Toronto, Canada Peter Evans is the former Chief of Procurement at WHO and UNFPA and Chief of Medical Procurement at UNICEF
Why Medicines for Africa and why now?
Because 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.
Geneva Switzerland. Lenias is passionate about improving access to quality affordable treatments.
The WEF in identified health inequality as a major issue that will shape global development in the coming years. According to the WHO Director General, Dr Margaret Chan, health inequalities are often aggravated by high prices of medicines. Prices for medicines would be substantially lower if procurement and distribution processes were more efficient with reasonable mark-ups and free of corruption. Limited financial resources and the growing trade in counterfeited medicines, a huge proportion of which are sold in African countries are major consequences of corruption world wide. Corruption constrains growth and development of countries. We need to address it in order to promote health as major driver of economic growth and sustainable development.
The enormous scale of the global medicines market makes it an attractive target of corruption. At an estimated $30 billion in 2016 with projections to grow to $65 billion by 2020, the African medicines market is not immune to this problem. Corruption remains a major obstacle to strengthening the supply chains of medicines in African countries. It reduces the availability of affordable quality medicines.
A social enterprise like Medicines for Africa with a mission to improve the availability of low cost, quality treatments for African people must reflect upon the complex problems of corruption, its multiple facets and create measure to counter it. This is important because corruption or the perception of corruption erodes trust which undermines supply chain efficiencies which raises the cost of medicines. Medicines being one of the largest components of health expenditure, it is important for African countries to ensure efficiency in their procurement processes in order to be able to achieve better value for money.
On the way to patients, the supply chain of medicines involves many steps with many participants that include agencies, ministries, service providers, manufacturers and patient representatives. Their respective roles and responsibilities, accountability and relationships are often not clearly defined. This complexity increases the supply chain’s vulnerability to corruption by providing numerous opportunities for it. Corruption in the medicines supply chain can take many forms.
These include the falsification of evidence, bribery or special influence on the selection of medicines and suppliers by countries, international agencies and development partners. Asymmetries in the availability of information’s to decision-makers along the supply chain, pharmaceutical companies, regulators, healthcare providers and patients add to the problem.
In Davos with Bill Gates and Matthew Bishop of The Economist discussing the launch of CEPI.
Davos Switzerland. Trevor is the President of Global Health at the Bill and Melinda Gates Foundation. He is passionate about science.
Greetings from Davos, Switzerland. I’m here this week to talk about what governments and the private sector can do to tackle the world’s biggest health challenges.
Yesterday, I attended the launch of the Coalition for Epidemic Preparedness Innovations (CEPI), a global initiative designed to accelerate the development of vaccines for emerging infectious diseases with the aim of preventing future pandemics. Here’s a fascinating interactive visualizationthat we produced to explain what CEPI is and why we need to take action now against a host of emerging infectious diseases.
But we also need to stay focused on existing epidemics. While the Ebola outbreak of 2014–15 and the Zika outbreak of 2016 have raised justifiable alarm, HIV, tuberculosis and malaria remain massive public health emergencies that claim millions of lives each year. One of the best ways to fight these diseases is to ensure that we make new tools designed to fight them available to the people who need them as quickly as possible. And so I also have been meeting in Davos with colleagues from sub-Saharan Africa to discuss how we can accelerate the discovery, development, and regulatory licensing of a range of life-saving interventions.
Innovation transforms lives. From the light bulb to penicillin to the personal computer, clever ideas turned into real products through painstaking research and development have radically changed the way we live. Innovative breakthroughs have also led to a major shift in how long we live. Vaccines, drugs and other medical technologies eradicated smallpox, turned diabetes and HIV from death sentences into a manageable conditions, and have made us healthier in countless other ways.
But good ideas and powerful products can’t change lives if people can’t access them. Many roadblocks keep lifesaving innovations out of reach for the people who need them most. Perhaps the most frequently debated are the cost of medicines and challenges in delivering them to remote communities. Less prominent is the preliminary milestone in making health products accessible: regulatory approval.
David Nabarro, MD
New York, USA. David Nabarro is the UN Secretary General's Special Advisor on Sustainable Development and Climate Change and he is running for Election as the next Director General of the World Health Organization.
Governments and health insurers find that increasing numbers of people need care for their NCDs and seek ways to cope with this rising demand. They wonder how best to reduce the numbers of their people with NCDs, and how to make reductions happen in practice. People, their societies, and their governments turn to different organizations for help. The World Health Organization sets the standards for what needs to be done and suggests how the standards can be achieved. There are big challenges with making this happen because the underlying causes of NCDs are woven into people’s lifestyles and are not easily reduced. It is not at all like removing the bacteria that cause an infectious disease. The consequences of this NCD epidemic are on the rise and affect individuals, their societies and economies of their nations. How can the principles and practice of public health best be used to reduce these consequences?
