Exacerbated Supply Chain Challenges During the COVID-19 Crisis & Creative Solutions that Bring Hope for People Living with NCDs

In the first blog of this series, we highlighted how COVID-19 is exposing and amplifying the pre-existing challenges that people living with NCDs (PLWNCDs) face when trying to find and pay for the care, medicines, and health products they require to manage their condition(s) and stave off serious complications, disability, and early death. Prior to COVID-19, a study conducted across 28 low-middle income countries found that the total unmet need for diabetes care (which is defined as the total of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but not controlled) was 77%[i]. COVID-19 brings into stark focus the inequities built into many health systems, around the world, that leave PLWNCDs unable to access treatment and care.

The Coalition for Access to NCD Medicines and Products recognizes the broad impact COVID-19 has had on disrupting the supply chain for health commodities, such as the imposition of export restrictions documented across 80 countries on medical supplies like personal protective equipment for health personnel, medical devices and pharmaceuticals. The Coalition sees first-hand the complex factors impeding access to NCD medicines and products. Some of these factors are caused by COVID-19, such as a reduction in NCD services at health facilities and some PLWNCDs are reticent to go to health facilities for fear of becoming infected with COVID-19. Other factors have been previously documented but are now being amplified by COVID-19 including funding, data quality, stock levels and distribution challenges[ii][iii][iv] We recognize that this is an unprecedented period of hardship which requires a greater willingness for all of us to push our boundaries, to act quickly and to discover new ways to ensure that commodities are distributed to those that need them most and PLWNCDs receive the care and treatment that is their human right. As the World Health Organization’s (WHO) director-general Dr. Tedros Adhanom Ghebreyesus stated, “health is not a reward for development; it is a prerequisite.” Health and wellness for all cannot be realized until we attend to the needs of people living with NCDs.

The Coalition — Leading Efforts to Raise Awareness and Strengthen Access to Treatment

The Coalition is working together in the immediate term across the global community and nationally within our focus countries to raise awareness and strengthen access to treatment. To strengthen health system resilience for the long term, we are developing a forecasting method in partnership with ministries of health and technical experts to refine forecasting estimates and quantify the unmet need for diabetes and hypertension medicines that exists in the countries where we work. The resulting estimates will inform planning, procurement and budget allocations in the future and provide the evidence needed to strengthen advocacy efforts towards consistent access to quality NCD medicines and products. The Coalition notes the importance of understanding the cost drivers for NCD medicines and products along the supply chain. The coming assessments will support policy recommendations to improve the efficiency of the NCD supply chain and strengthen advocacy and planning for the needed funding to ensure adequate supply is available at an affordable price. In addition, we will be building capacity of those managing NCD supplies to ensure better data capture and inventory management. These efforts combine with those of our members across all sectors to augment efforts to strengthen access to NCD supplies.

Promising Contributions Across Sectors

Bold interventions and innovations, in the immediate term, will produce lessons learned and drive longer term changes within the health system. Governments are adapting services to balance the need to focus efforts and resources on responding to COVID-19 while continuing to provide NCD treatment and care and other essential services, calling on partners and industry for support.

There is the opportunity to simplify access to essential medicines and other health commodities to NCD patients and other vulnerable populations through establishing mobile clinics, developing group drug supply, and outreach activities such as providing on line or telephone medical and psychological and social support to people living with NCDs to reduce the exposure and risk of COVID-19.” — Shared by Dr Kaushik Ramaiya, CEO of at Shree Hindu Mandal Hospital (Dar es Salaam, Tanzania) and member of the Coalition’s Technical Advisory Committee, during the 29April2020 NCD Alliance webinar.

Useful COVID-19 adaptations include:

· Multi-month prescriptions and reduced waiting times for PLWNCDs are being tested in Vietnam and Kenya to lower the risk of infection for PWLNCDs and facilitate access to treatment and care.

· With the support of partners like PATH, Kenya is providing virtual training on NCD care provision during COVID-19 and exploring innovative ways to use telemedicine and direct delivery of medication, along with leveraging proven last mile delivery solutions from other areas of health.

· Uganda is working on village health team-level interventions to mitigate the challenges PLWNCDs are experiencing with limited public transport which makes access to facilities and limited stock levels of medications more challenging.

Poor national and sub-national data quality and use continues to be a barrier to progress in consistent access to NCD medicines and, during this critical time, hampers timely response and supply distribution to those with greatest need. The research community and implementing partners are galvanized around quantitative and qualitative data collection to inform solutions and target resources.

· Being in New York at the epicenter of the US COVID-19 outbreak, the Arnhold Institute for Global Health partnered with the Elmhurst Global Health Institute to launch the COVID Unit for Research at Elmhurst (CURE-19) with a focus on social inequities that are impacting outcomes and to disseminate best practices globally. The Arnhold Institute is also developing strategies to adapt existing NCD interventions — such as a partnership to treat hypertension and depression in Navrongo, Ghana — both by offering NCD care remotely, and integrating COVID-19 prevention and care messages.

· Coalition members at RTI International recently released a blog highlighting how NCD interventions can mitigate COVID-19 and build resilience against future pandemics.

· The Center for Global Development (CGD) is using import/export data, retail pharmacy panels, wholesaler interviews and product registration data to proactively identify shortage risks for non-donor-funded essential medicines, including NCD medicines.

