The United Nations held an informal interactive civil society hearing last month in preparation for the High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases (NCDs), which will be held September 19 and 20 in New York. The hearing brought together UN officials, nongovernmental organizations (NGOs), the private sector, academia, and other civil society organizations, including the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), to offer input for the upcoming meeting. In line with the preparations for the UN meeting in September, IFPMA issued a Framework for Action, a 10-point plan that outlines the areas in which the research-based pharmaceutical industry can participate in tackling the growing problem of NCDs in the developing world.
The UN informal interactive hearing, which was held June 16 in New York, included participation by UN General Assembly President Joseph Deiss, UN Deputy Secretary-General Asha-Rose Migiro, and the World Health Organization (WHO) Assistant Director-General Ala Alwan. In a media forum on June 20, Migiro outlined the importance of addressing NCDs in the developing world. “Cardiovascular disease, chronic respiratory disease, cancer, and diabetes are often mistakenly viewed as diseases of affluence,” said Migiro in a UN statement. “After all, the thinking goes, if someone has plenty of money, they will buy rich foods, alcoholic drinks, and tobacco products. And they will have plenty of leisure, not physical work. Certainly this describes some cases, but not the vast majority. Poor countries suffer 80% of the noncommunicable diseases’ death toll. Poor mothers who lack good nutrition in pregnancy are more likely to give birth to babies vulnerable to noncommunicable diseases later in life.”
Migiro noted that an estimated 8 million premature deaths (i.e., people aged below 60) due to NCDs occur in developing countries each year. “The economic costs of noncommunicable diseases are astronomical. But let us put aside those costs for a moment, even though they are catastrophic for too many families,” she said. “There is no cost-benefit analysis that can sufficiently describe the suffering of family and friends. There is no calculation to determine what someone might have contributed to our world if only they had never fallen ill.”
The upcoming UN High-Level Meeting on NCDs is an outgrowth of several global health initiatives. In February 2010, WHO Director-General Margaret Chan addressed more than 100 stakeholders at the first Global Forum of the Non-Communicable Disease Network (NCDnet) in Geneva, pointing to the problem of NCDs in developing countries. “Diseases once associated with abundance are now heavily concentrated in poor and disadvantaged groups. Developing countries have the greatest vulnerability and the least resilience,” she said.
NCDnet, a voluntary network of UN member states, donors, philanthropic foundations, UN agencies, NGOs, and the private sector, focuses on the prevention and control of NCDs in low- and middle-income countries by augmenting collective advocacy, increasing resources, and promoting effective global and regional action to strengthen national capacity. It evolved from the May 2008 meeting of the 61st World Health Assembly, at which health ministers endorsed the Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (NCD Action Plan). The NCD Action Plan defined six objectives for implementation during a six-year period from 2008 to 2013. Under each objective, specific sets of action for UN member states, the secretariat, international groups, and other partners are detailed. Objective 5 of the NCD Action Plan specifically calls upon member states, WHO, international partners, and other stakeholders to promote partnerships for the prevention and control of NCDs. The creation of NCDnet is in direct support of this objective.
NCDs currently account for 35 million deaths annually worldwide, the majority of which happen in low and middle-income countries (28.1 million), according to an Apr.13, 2010, UN press release. WHO forecasts that globally, deaths from NCDs are likely to increase by 17% over the next 10 years, with the greatest increase projected in Africa (27%), followed by the Eastern Mediterranean region (25%).
At a press briefing at the UN on June 20, 2011, John Seffrin, president of the American Cancer Society, noted that on a worldwide basis, by 2030, NCDs are expected to cause about five times as many deaths as communicable ailments. David Bloom, Clarence James Gamble Professor of Economics and Demography at the Harvard School of Public Health, noted that the economic burden of NCDs on a global basis could evolve into costs of approximately $35 trillion from 2005 to 2030.
IFPMA’s NCD Framework for Action
The Framework for Action centers on four main areas: innovation and research, access and affordability, prevention and health education, and partnerships. “We want to step up to the plate where we can have an impact,” said Cinthya Ramirez, manager of global health policy at IFPMA, in an interview with Pharmaceutical Technology. “We are building on our existing approaches, partnerships, experience, and efforts in other global health initiatives to specifically address NCDs.”
In the area of innovation and research, the framework calls for continued investment in research and development (R&D) for new medicines for the prevention and treatment of NCDs overall and also in addressing the specific needs of developing-world populations. IFPMA estimates that there are more than 1500 drugs in development to address NCDs.