First – prevent people getting an NCD. Have them work out why they are at risk and then encourage them to remove the risk factor from their lives. Make sure the people most at risk are heard when risk reduction efforts are being planned. Bring them together with different organizations that have an interest in NCD Movements. Encourage joint action that is based on the best evidence of what’s wrong, and of what works. A shared purpose, agreed frameworks for action and partnering are needed for impact at scale. Second – make sure that people with NCDs are diagnosed early and get the best possible treatment so as to slow the progress of the disease (and, ideally, stop it).
Geneva Switzerland. Lenias is passionate about improving access to quality affordable treatments.
The first priority for public health is to protect populations from harm. In their duty to protect, governments use the law to promote and protect public health. There are also instances where the law is used in ways harmful to health. A new report launched by the WHO and its partners outlines how countries use the law for better or worse. Protecting health using the law requires the commitment of lawmakers who are often confronted with competing economic and social interests both at international level and domestically amongst citizens.
In line with their fiscal responsibility, governments often use the law to shape the environments in which their people live and influence the choices people make about their lives. When laws help people to live longer and healthier lives, they enable economies to become more resilient. People require access to quality prevention, treatment and care in order to maintain good health and lead economically productive lives.
This is why the role that the law plays in improving access to treatments is important. The law promotes and incentivises innovation of treatments needed to keep people healthy. In this case, it attempts to balance the rights of patients and those of innovators to ensure the common goal that treatment are available at affordable cost to those who need them. With affordability and access having become a mainstream concern, even in high-income countries, balancing the common and the competing interests of business is a constant source of tension between policy makers and businesses.
Delighted to have joined Lenias Hwenda of Medicines for Africa and Dan Rosen of IMS Health on a panel at the recent PharmaAfrica conference in London. We enjoyed a lively discussion on ‘Trust’ and how to encourage the Public and Private sectors to work together in delivering essential medicines to communities across Africa.
In the broader context, the PharmaAfrica event seeks to bring together private sector manufacturers and distributors with academics and government agencies to network and explore the challenges of the Pharma industry across the continent of Africa.
It was good to hear from African manufacturers and distributors, and to compare and contrast this with my knowledge of 'Big Pharma' from the European and US perspectives, and the Governmental, Public Sector and International Donor/Aid perspectives.
Health access requires the combination of quality, service and price to be right - quality products, available to the patient, at an affordable price. Local industry has an important role to play in this - one that I feel has been historically under-estimated and potentially neglected by international organisations.
In order to move the health agenda forward, African nations have to start to break-away from their dependence on others. Progressive graduation from aid is already occurring. As part of this, Africa needs to develop, grow and sustain a vibrant health industry - in manufacturing, in distribution, in retail pharmacies and in public and private health clinics where patients can access treatments. This work needs to be done in collaboration – working supportively towards joint objectives between the private sector, local industry, national governments and regulators, international donors and aid organisations.
To succeed, quality of medicines is a given, it must be there and the investment needed to achieve this has to be made. Price and affordability matters, and the gap with Indian generic producers and the mark-ups and inefficiencies in the local distribution chains have to be addressed. But this is not enough to succeed.
Local businesses have to differentiate - they must offer something valuable, that their larger international competitors cannot easily bring to the table - a connectivity to their local markets that is unique and can become a key differentiator. I refer to this as ‘Service Response - or Agility’ - the ability to rapidly tailor products and services to your local market, to be driven and respond to commercial opportunity and demand much faster than any of your competitors. There is an immense value here from being local - one that should be recognised and valued by all.
Support may be needed to create and foster a vibrant, profitable and therefore sustainable local industry. International organisations have an important role to play here, to encourage the development and support to a platform for local businesses and in strengthening the position and purpose of regional associations.
If I had one thought to come out of the recent conference for the leaders of these African industries – “it’s time to lift your voices, shout louder and be heard”.
London UK: Lenias Hwenda is a global health policy expert with a passion for improving access to quality affordable treatments.
A conversation that we had at the FT Africa Summit 2015 had great relevance for healthcare services and treatment availability. The conversation was about the economic momentum that we have been hearing about in Africa. Delegates agreed that the momentum is real. In 2015, the region maintained its projected upward trajectory. Real GDP that was higher than the 3.1% for the global economy and 1.5% for the euro zone, and it remained the world’s second fastest growing economy after East Asia.
Delegates agreed that policies in the region are generally moving in the right direction which meant that the momentum so far achieved could be sustained. However, there were many things that still required improvement such as the development of infrastructure, energy, economic integration and cross boarder movement of people, goods and services.
Maintaining economic productivity requires a healthy population that can access quality affordable healthcare and treatments when they need them. When too few people can afford treatment, more people sink deeper into poverty just to get treated. Alternatively, they may choose to go without treatment at the risk of requiring more expensive interventions in the future, or they risk losing their economic productivity.