Pharmaceutical companies are also stepping up in bold ways, both collectively and individually, to ensure people living with NCDs have access to medicines during this time. The International Federation of Pharmaceutical Manufacturing Association members responded quickly and committed to work to secure continuity of supply for all essential medicines and vaccines for patients with other life-threatening diseases, urging governments to implement policies and decisions that facilitate access for those in need. Access Accelerated, a pharmaceutical industry-led initiative continues to collaborate closely with Ministries of Health in Kenya, Ghana and Vietnam, the World Bank and civil society to build resiliency particularly within primary health care, digital technology and supply chain strengthening for improved access to treatment over the long-term while also adapting their approach to respond to country needs in the near term. Individual companies also quickly responded increasing production of high-demand products and donating insulin, antihypertensives and other medicines to support countries to maintain stock levels as national resources are re-directed and overwhelmed with the demand created by COVID-19. In addition, several companies and organizations have quickly adapted, with their implementing partners, to re-allocate funding to raise awareness of the enhanced risk to PLWNCDs at this time and to test innovative approaches to support access to treatment.

During the COVID-19 response, advocacy has played an essential role to ensure the voices of PLWNCDs are heard and that their rights are protected and promoted as critical policy and resource decisions are being made. The NCD Alliance, World Heart Federation, International Society of Hypertension and World Hypertension League are raising the voices of PLWNCDs and clinicians to ensure the global community understands the challenges people face when seeking medicines and products they need to survive. Local NCD Alliances like NCDAKenya are engaging civil society and PLWNCDs on COVID-19 preventive measures and continuity of services and are raising awareness through webinars and other channels.

The leadership of the WHO is critical in raising awareness and guiding governments to include NCDs in their response efforts which will lead to stronger systems to deliver medicines and products in the future. We are encouraged that NCDs were included in the WHO’s landmark resolution on COVID-19 adopted during the 73rd World Health Assembly in May. Through this global recognition of the challenges PLWNCDs are facing, along with Dr. Bente Mikkelsen’s leadership of the NCD technical working group, there is now a strong call on the global community to actively engage and shape the future for access to NCD treatment and care within a more resilient health system. Given the finding that smokers are more likely to develop severe COVID-19 compared to virus-infected non-smokers[v], the UN Interagency Task Force on NCDs, WHO, and PATH, with guidance from the Coalition, are working with a number of countries, manufacturers, digital partners, and others to increase access to treatment by working to establish a Tobacco Cessation Support Facility. The goal of this initiative is to increase supply and demand for cessation services and products to reduce tobacco use during this high-risk time. WHO’s continued work and leadership in NCDs is critical to continued progress to achieve access to medicines and products for PLWNCDs.

The COVID-19 pandemic is a time for solidarity across sectors and countries to work quickly to test and iterate solutions to ensure people can access NCD medicines and health products safely without fear of infection with COVID-19.

This was highlighted by Prashant Yadav and others in a recent Devex Opinion piece. If we codify the lessons learned, the solutions we implement today will help to shape a stronger health system for tomorrow that is more responsive to the needs of people with both infectious and non-infectious conditions. We are encouraged by the tremendous creativity and innovation reported across our membership in their efforts to maintain access to NCD treatment while responding to COVID-19. We are more aware than ever of the great need to strengthen forecasting, funding, procurement mechanisms, distribution, storage and data quality and use to achieve continuous access to affordable quality NCD medicines and health products. We are committed to working together to overcome these challenges.

To learn more about the Coalition, to join us in this important work, or to tell us about the work that you are doing to improve global access to NCD medicines and products, click here. Also, please join us for the upcoming webinar on Tuesday, June 2nd- “Ensuring Access to NCD Medicines and Products During the COVID-19 Crisis: Innovations, Partnerships, and Initiatives that Bring Hope.” Check out the dial-in details on the Coalition’s webpage.

About the Authors:

Helen McGuire is the Global Program Leader for Noncommunicable Diseases at PATH and leads the Secretariat efforts for the Coalition for Access to NCD Medicines and Products. Todd Dickens is a Senior Procurement Officer at PATH and leads the Coalition’s Supply Chain Strengthening Workstream. Particular thanks to the Coalition’s Supply Chain Strengthening Workstream members for their contributions to the shaping and authorship of this blog.

[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396901/pdf/pmed.1002751.pdf

[ii] Beran, D., Ewen, M., Lepeska, M., Laing, R. (2017). Access to Insulin: Current Challenges and Constraints. Update March 2020. ACCISS; 2017.

[iii] Tran, D. N., Njuguna, B., Mercer, T., Manji, I., Fischer, L., Lieberman, M., & Pastakia, S. D. (2017). Ensuring Patient-Centered Access to Cardiovascular Disease Medicines in Low-Income and Middle-Income Countries Through Health-System Strengthening. Cardiology Clinics,35(1), 125–134.

[iv] Wirtz VJ, Turpin K, Laing RO, Mukiira CK, Rockers PC. Access to medicines for asthma, diabetes and hypertension in eight counties of Kenya. Trop Med Int Health. 2018;23(8):879‐885. doi:10.1111/tmi.13081

[v] https://www.who.int/news-room/detail/11-05-2020-who-statement-tobacco-use-and-covid-19

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