UN City, Copenhagen: There is widespread hope that the HIV/AIDS epidemic ceases to be a major global public health threat, but the gains made are in grave danger of being reversed as a result of growing resistance to HIV medicines. The world is increasingly facing an urgent public health crisis of growing resistance to HIV treatment. This crisis is greatest in the Africa region, where increased access HIV treatment has significantly reduced AIDS-related deaths.
Lenias Hwenda, Geneva. Lenias is a public health professional passionate about improving access to medicines. She is a health entrepreneur and founder and CEO of Medicines for Africa.
Africa’s energy revolution has been largely overlooked because of the tendency to focus on the kind of stories that have come to define Africa, stories of strife and suffering such as disease outbreaks, disasters and terrorism when covering Africa.
The stories we do not hear enough of are the narratives about the resilience of Africa’s people and their enduring entrepreneurial spirit. Africa today should be defined by its steady, remarkable progress.
Picture: Dr Oly Ilunga Kilunga: Minister of Health Democratic Republic of Congo
Lenias Hwenda, Copenhagen. Lenias is a vaccine development expert and a public health practitioner who is passionate about improving access.
Photo: Copyright: Medicines for Africa
Tinotenda Gwisai. Harare Zimbabwe. Tino is a biomedical engineer and a young leader who specialised in social medicine and is currently embarking on Ph.D. studies at ETH Zurich in Switzerland.
This month,Medicines for Africa launched a nationwide essay competition on the Good Governance of Medicines in Zimbabwe. The aim of the competition is to encourage students to play an active role in formulating ideas and strategies for improving good governance in the pharmaceutical sector.
We believe that early and sustained engagement of students on issues pertaining to good governance will, over time, assist in equipping future leaders with some of the essential tools and knowledge necessary to strengthen good governance in the pharmaceutical sector.
Photo: WHO Director General Dr Tedros joins Committee A yoga breaks during the World Health Assembly in Geneva 2018, Palais des Nations.
Lenias Hwenda, Geneva. Lenias is a vaccine development expert and a public health practitioner who is passionate about improving access.
The majority of low and middle-income countries have evolved to become passive recipients of ideas, products and solutions towards some of their most pressing public health challenges. As a result, decades of development support has not resulted in significant strengthening of country capabilities in creating inclusive public health systems that meets the needs of entire populations.
Solutions that empirical evidence has shown to be ineffective continue to be implemented in countries. This disconnect between what all partners agree to be the best solutions and what is actually practiced is the paradox of global health and development support.
Photo: A meeting of cardiac surgeons celebrating 50 year anniversary of the first human heart transplant at Goose Schuur Hospital in Cape Town.
Lenias Hwenda. Cape Town, South Africa. Lenias is passionate about improving access to quality affordable treatments for the forgotten millions.
A week ago, from 2-4 December, we celebrated the 50th Anniversary of the first heart transplant by Dr. Christiaan Barnard at Groote Schuur Hospital in Cape Town. This medical breakthrough was a major feat of courage and innovation that has saved the lives of many cardiac failure patients over five decades.
Rheumatic heart disease is a major cause of cardiac failure affecting millions of the forgotten poor. It is caused by streptococcus throat infection that can be treated with injectable Benzathine Penicillin G. Lack of treatment can lead to heart failure. Unfortunately, the availability of Benzathine Penicillin G is affected by global shortages resulting from insufficient global production capacity. Only four companies in the world manufacture its active ingredient, three of them in China and the 4th in Europe. The few companies producing it are doing so at 20% of the potential production capacity.
Peter Evans, Brussels Belgium. Peter is the former Chief of Procurement at WHO and UNFPA and Chief of Medical Procurement at UNICEF
Medicines for Africa represents a sustainable approach in the long term, building on what is in place, leading to the best comprehensive health care that the countries can afford, with the least dependence on donors.
“Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” Currently, the “teaching” is often limited to learning how to advance each Agency’s objective and the provided “fish” are dumped in ways that cause long term collateral harm.
Donors more and more insist on almost immediate confirmation of success and choose target disease reduction, as a validation of success. The effectiveness, of investments in health systems, is difficult to measure and therefore difficult to fund. Over the past few decades, the transfer away from financial and technical support for health infrastructure, towards targeted support limited to specific diseases, has been significant. Indicators of success usually concentrate on dollars spent in a given time period, how many health units provided, then how many health units used and finally how much health was achieved. However, as far as I have seen, no one measures how much other health care was displaced.
The health gains from attention to the targeted diseases are significant and to be applauded but while all major international health programmes pay lip service to providing support to the basic health infrastructure of each country, the reality is that support is mostly given to the elements that require the vertical programme (disease-specific) to achieve success and not to the horizontal support (population-specific) required for all other health improvements.
David L. Heymann, M.D.
London, UK. David is a Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine. He is also Head and Senior Fellow at the Centre on Global Health Security at Chatham House in London.
