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Symposium 2008

Proposal - Improving Access to Health Care for the Poor, Especially in Developing Countries

The Challenge

Across the world, 1.3 billion people have no access to effective and affordable health care. Low and middle-income countries bear 93% of the world´s disease burden, yet account for only 18% of worl ...

Across the world, 1.3 billion people have no access to effective and affordable health care. Low and middle-income countries bear 93% of the world´s disease burden, yet account for only 18% of world income and 11% of global health spending.

Dr. Harvey E. Bale
Former Director General
International Federation of Pharmaceutical Manufacturers and Associations, Geneva, Switzerland

In 2008, the World Health Organization (WHO) took note of -- even celebrated -- the 30th anniversary of the Alma-Ata Declaration - a declaration arising out of the International Conference on Primary Health Care (PHC) in Alma-Ata, Kazakhstan. This declaration called for “the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life” - i.e., calling for “Health for all” by 2000. However, eight years beyond this target date, in many parts of the world, people lack adequate food and do not have access to clean water - both critical components of good public health. One billion people live in developing countries on less than US$1 a day, and 2.5 billion are living on less than $2 a day; more than 2.6 billion people lack access to toilets and other sanitation facilities; and 30,000 children under five-years of age die every day, mainly from dehydration, undernourishment, and preventable diseases. Where there are clinics and hospitals, they are too few, and they are inadequately staffed and equipped. Because of this devastating poverty, about a third of the world’s population lacks adequate access to quality health care, including medicines - a disturbing constant ratio that leaders of the WHO and other public health experts have cited over several decades (Poverty is clearly the key element behind the lack of access to health care. However, considering investment in health care also as a contributor to economic growth and social improvement is appropriately highlighted in the Report of the WHO Commission on Macroeconomics and Health. See http://whqlibdoc.who.int/hq/2001/a74868.pdf.)

In 2005, speaking of the HIV/AIDS crisis in Africa, former Zambian President Kenneth Kaunda said that this challenge “requires the total commitment of all stakeholders, on country, regional and international levels. We need to establish networks and partnerships at various levels.” (See http://www.uneca.org/chga/speech_kaunda22april2005.htm). Dr. Kaunda addresses not only what is necessary to address AIDS in Africa and other poor regions, but also other diseases and epidemics confronting thee countries. The critical point is that there is a need for a range of “partnerships” – financing, scientific collaboration, training in prevention and treatment, etc. -- necessary to improve access to health care. But for these partnerships to work, there need to be certain pre-conditions.

A partnership established in May 2000 in the field of HIV/AIDs offers a good example of establishing a strategy to improve access to health care, including prevention and treatment technologies and tools. Financing is a major component, but it is not the only, nor necessarily even the most important, component of an effective access strategy. Access to health care goods and services is dependent on their rational selection and use, the availability of financial resources, the strength of the health infrastructure and their affordability.

In May 2000 five UN organizations -- the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), World Health Organization (WHO), World Bank and UNAIDS) entered into a partnership suggested by five pharmaceutical companies (Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Merck & Co., and F. Hoffmann-La Roche Ltd. – later joined by Abbott Laboratories and Gilead Sciences) to address the lack of access and affordability of HIV medicines and to work together to increase access to HIV/AIDS care and treatment in developing countries. The following fundamental principles

underlie this “Accelerating Access Initiative” (AAI):

  • (i) Unequivocal and ongoing political commitment by national governments is essential for success;
  • (ii) Strengthened national capacity (infrastructure) is crucial for delivering care and treatment on an equitable basis;
  • (iii) Engagement of all sectors of national society and the global community is essential in facilitating access to treatment;
  • (iv) Efficient, reliable and secure distribution systems are necessary to ensure that medical supplies and other consumables are made available to people who need them;
  • (v) Significant additional funding from new national and international sources is necessary for long-term success; and
  • (vi) Based on the protection of intellectual property rights (in compliance with international agreements) continued investment in research and development by the pharmaceutical industry on innovative new treatments for HIV/AIDS is critical to expanding the global response to HIV/AIDS.

It is interesting that the agreed set of principles and priorities identify national political commitment as the first necessary element of a national HIV/AIDs strategy -- along with building national capacity, engaging NGO’s and other stakeholders, securing distribution systems against diversion, additional financing and continued research an development. The latter is especially important for infectious diseases, since resistance to therapy frequently develops, and given the need ultimately to develop an effective vaccine.

These principles can be generalized to apply to health care for the poor, especially poor countries; but to do so also requires the addition of another fundamental principle: setting of national health priorities, given the highly restricting limitation on available resources. The priorities not only relate to issues around disease campaigns which ones?), but also to prevention strategies, addressing persistent disease problems versus preparing for potential emergency pandemic threats (e.g., avian influenza) as well as addressing frequently needed quality/effectiveness of health care issues. This is especially critical in developing countries where quality and outcome standards and measurements are often absent.

In 2000, the United Nations Millennium Development Goals (MDGs) were agreed by member states, with the target of improving the health and welfare of those living in the poorest countries by 2015 (Three MDGs relate directly to health, while the others are linked indirectly. See: http://www.un.org/millenniumgoals/). Attaining them will require sustained, concerted global action. While states have the primary role and obligation to improve global health, other actors, including the pharmaceutical industry can and should play a role: developing innovative, safe and effective medicines and working with other stakeholders – especially states – to make them available, affordable and accessible to people who lack them. Earlier in 2008, the research-based industry set forth a set of commitments in the fields of R&D, access to medicines (including differential pricing) and good corporate governance in a document entitled “Principal Focus and Actions of the Research-Based Pharmaceutical Industry in Contributing to Global Health”. The conclusion to that document is quoted in full below:

Industry is committed to its prime function of discovering and developing new medicines, vaccines and, increasingly, products of biotechnology for patients worldwide. The enormous mortality and morbidity burden in the poorest developing countries can only be addressed by improving access to health care via a concerted, partnership-oriented strategy that is supported globally with financial resources as well as know-how about good practices, and with national and community efforts to increase poor people’s access to essential health services, regardless of where they live.

It is obvious that single actors on their own will have a limited impact on global development and health problems. All actors in society - state and non-state - must contribute to solutions according to their obligations, abilities, and enlightened self-interest. All societal actors must make resources available and cooperate in a creative way in order to meet all the Millennium Development Goals. Industry commits to continue to act responsibly in its sphere of capability and is committed to work collaboratively to make its novel preventative and therapeutic products available and accessible to the global patient community.

If key stakeholders, including industry, faithfully pursue the principles outlined in the joint UN/industry AAI agreement and the industry document referenced immediately above, major strides will be made in increasing financing and access to health care for the poor.

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