Fighting the double burden of disease
Chronic diseases are on the rise in developing countries, yet infectious diseases still continue to debilitate many poor countries. While chronic diseases rightly gain increasing attention, it is crucial that key stakeholders, including the pharmaceutical industry, strengthen and expand existing efforts to fight infectious diseases. Tara Prasad discusses.
With economic development comes increased urbanization, population growth and the rise of middle and affluent classes. In turn, this leads to a rise in lifestyle diseases – chronic, non-infectious diseases, such as diabetes, stroke, and cancer. In certain developing countries, gaps in healthcare mean that this trend takes off while infectious diseases are also still problematic – including three of the biggest global killers, HIV, Malaria and TB.
This is becoming known as the “double burden”1 of infectious and non-infectious diseases: the WHO reports that at least 70% of deaths from non-infectious diseases and 90% of deaths caused by infectious diseases each year occur in developing countries.2
The associated lower life expectancy, higher infant mortality and increased overall morbidity and mortality engender a cycle of poverty and illness. Limits on productivity slow economic growth, which in turn, slows investment in healthcare. The Roll Back Malaria Programme, for example, estimates that malaria costs African economies an average of 1.3% of their GDP each year2.
By definition, infectious diseases spread. Without coordinated and comprehensive prevention and treatment efforts, small pockets of disease quickly grow in our increasingly globalized world. For this reason alone, infectious diseases are a public health threat that requires constant attention.
So what do we do about it?
The good news is that many infectious diseases are preventable and controllable. The question is whether the necessary measures for control, prevention, diagnosis and treatment are available, accessible and affordable.
Many stakeholders share responsibility for fighting these diseases, not least governments. As economies develop, governments need to look for new models for identifying healthcare gaps and for providing affordable, accessible healthcare and education.
Pharmaceutical companies also have an important role to play. Where the tools for enabling prevention, diagnosis and treatment already exist – such as for Malaria and HIV – companies can help by fitting the jigsaw pieces together, scaling up their efforts and by continuing to invest in innovation. For other diseases, such as the neglected tropical diseases, their efforts are best directed toward innovation and research.
Malaria – preventable but prevalent
Malaria is preventable and curable. However, according to estimates released in December 2013, there were around 207 million cases of malaria globally in 2012, and an estimated 627,000 deaths. 90% of all malaria cases are in sub-Saharan Africa, where a child dies every 30 seconds from this disease.3
There are two main areas where pharmaceutical companies can take the lead: in scaling up their efforts to donate treatments, nets and insecticides; and in ensuring that the malaria products they sell are affordable and in sufficient supply.
At the same time, companies must continue to innovate in insecticides and treatment options – this is essential for controlling the spread of malaria and for managing growing resistance to existing treatments.
A malaria vaccine is the ultimate innovation goal. The WHO lists 27 malaria vaccine candidates currently in clinical trials, with most in early stages of testing. For the most advanced, P. falciparum, RTS,S/AS01 (from GlaxoSmithKline), the full results from Phase 3 trials will become available this year.
HIV – access to ARVs
There are 26 million people worldwide who live with HIV/AIDs. Two thirds of them currently live without any treatment.4
Companies already engage in a range of initiatives to improve access to existing ARVs, for example, by strengthening supply chains, implementing milestone-based technology-transfer agreements and building the capabilities of local health workers to assess the efficacy of HIV treatments in their communities.5 By contributing to prevention programmes on the ground for populations most-at-risk, companies can increase their impact still further.
Over the past decade, the cost of anti-retrovirals (ARVs) has fallen significantly. Many companies began using tiered pricing and licencing to improve their affordability and supply. One current leading example is a joint venture between GlaxoSmithKline and Pfizer, called Viiv Healthcare, which uses differential pricing, local partnerships and royalty-free licencing to improve access to existing HIV medicines6.
Nevertheless, treatment remains unaffordable for many, especially where out-of-pocket payments are the norm. Companies need to engage in more public-private partnerships in countries with the highest needs and funding gaps to ensure governments also commit to taking ownership and directing financing towards HIV/AIDS, leading to more sustainable long-term outcomes.
