If we fail to diagnose half of patients then we fail to provide access to medicines.” Improving the development of diagnostic tests requires a better understanding of the local contexts they are used in and an iterative, flexible approach to development which is grounded in data. Often this test will be the patients first interaction within a formal healthcare setting and an important engagement point to drive behavior change.
Recognising that every community, geographic region and disease is unique and thus may require a different approach helps to effectively support better access to care and treatment across the globe. The London Declaration on Neglected Tropical Diseases (NTDs) was adopted in 2012 as a global commitment to ending preventable deaths from NTDs, by supporting better treatment and prevention of these diseases among the world’s poorest populations. As we approach 2020 we have an opportunity to review the declaration. NTDs affect 1/7 of the global population, and they have a unique incidence distribution and transmission which means progress relies heavily on patient engagement and donation programs. For the fourth successive year, over one billion people were treated for at least one of the five targeted NTDs.[4] Dr Thoko commented that “Access to treatment discussions presume donations are a thing of the past, however donations are essential for disease areas like NTDs that affect the poorest of the poorest”. Together under the Uniting to Combat NTDs program, and through individual programs, the innovative biopharmaceutical industry donated over 1.7 billion treatments.
I was humbled by our panellist’s examples of collaborative and innovative approaches to increasing access to care and treatment in LMICs and look forward to revisiting this topic again in 2020. I invite you to visit our newly launched platform, Global Health Progress, to explore the full breadth of global health programs which the innovative biopharmaceutical industry are collaborating on with diverse partners in support of the SDGs. As we approach 2020, 10-years until the SDG deadline, we must come together to drive improved program implementation and forge new partnerships to effectively tackle global health access challenges and get closer to achieving the SDGs.
[1] https://www.who.int/publications/10-year-review/medicines/en/
[2] Beall, Reed. (2016). Patents and the WHO Model List of Essential Medicines (18th Edition): Clarifying the Debate on IP and Access.
[3] Tagliabue, A., & Rappuoli, R. (2018). Changing Priorities in Vaccinology: Antibiotic Resistance Moving to the Top. Frontiers in immunology, 9, 1068. doi:10.3389/fimmu.2018.01068
[4] https://www.who.int/neglected_diseases/news/treating-over-one-billion-people-for-the-fourth-successive-year/en/