In the 1980s when I was on assignment from the US Centers for Disease Control and Prevention (CDC) in Malawi, I worked for five years with the ministry of health to better understand how to develop a more effective malaria control programme in view of the challenge caused by chloroquine resistance. One of the lessons I learned at that time is that there is a fine line to walk between rapid access to life-saving antimicrobials, and the need to use them responsibly by confirming diagnosis before treatment. Children with high fevers caused by plasmodium falciparum die if treatment is delayed while awaiting a diagnostic test result from a distant laboratory.
This lesson remains valid today as antimicrobial resistance continues to erode the effectiveness of medicines to cure malaria, and also the effectiveness of the medicines used to cure other parasitic, bacterial, and viral infections. Easy access to life-saving antimicrobials must be a part of the agenda to control antimicrobial resistance, and it cannot be compromised or delayed.
Recently I spoke with a developing country colleague who told me that he is aware that some governments are considering legislation to require laboratory diagnosis prior to treatment of any suspect infection, a national interpretation of the WHO Action Plan on Antimicrobial Resistance. Any clinician faced with infectious diseases day in and day out knows the harm that would come if such legislation were developed and enforced in a country where access to diagnostics is limited because of lack of laboratory infrastructure and/or cost or of point of care diagnostics that are already on the market.
The need for rapid, inexpensive and stable point-of-care diagnostics to guide treatment and slow the evolution of antimicrobial resistance has never been greater. Medicines For Africa must advocate for their development, and ensure that as they become available countries have access to them as well.
Geneva, Switzerland. Lenias is passionate about improving access to quality affordable treatments.
An estimated 18 million people die each year from treatable and preventable disease mainly because they lack access to medicines. Huge efforts to reduce rates of infection and death from infectious diseases such as HIV and malaria have brought significant gains and improvements though more still needs to be done. However, African countries face additional challenges that urgently require effective solutions that are sustainable. Chronic diseases such as cancer, diabetes and cardiovascular diseases are expected to become the leading cause of disability by 2030 and will contribute significantly to lost productivity and higher healthcare costs for Africans.
Better availability of quality affordable treatments for these problems will be part of the solutions needed to prevent and treat these illnesses. Whilst many countries around the world are confronting the challenge of the rising cost of medicines, in the African context, the problem is exacerbated by weak infrastructure, which prevents the good results that are possible. Countries are not using their purchasing power and the African medicines market is dominated by suppliers who dictate the terms and influence the greater use of more expensive treatments that are not cost-effective. This is part of the reason why African countries are paying some of the highest prices for medicines outside of the areas supported by donors. Medicines for Africa is working to correct the anomaly that within areas not supported by donors, most medicines used within African countries are bought by governments themselves, quite inefficiently and at very high cost.
We believe that the challenges contributing to the excessive cost of medicines in African countries are not insurmountable and can be solved if we commit ourselves to doing so. To address them, African countries require resources that are far beyond what is available to them. Making making better use of the resources that are available to countries will go a long way towards bringing the change that is possible. Medicines for Africa's vision is to work with countries to achieve this by making sure that available resources are used more efficiently and countries avoid paying excessively in some areas to the detriment of others. We believe that African countries could make system wide improvements that strengthens their ability to provide treatments for the health needs of entire national populations.
It is a huge challenge that no single country has the capacity to tackle alone. However, countries can work together to achieve it. They can make significant improvements over time with very modest investments. Ensuring the health of African populations health is one of the most pressing challenges facing African nations. Failure to make the necessary changes and investments will undermine the productivity of individual citizens which in turn will retard the economic growth of countries throughout the region. All of us Africans should be concerned about how we are going to meet the growing health needs of our people in a way that is sustainable. Medicines for Africa has a sustainable solution that improves infrastructure for delivering treatments needs of entire national populations.
A cardinal point for Medicines for Africa that we keep in mind at all times, the north star that keeps us on course in our search for adequate solutions is that breakthrough will not likely result from individual effort. Navigating the healthcare landscape towards improving the strength of health systems to make them more resilient and responsive to the needs of entire populations is a complex task. It will require a collective effort, and all the best minds available. Medicines for Africa has benefited enormously from the collective effort of many professionals and experts from across the globe who have contributed their knowhow and experience in various ways in support of the vision of Medicines for Africa. This has propelled us to come so far, with so little. The biggest lesson from all of this is that people are our best resource.
This has remained true even as differences on the best path towards our destination have risen. Constructive debate serves a very important purpose in any organisation. It can lead to stronger, more confident teams with a better focus on the implementation of the organisation's vision. This unwavering focus on our vision has been our basic guiding principle. It keeps us on course as we continue to explore and iterate to find the the best approach. We owe it to ourselves and to the future of our children to stay the course and give our very best in searching for credible sustainable answers to the biggest problems facing our nations during our time. Our people's health is our nations' wealth.
Medicines For Africa
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