No cure for HIV exists as yet, and rising resistance to existing ARVs means that the need for pharmaceutical companies to step up innovation efforts is growing. Once new treatments are available, it is important that companies engage with IP-sharing initiatives, such as the Medicine Patent Pool (MPP), to ensure sustained access to new treatments.
Neglected tropical diseases
Neglected Tropical Diseases (NTDs) are 17 diseases, as classified by the WHO7, that spread in tropical environments, due to a lack of hygiene, sanitation and clean water, and affect the most marginalised, impoverished and “neglected” people. Large commercial markets that usually drive pharmaceutical investment are lacking for NTDs. More than 500 million people – half of all people infected with NTDs – live in sub-Saharan Africa.
The London Declaration, launched in January 2012, was a new and coordinated multi-stakeholder push between pharmaceutical companies and international donor organizations to accelerate progress toward eliminating or controlling 10 NTDs by 20208. Following the London Declaration, many big pharmaceutical companies committed to continuing or expanding long-term donation programmes – even to providing an unlimited supply of the necessary medicines until specific NTDs are successfully eliminated.
However, many African countries struggle to implement large-scale donation programmes. Pharmaceutical companies can help by ensuring that their programmes target specific local needs and include prevention and awareness education, as well as other forms of capability advancement.
For many NTDs, there is a significant need for new diagnostic products and treatments. Increasingly, pharmaceutical companies are actively engaging in R&D and multi-stakeholder partnerships that target NTDs. Recently, for example, Japan’s top pharmaceutical companies joined a $100million effort to tackle tropical diseases, HIV, malaria and tuberculosis.
The R&D needs and gaps for NTDs are not well understood. In addition to investing more in this area, pharmaceutical companies can contribute by thoroughly assessing these needs and sharing their findings.
Stopping the spread
The potential for companies to make a difference in the fight against infectious diseases is huge, for example in middle-income countries, where partnerships can flourish, governments are (generally) more capable, and where the infrastructure, including health systems, is stronger and more mature.
However, the need for companies to step in is actually greater in developing countries – the countries that have yet to earn full “emerging market” status and join the ranks of the BRICs and MINTs, but that are already seeing a growth in chronic diseases. Sub-Saharan Africa, in particular, needs help.
Companies need to engage in holistic and targeted initiatives that include elements of prevention, treatment and control, whilst taking local and environmental considerations into account. Coordinated investment in innovation is also extremely important, to address growing antimicrobial resistance and also to fill existing gaps and needs. Although chronic diseases are also on the rise in these countries, companies need to continue to scale up existing efforts and to collaborate with governments and other key stakeholders, to ensure availability, affordability and accessibility of tools and treatments to fight infectious diseases.
1. WHO, 2004
2. ‘Key malaria facts’, Roll Back Malaria Report, 2010, http://www.rollbackmalaria.org.
5. Access to Medicine Index 2012, http://www.accesstomedicineindex.org/ranking
About the author:
Tara completed her B.A. from McGill University with a double major in Economics and International Development Studies and a minor in Management. She earned her M.Sc. in Development Studies from the London School of Economics, where she focused on Economic Development Policy and the use of econometrics to examine social and economic development trends. She is currently pursuing a postgraduate diploma in Pharmacoeconomics.
Tara works at the Access to Medicine Foundation, an independent not-for-profit organisation, as a Lead Researcher, engaging in research and analysis for the Access to Medicine Index (the next iteration will be published at the end of 2014). Published every two years, the Index (http://www.accesstomedicineindex.org/) ranks the world’s top 20 pharmaceutical companies on their policies and practices to improve access to medicine in low-income and middle-income countries. It publically recognises good practice in the area of access to medicine, and provides a transparent means by which all stakeholders can assess company performances.
Tara can be reached at email@example.com.
Closing thought: What can be done to tackle the challenge of infectious diseases in developing countries?