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A disaster in slow motion; that is how Dr Githinji Gitahi, CEO of African health NGO AMREF, describes the threat of non-communicable diseases (NCDs).
Long thought of as diseases of the richer countries, the threat of NCDs – including cancer, diabetes and hypertension – is growing in low-to-middle-income countries, which now account for three-quarters of the annual death toll of more than 40 million.
A toxic mix of modernization, urbanization and lifestyle changes has seen this growth in NCDs in developing countries, a scenario that has already played out in developed countries, where smoking, alcohol, processed food and increasingly sedentary lifestyles have taken their toll on people’s health.
However, while citizens of countries like the US, Britain and Japan have access to robust healthcare systems that diagnose and treat NCDs, patients in the developing world have far fewer resources on which to fall back. What’s more, the growing pressure of NCDs is pushing already over-stretched healthcare systems to breaking point.
Now, governments, NGOs and pharma are coming together to tackle the problem, including at a recent conference in Geneva – The Blueprint for Success – supported by Takeda.
Hitting the gas
One of the UN’s Sustainable Development Goals is to cut deaths from NCDs by a third by 2030, a challenge that has been taken up by Access Accelerated, a partnership of 23 pharmaceutical companies, the World Bank and the Union for International Cancer Control.
Alongside work around prevention, diagnosis and treatment, the group is looking to expand healthcare access and share solutions with governments and healthcare leaders, recognizing that the cost of funding long-term treatment for chronic diseases can be prohibitive.
“Access Accelerated shows industry is responding, working together (and) going in the right direction,” says Brendan Shaw, Assistant Director of the International Federation of Pharmaceutical Manufacturers & Association (IFPMA). “It’s designed to take the industry’s NCD care to the next level.”
The initiatives championed by Access Accelerated are, on the whole, developed by member companies; this year, 19 new program will be launched. One scheme is Healthy Communities, a $1 million joint-venture between Pfizer and the nonprofit Population Services International, which aims to expand access to hypertension medicines and treatment services in Myanmar and Vietnam, with an initial goal to screen more than 500,000 people and train up to 400 healthcare workers in hypertension management services.
Other initiatives include a Novartis Access program based around a portfolio of 15 critical chronic disease medicines to treat Type 2 diabetes, cardiovascular diseases, respiratory illnesses and breast cancer. The drugs are part of a package that costs $1 per treatment per month.
Takeda’s Access to Medicines strategy is based around its Patient Assistance Programs (PAPs), which guarantee eligible patients the treatment they need even if they can’t afford to pay for it in full. The service, which is means tested, is available in 13 countries includingMalaysia, Singapore and Ukraine.
“The idea is that because patients that can pay will pay, it’s sustainable,” says Isabel Torres, Takeda’s Global Head of Access to Medicines. “We guarantee that the patient will have the full course of treatment; they pay what they can and we meet the rest of the costs.”
The drugs, which include cancer treatment Adcetris, are new and innovative, says Torres, and Takeda wants to include other specialty medicines in the scheme, as well as vaccines, in the future.
Increasing access to medicines is just one way that pharma can help countries overcome the burden of NCDs, says Rebecca Stevens, Head of Access Partnerships at Novartis Social Business. She believes the industry has an important role to play in filling the gaps in a country’s healthcare system and making sure the provided medicines actually reach the patient.
Lessons can be learnt from the way communicable diseases such as HIV and malaria have been tackled in developing countries, says Torres. A central figure in this success was the community health worker, often a well-known and respected member of a town or village, and crucial in raising awareness at a local level, as well as driving behaviour change and providing a crucial link between patients and the healthcare system.
Given their importance, pharma companies are increasingly involved in their training. For example, Takeda teamed up with AMREF on its platform, LEAP, using the deep penetration of mobile phones in Kenya to provide content to help health workers better understand hypertension and causes of diseases like diabetes.
GSK is also working with AMREF to train workers, including vital teaching around screening for NCDs. A key focus is on diabetes, where up to 60% of cases can be missed, leading patients to seek treatment when it is too late and the complications become irreversible.
Training health workers to scale up screening at a community level could be transformational, says Marijke Wijnroks, Chief of Staff and Interim Executive Director of the Global Fund, a collaboration formed in 2002 to accelerate the end of AIDS, tuberculosis and malaria as epidemics.
The Fund, which has helped to save 22 million lives so far, is now working to develop one-stop shops offering efficient, integrated screening for both communicable and non-communicable diseases.
“If every woman was screened for cervical cancer just once in a lifetime the effect would be dramatic,” says Wijnroks, who believes prevention and encouraging lifestyles changes are also important. “We can’t just fund our way out of this epidemic.”
The global success in tackling communicable diseases means that many people in developing countries are living longer, paradoxically, another factor in the rise of NCDs. “If you live longer, then the chances of getting cancer are bigger; that’s life, you cannot fight that,” says Torres.
“At the moment, many people, especially those with cancer, are being diagnosed too late. Getting patients into the system sooner, and through prevention and early diagnosis, you can treat them at stage 1 and they will survive. They don’t have to die.”
Myths must also be busted, says Torres, who recalls the shock at discovering the persistent perception in Ethiopia that cancer is contagious. “Often, when a woman is diagnosed with breast cancer, she is separated from the kids. There’s a lot to do in terms of patient awareness,” she says.
Partnerships are essential, says Dr Joseph Kibachio, Head of NCDs at the Kenyan Ministry of Health. “There are all kinds of partnership forming around access to NCD care, which we are welcoming,” he says. “Pharma has not had the best of names traditionally, but slowly we are trying to see how we can work together for a win-win.”
In Kenya, Takeda has created the Cancer Alliance in Kenya in partnership with hospitals, patient associations and healthcare professionals. The Alliance links oncologists and is helping to fill in the gaps around specialist knowledge and best practice. The company is also working with the University of Nairobi to offer fellowships and help train oncologists from all over the continent.
Elsewhere, Roche has invited technicians and pathologists from across Africa to their Johannesburg health campus to learn more about how to test tumours.
This kind of work shows the wide role that pharma has to play beyond simply ensuring access to affordable drugs. However, there is one factor that everyone needs to beat NCDs – political will. “If the President wants to make sure there is universal health coverage, there will be,” says Stevens. “As companies, there is only so much we can do if there’s not the leadership or the commitment from the top to really make a difference.”
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