World leaders met in late September 2013 in New York at the United Nations (UN) to examine the progress and future direction of the UN Millennium Development Goals (MDGs), a set of eight goals to improve social and economic conditions of people living in developing countries. Three of the eight MDGs specifically address health-related outcomes in improving children's health, reducing maternal mortality, and addressing diseases endemic to the developing world, such as malaria, tuberculosis (TB), and HIV/AIDs, and a fourth goal encourages partnerships to resolve these challenges as well as help realize the other MDGs. The pharmaceutical industry has been a key stakeholder, particularly through the use of public–private partnerships, to address global health issues and help realize the health-related MDGs.
Progress report and a look ahead
At the UN meeting, world leaders agreed to scale up action against extreme poverty, hunger, and disease and called for a 2015 summit to adopt the next set of goals to continue efforts after the target date for the MDGs in 2015 and also noted progress thus far. A joint statement by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), UNAIDS (a joint UN program on HIV/AIDS), UNICEF, and the UN Secretary General’s Special Envoy for Financing the Health MDG, summed up progress thus far. "Over the past 12 and a half years, the world has made remarkable progress against the goals, especially the health-related MDGs. Child and maternal deaths have been almost halved from 1990 levels. Malaria deaths have dropped 50%, driven largely by the distribution of over 400 million mosquito nets in the past several years. Over 6 million people, of the 9 million who need TB treatment, are now on treatment. HIV, once a death sentence with virtually no one on treatment, has undergone a dramatic shift with almost 10 million people on treatment today; and if we can finish the job and put everyone on treatment, we will irreversibly halt the AIDS epidemic. These results are unmistakable proof that success is possible. Now we must come together in one final big push to achieve the health MDGs and lay the strongest of foundations for a post-2015 world."
A recent UN report examined the progress of achieving the health-related MDGs. MDG 4 seeks to reduce children mortality, and a recent UN report outlines gains made thus far. Worldwide, the mortality rate for children under five dropped by 47% from 90 deaths per 1000 live births in 1990 to 48 in 2012. Despite this accomplishment, more progress is needed to meet the 2015 target of a two-thirds reduction in under-five mortality, according to the UN report. In 2012, an estimated 6.6 million children—18,000 a day— died from mostly preventable diseases. Increasingly, child deaths are concentrated in the poorest regions—sub-Saharan Africa and Southern Asia accounted for 5.3 million (81%) of the 6.6 million deaths in children under five worldwide. The main killers are pneumonia, preterm birth complications, diarrhea, intrapartum-related complications, and malaria. Newborns account for almost half (44%) of under-five deaths. Also, undernutrition contributes to 45% of all under-five deaths. On the positive side certain countries are making progress. Bangladesh, Ethiopia, Liberia, Malawi, Nepal, Timor-Leste, and the United Republic of Tanzania have lowered under-five mortality rates by two-thirds or more since 1990, according to the UN report.
MDG 5 is directed to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio and by 2015, to achieve universal access to reproductive health. Maternal mortality declined by 47% on a global basis over the last two decades and declined by two-thirds in Eastern Asia, Northern Africa, and Southern Asia. The UN report points out that only half of pregnant women in developing regions receive the recommended minimum of four prenatal care visits, and complications during pregnancy or childbirth are one of the leading causes of death for adolescent girls. Most maternal deaths in developing countries are preventable through adequate nutrition, proper health care, including access to family planning, the presence of a skilled birth attendant during delivery and emergency obstetric care.
In terms of progress, maternal mortality has declined by nearly half since 1990. While progress falls short of achieving MDG 5 by the 2015 deadline, all regions have made important gains, according to the UN report. Globally, the ratio declined from 400 maternal deaths per 100,000 live births in 1990 to 210 in 2010. "Still, meeting the MDG target of reducing maternal mortality by three-quarters will require accelerated efforts and stronger political backing for women and children," according to the UN. Improving maternal health is also key to achieving MDG 4 of reducing child mortality.
MDG 6 has a target to halt and begin to reverse, by 2015, the spread of HIV/AIDS and to achieve universal access to treatment for HIV/AIDS for all those who need it as well as to halt and begin to reverse by 2015, the incidence of malaria and other major diseases. Worldwide, the number of people newly infected with HIV dropped 33% from 2001 to 2012, but 2.3 million people are newly infected by HIV each year, with 1.6 million of them in sub-Saharan Africa, according to the UN report. The MDG target of halting and beginning to reverse the spread of HIV has been met. In addition a record 9.7 million people living with HIV were accessing treatment in 2012 compared to just over 8.1 million in 2011, an an increase of 1.6 million in one year alone. Global malaria deaths fell by an estimated 26% from 2000 to 2010. More than half of the 1.1 million lives saved were in the 10 countries with the highest malaria burden. The TB mortality rate decreased 41% between 1991 and 2011. Still, TB killed 1.4 million people in 2011, including 430,000 among people who were HIV-positive. Multidrug-resistant TB is a major global challenge. Progress is being made in increasing the percentage of cases being detected, but the rate of people accessing treatment needs to improved.
Pharmaceutical industry participation
With more than 220 global partnerships addressing a wide range of diseases and focusing on prevention, improvements in health system infrastructures, training, pharmaceutical R&D, and medicine and vaccine donations, the pharmaceutical industry has played an important role in advancing progress toward the health-related MDGs. A recent analysis by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) shows that partnerships and accountability frameworks between civil society, the private sector, and governments can promote more equitable, inclusive, and sustainable development.
"To maximize the impact of private-sector action on global health goals, we need proactive, cross-sector engagement in framing the next set of development goals," said IFPMA Director General Eduardo Pisani, in an IFPMA press statement. "The original MDGs were conceived without a clear map as to how the private sector could contribute. Pharmaceutical companies came to the fore anyway, recognizing the criticality of their unique contributions. But we know that there is no sector—not government, not civil society, not industry—that can alone drive the system-wide change that is required to address the most intractable health."
In its report, IFPMA highlighted key information on the 220 health partnerships in which the research-based pharmaceutical industry is involved. One of two programs is focused on strengthening health-systems infrastructure. Seven-nine percent focus on training, 38% on awareness raising, prevention, and outreach, and 36% on improving availability of treatments. With respect to specific health targets, 20% of the partnerships focus on HIV/AIDS, 16% on neglected tropical diseases, 16% on women's and children's health, 14% on malaria, and 14% on noncommunicable diseases. On a geographic basis, Tanzania, Kenya, Uganda, India, and South Africa respectively represented the five largest recipient countries, but partnerships are active globally. Sub-Sahara Africa accounts for 146 partnerships, East Asia and Pacific 80 partnerships, and South Asia 76 partnerships. Latin America and the Caribbean account for 71 partnerships, the Middle East and North Africa 39, Europe and Central Asia 38, and North America nine pacts, according to the IFPMA report.