This blog was first published on Devex on 23 May 2018
At the 2014 Nobel Laureate Meeting in Lindau, Germany, the late Professor Hans Rosling quizzed his audience of leading scientists on average life expectancy. Given three choices, just over a quarter of the crowd picked the correct answer of 70. That’s fewer than would be likely randomly. It is reassuring that even eminent scientists have a few things to learn. With his fascinating data-bubble software and using his washing machine and boxes as props, Rosling destroyed myths about the developing world, powerfully demonstrating that the world is doing better — much better — than many people think. Here again, Rosling dared to go where many others feared to tread. “Global health seems to have entered into a post-fact era, where the labelling of numerators is incorrectly tweaked for advocacy purposes,” he wrote in the Lancet.
As a former journalist, before turning my hand to representing the pharmaceutical industry, my experience has led me to believe that people tend to think things are getting worse because bad news make the headlines. Sadly, bad news sells more than good news. Surely all those headlines about the rise of diabetes, cancer, dementia, antimicrobial resistance, and pandemics can’t all be wrong. Well, they are not wrong, but they can distort our perception of change: the truth is that we have lived through a period of phenomenal health progress as the International Federation of Pharmaceutical Manufacturers and Associations maps in a new report. It is also true that there is still much more to be done to bring the fruits of our innovation to all patients, regardless of their economic circumstances.
Medicines and vaccines have played a part in this transformation and have been a game changer for many. For example, today a child receiving a routine immunization can benefit from vaccines such as meningitis, rotavirus, hepatitis A, hepatitis B, pneumonia, TDAP (typhoid, diphtheria and pertussis), MMR (measles, mumps and rubella), BCG (Bacillus Calmette–Guérin), yellow fever, and Hib (Haemophilus influenzae type B vaccine). A man diagnosed with HIV/AIDS can manage his illness and expect a near normal lifespan thanks to antiretroviral treatment. A community suffering from a Neglected Tropical Disease can access treatment through large scale donation efforts. A woman discovering a lump in her breast can receive treatment that is more targeted and has a lower risk of returning. Persons at risk of heart disease can manage their condition through medication. People with diabetes can live more comfortably and manage their condition. Someone with Hepatitis C can be cured through treatment.
Learning from mistakes
However, it’s not all been good news. As with any wave of progress, setbacks happen and mistakes are made. One of the gravest mistakes made by the pharmaceutical industry was in 1998 when 39 companies sued the South African government to stop legislation facilitating imports of lower priced medicines to treat HIV/AIDS. The lawsuit epitomized, in many eyes, the industry’s insensitivity to patient plight in sub-Saharan Africa: profits before patients. Eventually, the parties reached a then-revolutionary settlement. The court case led to serious soul-searching among pharmaceutical companies and resulted in government and industry combining to find solutions for the epidemic — a precursor to the norm today. From suing Nelson Mandela to becoming an active partner in delivering global health solutions, the industry has evolved and learned. It is active in more than 300 active health partnerships that touch the lives of millions of people. This must continue, and it will.
While the protection of intellectual property rights is critical for the research and development business model, the industry has shown its willingness to collaborate and find new solutions to expanding access to innovative medicines. This model has led to the discovery of many treatments, many now available as cheaper generics. Indeed, 90 percent of “essential” medicines are generics yet, unacceptably, they do not all reach patients. When 60 percent of health spending in low- and low-middle income countries takes the form of out-of-pocket payments, even 20 cents a day is too expensive for many patients.
A recent report from the World Bank and World Health Organization stated that at least half of the planet’s population cannot obtain essential health services. Moreover, it found that 800 million spend at least 10 percent of their household budgets on health expenses for their families and themselves. For nearly 100 million people, these expenses are big enough to push them into “extreme poverty.”
WHO Director General Tedros Adhanom Ghebreyesus said that a solution existed in the form of Universal Health Coverage. Such a system would allow “everyone to obtain the health services they need, when and where they need them, without facing financial hardship.”
“Today’s complex health challenges call for out-of-the-box thinking […] Our innovative industry is prompting, and will continue to prompt, new discoveries and is evolving, learning, and pioneering on ways to do more to reach all patients.”
— Thomas Cueni, Director General, IFPMA
This month at the World Health Assembly in Geneva, the WHO’s General Programme of Work 2019-2023 will hopefully be approved by all United Nations member states. At its heart is a commitment to work towards achieving UHC.
Global health requires building and supporting strong health systems, promoting prevention in communities, strengthening standards and regulations, and creating innovative financing models. If we work constructively with others towards achieving UHC, we can improve access to healthier lives. But this requires governments to step up to the plate as well, investing in health care systems — even when times are bad.
This year the WHO marks its 70th birthday and the 40th anniversary of the Declaration of Alma-Ata, the first international call for primary health care to be key to achieving WHO’s goal of health for all.
The coming decades will see further delivery on our purpose: putting patients first to bring better health for everyone, everywhere. This is a commitment that the research-based biopharmaceutical industry makes — but we cannot do it alone.
And the story does not end there. Climate change, demographic shifts (ageing populations), urbanization, unhealthy lifestyles, and antimicrobial resistance pose a real threat to global health and require new ways of thinking about delivering care. Today’s complex health challenges call for out-of-the-box thinking based on the facts, involving all those with the relevant experience. Our innovative industry is prompting, and will continue to prompt, new discoveries and is evolving, learning, and pioneering on ways to do more to reach all patients. If we are to avoid Rosling’s post-fact era we must ensure health policy is developed on the basis of need and not news headlines.