Actions on access and affordability for IFPMA and its member companies include working with governments and WHO to promote policy, regulatory, and supply- chain environments to enable and implement commercially sustainable access and pricing strategies for the supply of NCD vaccines and medicines in the developing world. IFPMA’s Ramirez offers as an example access to palliative care, which may be limited in certain developing countries due to trade or policy issues that limits access to painkillers and other palliative-care measures. Improving the infrastructure and supply-chain practices is another example. “Strategies to prevent stock outages of medicines are another way in which access to medicines can be improved,” says Ramirez, who points to certain innovative approaches using mobile-phone and telecommunication technology in monitoring supply in remote areas that the industry has used in supplying anti-malaria drugs to the developing world.
Also, with respect to access and affordability, IFPMA’s action plan also calls for advising and assisting WHO’s work on the appropriate use of medicines for preventing and treating NCDs on WHO’s Essential Medicines List and to work with WHO to remove administrative hurdles that currently limit access to essential medicines. WHO’s Essential Medicines List is a listing of more than 350 medicines that satisfy the priority healthcare needs of a population and are selected with regard to disease prevalence, evidence of efficacy, safety, and comparative cost-effectiveness. IFPMA also plans to work with other key stakeholders to eliminate import duties on medicines that prevent and treat NCDs and other charges, such as consumption or value-added taxes, throughout the supply chain that increase prices to patients.
Lifestyle choices play a major role in NCDs and part of the strategy to combat NCDs involves health education to consumers, patients, physicians, and healthcare professionals. At the UN press briefing in June, UN Deputy Secretary-General Migiro noted that two-thirds of all new cases of NCDs can be prevented by addressing four main risk factors: tobacco use, unhealthy diets, lack of exercise, and excessive alcohol consumption. The importance of health education in preventing NCDs also was a key finding of a recent study by IFPMA and the Association of International Pharmaceutical Manufacturers (AIPM), the Russian national pharmaceutical industry association. The survey, Population Attitude to Personal Health: Perception of Health, Understanding of Risk Factors, Morbidity and Mortality, which was conducted in Russia from January 2011 to April 2011, was presented on the occasion of the first global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control in Moscow in April 2011. “The survey showed that although people recognize the negative impact of smoking, abuse of alcohol, obesity, and lack of physical exercise has on health, they still engage in at least one of those activities,” said Ramirez, underscoring the need for increasing knowledge on the link between lifestyle choices and NCDs.
The IFPMA Framework for Action addresses prevention and health education in several ways. First, the pharmaceutical industry will seek to promote innovative tools to increase health literacy, such as awareness of NCDs, their respective risk factors, and the need to adhere to treatment as well continue advocacy and support of screening initiatives. Ramirez points to IFPMA’s cooperation with the World Health Professions Alliance (WHPA), an association representing more than 26 million health professionals in 130 countries. WHPA has been a vocal voice on NCDs by advising its members of NCDs, the social determinants of NCDs, and the ways in which healthcare professionals can inform patients on NCDs, including with simple tools such as scorecards. Within the pharmaceutical industry itself, the member companies of IFPMA plan to actively promote best practices to advance a healthy workforce for the more than 1 million employees of IFPMA member companies.
As in other global health initiatives, a multi-stakeholder approach is an important component in tackling NCDs, and the IFPMA Framework for Action addresses the value of private, public, and public–private partnerships. Part of the focus is on developing innovative health delivery models in this multi-stakeholder approach, including public-private partnerships. Also, the member companies of IFPMA will continue to work with the UN, principally through WHO, governments, healthcare providers, health financing mechanisms, the wider business community, procurement bodies, NGOs, and other patient groups in prevention, access, financing, and capacity-building initiatives targeted at NCDs.
Ramirez emphasizes the importance of these collective efforts. “We recognize NCDs are a major global health problem in the developing world and that the pharmaceutical industry can play an important role with its partners,” she said. She adds that the pharmaceutical industry will continue to participate in developing and implementing specific programs in support of combating NCDs, including efforts of the UN and WHO.
IFPMA’s Pisani sums up the value of these partnerships. “This NCD Framework For Action represents a paradigm shift for the research-based pharmaceutical industry,” he said. “It puts our industry’s collective global health responsibilities firmly at the forefront of how we see our role in the new global health community…In order to tackle the rise of NCDs, and stay the course, we need to look at sustainable new approaches to global health which have prevention at the core.”